Sharp Foreign Body Research Articles

Unusual presentation and management of a penetrating foreign body in the pyriform fossa: a case report

Foreign body impaction in the upper aerodigestive tract is considered an emergency that necessitates extraction within 24 hours to prevent adverse events. Rigid oesophagoscopy is crucial in managing sharp, penetrating, and large foreign bodies lodged in the pharynx or at the cricopharyngeus muscle level. In this case report, a 15-year-old male patient presented with throat pain after consuming a chicken meal. He experienced dysphagia and odynophagia but no vomiting, drooling, or hematemesis. Initial video direct laryngoscopy did not reveal any foreign body, and subsequent rigid oesophagoscopy under general anaesthesia was inconclusive. However, a post-operative X-ray of the neck confirmed the presence of a foreign body. A contrast-enhanced computed tomography scan showed the foreign body penetrating the right pyriform fossa. With the assistance of a medical gastroenterologist, a flexible upper gastrointestinal endoscopy was performed, and the foreign body was successfully removed from the right pyriform fossa. Prompt endoscopic removal under conditions of minimal trauma and maximum safety is the preferred treatment approach for foreign bodies in the upper aerodigestive tract, necessitating a multidisciplinary team involving radiologists, otorhinolaryngologists, medical gastroenterologists, and anesthesiologists to develop tailored treatment plans for each patient.

Varied Manifestations of Sharp Penetrating Foreign Bodies in the Aerodigestive Tract: Our Experience.

Introduction Foreign bodyingestion or aspiration is an emergency dealt by otorhinolaryngologists. It is most common among children and the geriatric population. It paves the way for critical morbidity when prompt treatment is not initiated. Therefore, in the absence of strong evidence to guide decision-making, all suspicious presentations of the ingested sharp foreign body needto be kept in mind while making a diagnosis. Hence, our study is aimed to document the varied manifestations of sharp penetrating foreign bodies in the aerodigestive tract. Materials and methods The medical records of 40 patients who presented with sharp foreign body ingestion/aspiration in the department of otorhinolaryngologyin our centre from September 2012 to September 2022were reviewed retrospectively. Results In all 40 patients, we were able to retrieve the foreign body as such without crushing or breaking it.In our study, the most common foreign body retrieved among middle-aged and elderly were chicken bone (22.5%) or fish bone (25%), and the most common foreign body following accidental ingestion in children were stapler pins (20%). Conclusion The findings of our study concluded thatrelevant clinical history, atypical presentation, and radiological imaging of sharp penetrating foreign bodies in the neck should be addressed with the utmost caution, as foreign bodies migrate to deep neck space and bronchus and can result in untoward complications. Hence, we need to be suspicious of the varied manifestation of aerodigestive tract foreign bodiesfor early diagnosis and prompt treatment.

Management of foreign body ingestion in pediatric population: A single-center study

Abstract Background: Children of all ages may ingest a foreign body (FB). Most (>95%) of ingestions are accidental. Gastrointestinal tract obstruction or impaction by a FB depends on the physical properties of the object such as size, shape, and composition. The majority of ingested FBs are low-risk objects and can be managed without imaging or intervention where as high-risk objects and symptomatic children may require careful observation and surgical intervention. The aim of our study is to discuss our experience of management of FB ingestion in children in IPGME&R and SSKM Hospital, a tertiary care centre and to identify the high-risk FBs ingested and discuss the symptoms where conservative managements can be done even in sharp objects. Materials and Methods: This observational single institute-based study was conducted in the Department of Pediatric Surgery in IPGME&R and SSKM Hospital and data were collected and analyzed statistically. Results: A total of 84 patients came with ingested FBs (Boy – 59 and Girl – 29) and 22 were sharp FBs. Among nonsharp FBs, coins are most common 40 (47.6% of all FBs). Most of them were asymptomatic 75 (89.3%) and among all four required surgical intervention and eight were removed by endoscopy. In 72 patients, no intervention was required for FB ingestion including 16 sharp objects. Conclusion: Most of the ingested FBs are expelled through stool spontaneously. Nonsharp FBs such as magnets and button battery large size are high-risk objects and require active surgical intervention and sharp FBs need very much careful observation after admission and very few requires surgical intervention. Endoscopic removal is indicated in some early cases.

Neglected foreign body in esophagus treated as chest infection: a case report

BackgroundEsophageal foreign body impaction is one of the common reasons of referral to Ear Nose Throat clinic. It is a medical emergency requiring urgent evaluation and treatment. Esophageal foreign body in a very young child can be a diagnostic challenge.Case presentationIn this case, we report an unusual sharp foreign body in the upper aerodigestive tract of a 20-month-old female child. It was neglected and misdiagnosed in the initial phase and was treated as a case of upper respiratory tract infection. Chest X-ray done was suggestive of a radiopaque irregular sharp foreign body at the level of the 6th cervical vertebra. The patient underwent rigid esophagoscopy on an urgent basis, and the foreign body was removed without any complication.ConclusionEsophageal foreign body in a very young child can mimic upper respiratory tract infection due to atypical symptoms. Strong witness history along with X-rays of the neck, chest, and abdomen help in making the immediate diagnosis. Clinicians should always advise parents for supervision of their children during play.

Multiple sewing needles ingestion: a case report and review of the literatures

Sharp foreign body ingestion and management pose a great challenge to the surgeon. Majority of ingested foreign bodies pass through the gastrointestinal tract spontaneously. Organ perforations and possible migration should be kept in mind in patients with abdominal pain when the progress of the foreign body through the gastrointestinal tract cannot be ascertained by radiography. A 26-year-old male psychiatric patient presented with epigastric pain following ingestion of 18 sewing needles. His abdominal radiograph showed multiple metallic foreign bodies in the abdominal cavity consistent with the shape of sewing needles. He passed some needles spontaneously while the others which were retained were removed via a laparotomy after a successful pre-operative localization. Post-operative period was uneventful. A deliberate ingestion of foreign bodies should be kept in mind in patients with psychiatric disorders and mental retardation when they present with abdominal pain to the emergency department. An initial wait and see line of management may be instituted with the hope of spontaneous passage which can be monitored via radiological means. However, if the objects fail to pass naturally, surgery is indicated. Sharp foreign bodies which fail to pass spontaneously should be surgically removed after a proper localization since they could cause life threatening complications.

Newly developed endoscopic retrieval device: funnel-shaped overtube formed by air inflation-deflation.

Techniques for endoscopic retrieval require further development. Traditional measures using nets, grasping forceps, and overtubes [1] are sometimes inadequate for retrieval of large, endoscopically resected specimens or sharp foreign bodies with a potential risk of perforation. Although new alternatives include plastic [2], laparoscopic [3], and commercially available bags [4], reliable retrieval of solid gastrointestinal mesenchymal tumors (GIMTs) during endoscopic full-thickness resection is still being investigated. Based on our previously published concept [5], we have developed a novel retrieval device, a funnel-shaped overtube formed by air inflation–deflation (Fuji Systems, Tokyo, Japan). We here report a successful animal experiment in which the device achieved retrieval of press-through package (PTP) sheets and simulated gastric GIMTs ([Video 1]).

Foreign body impaction between diverticula: an uncommon cause of chronic abdominal pain.

A woman in her 70s with a medical history of hypertension and dyslipidemia was admitted for colonoscopy due to long-term abdominal pain. During the procedure, a sharp cylindrical foreign body was identified in the sigmoid colon, imprisoned in two diametrically opposite diverticular orifices, with purulent drainage and exuberant reactive inflammatory tissue in each diverticulum. Carefully mobilization from both diverticular orifices into the colon lumen and safety removal were performed using a rat tooth forceps, without intercurrences. The removed foreign body corresponded to a chicken bone about 3 cm in size. The plain abdominal X-ray had no evidence of pneumoperitoneum. Empirical antibiotic therapy was started with complete resolution of abdominal pain during follow-up. Most foreign bodies lodged in the colon are treated conservatively as they typically pass without intervention, however, they can cause damage to the colonic mucosa and lead to perforation or infections (namely peritonitis, peritoneal abscesses, and fistulas).

Perforation of ileum by unnoticed toothpick ingestion presenting as acute appendicitis: A case report

Many distinct pathologic disorders can cause acute abdomen, and it can be challenging for doctors to distinguish between them. Appendicitis and small bowel perforation are two examples. This case is being reported to highlight a rare instance in which acute appendicitis can be mistaken for ileal perforation by sharp solid objects. We discuss the case of a 9-year-old boy who arrived at our hospital complaining of right iliac fossa abdominal pain that started two days earlier with no other associated symptoms. Physical examination revealed right iliac fossa tenderness and rebound tenderness. The results of the imaging and laboratory tests were inconclusive; therefore, the patient was admitted for observation and further assessment. Re-evaluation 4h after admission found no clinical improvement, and abdominal examination revealed guarding and rebound tenderness, prompting the surgical team to opt for an appendectomy. During surgery, an elliptical incision was made to remove a sharp foreign body penetrating the ileum. Even during surgery, diagnosing acute appendicitis is difficult. Some cases of small bowel perforation caused by foreign body ingestion have been linked to a clinical picture similar to acute appendicitis, while others present with acute peritoneal signs. This report describes a sealed ileal perforation by a sharp solid object, manifested as acute appendicitis. Perforation of the small bowel by sharp solid objects may easily be missed on imaging, probably related to their ability to seal off the resulting perforation. A sharp solid object's perforation seems to cause localized tenderness mimicking appendicitis.

Oral ingestion of foreign body in neonates and infants: a clinical review

Foreign body (FB) ingestion in adult and children population is not uncommon but accidental. Same is rare in neonates and infants. Many of the FBs ingestion go unnoticed or unexpressed if baby is preverbal. Most of the foreign bodies pass spontaneously per anal. Only the larger size or sharp FBs get stuck in places of gastro intestinal tract and presents the patient in emergency department. Similarly corrosive and toxic FBs also invite immediate attention. Literature on the clinical aspects of the foreign body ingestion among neonates and infants was searched electronically through PubMed and individual study. Relevant articles were reviewed thoroughly and summarized. Instances of foreign body ingestion (FBI) in neonate and adult are in ascending trend over last several years. Imaging and identification of radiolucent FBs become challenging for surgeons. Conservative treatment for spontaneous evacuation, endoscopic retrieval and surgical removal are the modalities for FBI management.

The Use of Intravenous Nitroglycerin During Endoscopic Removal of Sharp Esophageal Foreign Body: A Case Report

Background: Esophageal spasm is a common problem after Foreign Body Ingestion (FBI) and causes difficulties for foreign bodies’ removal by endoscopic intervention. Sometimes, medication may help relieve spasms and facilitate the removal of a foreign body. In the current study, we introduce a patient with esophageal spasm due to FBI for whom intravenous nitroglycerin was used to treat the spasm.
 Methods: The patient was a 48-year-old man who was admitted to emergency department of Shohadaye Tajrish academic Hospital, Tehran, Iran due to FBI and following sever mid-anterior neck pain, nausea and drooling. His vital signs were normal and during endoscopic procedure, we noticed a sharp object attached to the wall of the upper third of the esophagus, causing severe spasm. After trying for an hour to remove the glass under general anesthesia, we were not able to remove it. Finally, intravenous nitroglycerin was used to relieve the spasm and it was easily removed after 2 minutes.
 Conclusion: Due to inconsistencies in the clinical results of nitroglycerin, and as notable lack of studies are investigating the effectiveness of the intravenous method, we aimed to share our successful experience.

Accidental duodenal foreign body of toothbrush removed laparoscopically: a case report

BackgroundForeign body ingestion is a common case in daily medical care, and it usually passes through the entire gastrointestinal tract naturally and is excreted in the feces. However, long and sharp foreign bodies may be difficult to pass naturally due to their shape. Here, we present a rare case of a duodenal foreign body, a toothbrush, that required laparoscopic surgical removal after a failed endoscopic attempt.Case presentationA 51-year-old male with intellectual disability presented to our hospital due to fever. Initially, he was diagnosed with aspiration pneumonia by chest X-ray and blood examination. However, abdominal X-ray examination suggested a foreign body, and a computed tomography scan revealed a toothbrush in the duodenum. Therefore, upper gastrointestinal endoscopy was immediately attempted to remove it, but it could not be safely removed because the handle part of the toothbrush seemed deeply embedded in the duodenal mucosa. Therefore, this case was diagnosed as duodenal incarceration of the toothbrush, and it was removed by laparoscopic surgery. The operation was performed safely, and the patient’s postoperative course was good without any complications. The extracted toothbrush was 15 cm in length.ConclusionWe experienced a rare case of a duodenal foreign body, which was a toothbrush. The duodenal foreign body was safely removed by laparoscopic surgery for the first time.

An Unusual middle ear foreign body in a welder; our experience

Introduction: Welding accidents commonly present as burns, electrocution, skin injuries and penetrating foreign body in the eyes, face and neck. Ears are usually uninvolved, but the possibility of foreign bodies in the external ear canal or even in the middle ear should always be considered in non-resolving ear infections in welders.
 Case Presentation: A thirty-year old welder presented with ear discomfort and swollen ear canal and initially diagnosed and managed as otitis externa. But since it failed to resolve, he was extensively investigated and a metallic foreign body was identified in the middle ear, which was removed via endoscopic tympanotomy.
 Conclusion: This case highlights the fact that small sharp foreign bodies can penetrate through the tympanic membrane and leave an almost invisible perforation which heals completely. But in suspicious or symptomatic cases further investigations such as an X-ray or Computed Tomography [CT] scan might be needed to confirm diagnosis.

Management of Airway Foreign Body Aspiration with Atelectasis Complication

Background: A sharp foreign body aspirationis a problem that is usually found in teenage women who wear hijab.Straight-pins are used in wearing hijab to make a model and to hold it tight in place. Straight-pin aspiration has thepotential to become a serious problem if it is inhaled in the airway and must be removed immediately in optimalconditions by using complete equipment to prevent complications.Case Report: A 14 year old girl with straight-pin aspiration in the airwayhad come to emergency room ofDrSoetomo General AcademicHospital, Surabaya, Indonesia. The initial location of the straight-pinwas in the rightmain bronchus and a rigid bronchoscopy was planned. Rigid bronchoscopy was performed but the foreign objectfailed to be removed and the foreign object moved further down and difficult to reach. A flexible bronchoscopywas performed and the foreign body was successfully removed. However, there was a complication of left lungatelectasis after the procedure. It was treated conservatively and healed.Conclusion: Straight-pin aspirationin the airway is treated by rigid and flexible bronchoscopy with atelectasis asa complication. Flexible bronchoscopy is an alternative therapy for inhaled foreign bodies that are located distallyand cannot be reached by rigid instruments.

An Impressive Case of Compulsive Chicken Bones Ingestion.

CASE REPORT A 53-year-old woman with a medical history of depression and anxiety was admitted because of idiopathic anaphylaxis. Owing to acute respiratory failure, she underwent a thoracic computed tomography scan, which revealed a large number of bone fragments inside the stomach and duodenum (Figure 1). The patient was evaluated by psychiatry and admitted because she had ingested numerous chicken legs in the context of acute alcohol intoxication. We had some concerns about the efficacy and safety of performing an upper gastrointestinal endoscopy in this scenario. Indeed, there were already some bone fragments beyond the proximal duodenum and the objects were numerous and sharp. Thus, there was a high risk of complications (e.g., perforation and aspiration) during the procedure, with the probability of successful removal of all the fragments being very low. Therefore, we chose to start treatment with metoclopramide. During hospitalization, she underwent daily abdominal imaging examinations, which showed progression of the bone fragments through the small bowel and colon (Figure 2), with no evidence of obstruction or perforation. Later, the patient started oral feeding, with good tolerance. Because she maintained abdominal pain, and to exclude local complications, a colonoscopy was performed 10 days after admission. No foreign bodies or mucosal changes were identified. Given the progressive improvement in her clinical condition, the patient was discharged and oriented to immunoallergy and psychiatry consultation.Figure 1.: Computed tomography scan showing multiple chicken legs inside (A) the stomach and (B) the duodenum, with no evidence of obstruction or perforation.Figure 2.: Computed tomography scan showing the progression of the bone fragments through the small bowel and colon, without complications.We report an impressive case of ingestion of large amounts of chicken bones, which crossed the entire gastrointestinal tract without complications and only minor symptoms. Foreign body ingestion remains a common problem both in pediatric and adult populations.1,2 The associated morbidity and mortality are significant, with some reports estimating that nearly 1,500 deaths occur annually in the United States due to foreign body ingestion.3 In fact, sharp foreign bodies such as chicken bones can lead to acute and life-threatening complications, such as obstruction, hemorrhage, perforation, and associated infection, including peritonitis and sepsis.4 Complications and their severity are usually related to the object ingested, its location, and the amount of time that has passed since the ingestion.5 Gastrointestinal tract obstruction and perforations have been reported in all segments but tend to occur at sites of acute angulation. DISCLOSURES Authors contributions: I. Garrido drafted the manuscript and is the guarantor of the article. I. Garrido, P. Moutinho-Ribeiro, and G. Macedo critically revised and finalized the manuscript. All authors approved the final version of the manuscript. Financial disclosure: None to report. Informed consent was obtained for this case report.

Laparoscopic Retrieval of multiple Sharp Foreign Bodies from Stomach in a Patient of Acuphagia – A Case Report

Foreign body ingestion is a common clinical scenario encountered in the emergency room with commonest cases presenting among children and in psychiatric adults. The key principle of management is dependent upon appropriate diagnosis and exact localization of the foreign body ingested and its type. Once an appropriate characterization of the ingested foreign body is made, further decision about its retrieval is based on whether any complication related to the foreign body, such as peritonitis is present or not. The method of retrieval can vary from minimally invasive to open surgery mostly dependent on availability of instruments and surgeon’s expertise. Unless any complication has occurred, surgeons in the current era are erring more towards minimally invasive methods. In cases where large or sharp foreign bodies are involved, that would demerit the use of endoscopy for its removal, surgeons are nowadays opting for laparoscopic removal instead of the traditional laparotomy. This case report highlights the use of laparoscopy for salvaging such foreign bodies especially when advantages such as, early post-operative recovery, less pain, minimal scar and decreased hospital stay over traditional laparotomy is involved Keywords: Gastro-intestinal tract, stomach, Foreign body, Acuphagia, Laparoscopic retrieval, Complications

A Choking Child with Unexpected Foreign Body

Foreign body ingestion is a common problem in children age from 6 months to 3 years as they explore things by placing them in the mouth. Coins are the most common being ingested and not surprisingly other sharp foreign bodies such as needles, fishbone, brooch or an open safety pin can also be accidentally ingested by them. We present a case of the ingested open safety pin in a 10-months-old girl. She presented with choking and a brief cyanosis episode. Physical examinations were unremarkable but the chest radiograph showed an open safety pin at the mid oesophagus. She was put under general anaesthesia for removal of the open safety pin however retrieval was unsuccessful. Repeated chest radiograph showed the safety pin had migrated further and 3 days later it was spontaneously eliminated in her stool. We reviewed the urgency, management and techniques for the removal of an open safety pin.

Removal of sewing needles from interventricular septum under the guidance of multiple imaging modalities

Penetration of the interventricular septum (IVS) by a sharp foreign body is a rare and potentially life-threatening event. We present the case of a 43-year-old female who had thrust four embroidery needles into her left chest wall while experiencing hallucinations after using an illegal drug. One needle had penetrated the heart and was embedded in the IVS, as confirmed by intraoperative transesophageal echocardiography (TEE), and one needle had lodged in the left chest wall. The sewing needles penetrating the IVS and chest wall were successfully removed under the guidance of TEE and a cardiopulmonary bypass without cross-clamping the aorta or opening the heart. The sewing needles embedded in the IVS and left chest wall were successfully removed with the aid of multiple imaging modalities.

Unusual glass foreign body in the urinary bladder: a COVID-19 lockdown effect

A variety of foreign bodies/objects have been recovered from the urinary bladder and urethra. However, trauma may also be a cause of delayed intravesical foreign body presentation. Delayed presentation with minimal bothersome symptoms and with no other associated organ injury is very unusual. As per available literature on urinary bladder FBs, this is the rare case in which isolated glass foreign body was recovered from urinary bladder. A 38-year-old male presented with complaints of pain in the lower abdomen after passing urine and occasional terminal haematuria after straining on stools, for 5-6 months. Patient gave history that he had a fall over glass table while dusting a ceiling fan 6 months ago. He had glass piece injury to left buttock. Due to COVID-19 lockdown he was unable to contact nearby health facility, so, he self-removed a glass piece from buttock wound. Patient was planned for cystoscopy with exploration and removal of foreign body under spinal anaesthesia. Detailed history and examination are of paramount importance in intravesical foreign body cases. Cross-sectional imaging should be done to rule out associated adjacent organ injury and retained foreign body parts. Sharp glass foreign body in urinary bladder should be removed via cystotomy in order to avoid mucosal injury by sharp edges.

A Novel Method of Esophageal Impacted Sharp Foreign Body Retrieval

A Novel Method of Esophageal Impacted Sharp Foreign Body Retrieval

Spontaneous passage of accidentally ingested metallic nail in an adult: A case report.

Introduction and importanceForeign body ingestion is most common in children, as well as adults with neurodevelopmental and psychiatric problems. The most commonly swallowed foreign bodies in adults include fish bones, chicken bones, toothpicks, and dentures. Sharp and elongated ones are the most typical causes of gastrointestinal perforation among the aforementioned. In about 1% of cases, foreign bodies are known to remain lodged within the bowel and cause luminal erosion and perforation.Case presentationA 23-year-old male construction laborer presented to the Emergency Surgical Unit of Debre Markos Hospital 7 h after he accidentally swallowed a nail while at work. He didn't have abdominal pain, vomiting, or rectal bleeding. On exams his vital signs were stable. His chest and abdominal exams as well as the digital rectal examination were unremarkable. He was evaluated with a plain erect abdominal x-ray based on his complaint, which revealed a long nail lying longitudinally in the right lower quadrant of the abdomen. Twenty-nine hours after swallowing the iron nail, he passed it through his rectum spontaneously.ConclusionPlain radiography should be performed to locate and follow-up on radiopaque foreign entities before sophisticated imaging and invasive procedures. When treating people who have accidentally ingested a sharp foreign body, clinicians should find a balance between prompt action and careful follow-up.