Small Foreign Bodies Research Articles

Analysis of Radiopaque Gastrointestinal Foreign Bodies Expelled by Spontaneous Passage in Children: A 15-Year Single-Center Study.

Background: Most ingested foreign bodies (FBs) pass spontaneously through the gastrointestinal (GI) tract, but only limited data on transit time are available. We evaluated the relationship of FB size and shape with transit time.Methods: We retrospectively reviewed medical records collected over 15 years (January 2001 to December 2015) on pediatric patients with radiopaque FBs in the GI tract. We categorized the FBs as regularly (round or spherical) or irregularly shaped (ovoid, long, flake-like, or projecting) and measured their sizes radiographically. The diameter of regularly shaped FBs and the length of irregularly shaped FBs were correlated with transit time.Results: In total, 484 patients with GI FBs were surveyed, and 267 (55.1%) FBs were radiopaque. Among the 267 radiopaque FBs, 88 (33.1%) required endoscopic removal and 7 (2.6%) underwent surgical intervention. Eighty-seven patients with single FBs in the GI tract for whom precise details of transit time were enrolled into the analysis of transit time; their mean age was 3.48 ± 2.21 years. Of the 87 FBs, 61 (70.1%) were regularly shaped, and 26 (29.9%) were irregularly shaped. The diameter of regularly shaped FBs was positively associated with transit time, as revealed by Mann-Whitney U test; diameters >1.5 and >2 cm were significantly correlated with longer transit times (both p = 0.003). A trend toward an increased transit time for long irregularly shaped FBs was also apparent; the p-values for lengths of 1.5, 2, and 2.5 cm were 0.824, 0.153, and 0.055, respectively. Under receiver operating characteristic (ROC) curve analysis, the optimal cutoff diameter for regularly shaped FBs, and length for irregularly shaped FBs, to predict a transit time of longer than 72 h were 1.95 and 2.25 cm, respectively.Conclusions: The passage rate of ingested radiopaque FBs is 64.4%. Small FBs that have passed the duodenal curve should be managed conservatively via clinical observation and radiographic surveillance. Our results indicate that the larger an FB is, the longer the transit time will be.

The detection of wooden foreign bodies: An experimental study comparing direct digital radiography (DDR) and ultrasonography

IntroductionThis experimental study compares the appropriateness of direct digital radiography (DDR) and ultrasonography at detecting soft-tissue wooden foreign bodies (FBs) in extremities. MethodsVarying wooden FB splinters (2 mm, 5 mm and 10 mm) were inserted into eight porcine feet to simulate a patient presenting with a soft-tissue FB injury. Each of the FBs was placed in muscle distant, behind and near bone in the porcine feet. Control groups were used to check for false-positive diagnoses and, based on the presence of FBs; images were given a score depending on the level of visibility by the researcher. ResultsA higher detection rate was achieved for all FBs in muscle distant from bone using ultrasound. All of the 2 mm and 5 mm wooden FBs were not detected using DDR. The sensitivity in detecting the FBs was 5.8% and 30% in DDR and ultrasound respectively. ConclusionPoor sensitivities and specificities were identified in this study. However, this study shows that ultrasound remains superior to DDR at identifying small foreign body objects. This study demonstrates that ultrasound can be a clinically effective tool for detecting suspected wooden FBs >5 mm in the foot and thus should be considered as the primary imaging modality of choice for referring clinicians.

Lanthanum-Induced Mucosal Alterations in the Stomach (Lanthanum Gastropathy): a Comparative Study Using an Animal Model.

Lanthanum (La) carbonate (LC) is one of the most potent phosphate binders that prevents the elevation of serum phosphate levels in patients with end-stage renal diseases undergoing dialysis. LC binds strongly to dietary phosphate and forms insoluble complexes that pass through the gastrointestinal tract. La deposition in patients treated with LC is a recently documented finding particularly observed in gastric mucosa. We herein describe the detailed gastric mucosal lesions in 45 LC-treated patients and address the potential underlying pathologic mechanism using oral LC administration in rats. Microscopically, La deposition, as shown by subepithelial collections of plump eosinophilic histiocytes or small foreign body granulomas containing coarse granular or amorphous inclusion bodies, was found in the gastric mucosa of 44 (97.8%) of the 45 dialysis patients in the study cohort, which was most frequently associated with foveolar hyperplasia (37.8%). Using oral administration of rats with 1000mg/day LC for 2 or more weeks, La deposition was consistently detectable in the gastric mucosa but not in other organs examined. In addition, various histologic alterations such as glandular atrophy, stromal fibrosis, proliferation of mucous neck cells, intestinal metaplasia, squamous cell papilloma, erosion, and ulcer were demonstrated in the rat model. Thus, orally administered LC can induce mucosal injury, designated here as La gastropathy, which may alter the local environment and result in La deposition in the gastric mucosa, thereby potentially inducing abnormal cell proliferation or neoplastic lesions.

Visual loss resulting from siderosis bulbi caused by a missed intraocular foreign body

Introduction: Intraocular foreign bodies (IOFB) represent an important cause of visual impairment, especially within the group of working age population. Case report: A 38-year-old male presented with severe left eye pain, accompanied by left headache, visual loss, redness, photophobia, tearing and nausea, 30 months following a minor left eye trauma when hammering metal on metal. Eye ultrasound identified a small intraocular foreign body as well as the crystalline lens luxated into the vitreous cavity. Pars plana vitrectomy was carried out with the extraction of the foreign body and of the lens. Pain was relieved, but vision was not regained. Conclusion: The poor outcome of this case follows from a combination of unusual factors: ophthalmologists’ failure to identify an occult IOFB and the lack of patient’s concern about his eye condition, until the moment when he experienced excessive pain and vision was already lost.

How useful is abdominal ultrasonography in dogs with diarrhoea?

To assess the utility of abdominal ultrasonography in the diagnostic work-up of dogs with diarrhoea. Retrospective cross-sectional study based on a referral population of dogs with diarrhoea. Associations between the clinical signs, use of abdominal ultrasonography, results of abdominal ultrasonography and subsequent work-up were examined. The utility of abdominal ultrasonography was scored as high, moderate, none or counterproductive based on review of medical records. Medical records of 269 dogs were reviewed, of which 149 (55%) had abdominal ultrasonography. The most frequent result was no ultrasonographic abnormalities affecting the intestine in 65 (44%) dogs. Ultrasonography results were associated with subsequent work-up as follows: (1) no detected abnormalities and dietary trial; (2) focal thickening of the intestinal wall, loss of intestinal wall layers or enlarged abdominal lymph nodes and ultrasound-guided fine-needle aspirates; (3) diffuse thickening of the intestinal wall or hyperechoic striations in the small intestinal mucosa and endoscopy; and (4) small intestinal foreign body and coeliotomy. Abdominal ultrasonography was considered to be diagnostic without further testing in only four (3%) dogs: two had a portosystemic shunt identified ultrasonographically, one had a linear foreign body and one had a perforated pyloric ulcer. Abdominal ultrasonography had moderate utility in 56 (38%) dogs and no utility in 79 (53%) dogs. Abdominal ultrasonography was considered counterproductive in 10 (7%) dogs because results were either falsely negative or falsely positive. These results should prompt clinicians to reconsider routine use of abdominal ultrasonography in dogs with diarrhoea.

Use of EUS for Localization of an Ingested Needle Penetrating Through the Stomach to the Pancreas

Computerized tomography (CT) scan is considered to be a sensitive test for detection of foreign bodies in abdominal cavity. However, in special circumstances it may not be able to accurately depict the location of a foreign body, especially if a small foreign body penetrates through the stomach wall into an adjacent organ. Till now, there have been on reported cases on the use of Endoscopic Ultrasound (EUS) for localization of foreign bodies penetrating through the gastric wall. We hereby present a unique case in which an ingested foreign body was successfully localized by EUS with subsequent targeted surgical removal. A 65 year old male with a history of schizophrenia initially presented to our institution with a right hip fracture. Interestingly, initial pelvic X-ray revealed two foreign bodies likely in the rectum. Upon further history, the patient admitted that he had inserted two razor blades into his rectum. Subsequently, a CT scan was performed to further evaluate the location of the razor blades and evaluate for the extent of trauma. Surprisingly, two additional needle-like foreign bodies were seen, most likely in the stomach. Esophagogastroduodenoscopy (EGD) was performed in order to attempt removal of the foreign bodies. A single 3 cm long needle was found in the duodenum with the sharp end embedded into the mucosa. It was successfully retrieved using a snare. The second foreign body could not be visualized despite an extensive search of the GI tract up to the distal jejunum with an enteroscope. As a result, another CT of the abdomen and pelvis was obtained which showed the needle-like foreign body penetrating through the gastric wall into the pancreas. However, the end of the needle appeared to be in the gastric wall. At this point linear EUS was performed with the intention to locate the foreign body and attempt to retrieve it if the one end was still within the gastric wall. EUS confirmed passage of the entire foreign body into the pancreatic parenchyma, making it impossible to retrieve endoscopically. However, no evidence of bleeding or vascular involvement was noted. Furthermore, the location of the needle within the pancreatic neck was able to be pinpointed using anatomical landmarks documented during the EUS. As a result the needle was able to be removed laparoscopically without incident. EUS can be useful in the location and removal of ingested sharp foreign bodies penetrating through the GI tract.Figure: Sagital CT scan image showing the needle tip in the proximity of the posterior gastric wall.Figure: EUS image showing needle tip in the pancreatic parenchyma in the vicinity of pancreatic duct and portal confluence beyond the gastric wall.

Oesophageal coins invisible on chest radiography: a case report

BackgroundCoins are made of metal, which is generally radiopaque, and so physicians often have the misconception that all coins are detectable by radiography. Here, we report a case of intentionally swallowed coins in the oesophagus of an adult; the coins could not be detected on chest radiography but were detected using computed tomography (CT).Case presentationA 46-year-old woman with a history of depression presented to the emergency department after an intentional medication overdose and ingestion of two Japanese 1-yen coins. She complained of persistent retrosternal discomfort. In order to confirm whether the coins were in the oesophagus or trachea, an anteroposterior chest radiograph was obtained; however, no coins were detected. Owing to her persistent symptoms, a chest CT was performed. On the initial CT scan, two 1-yen coins were observed in the oesophagus: one in the middle oesophagus and the other in the lower oesophagus. After the scanning, the patient drank water with permission, but vomited. No coins were found in her vomit, and the symptoms of retrosternal discomfort had completely disappeared. A subsequent CT scan revealed that the two 1-yen coins were in the patient’s stomach.ConclusionsJapanese 1-yen coins are made of 100% aluminium, which is less radiopaque than the metals that make up coins (nickel, bronze, and lead), and so, they were not visible via chest radiography in our case. Detecting very small or thin radiolucent foreign bodies is not possible using a chest radiograph or contrast oesophagram, but is possible via CT. CT is both increasingly convenient and non-invasive, unlike endoscopy or bronchoscopy, and so, the use of CT scans should be considered in cases of possible radiolucent foreign body ingestion.

Unilateral corneal edema caused by a hidden foreign body

Abstract Case report A middle-aged adult male was referred to our institution due to unilateral corneal edema for a possible corneal transplant. At first, the patient denied a history of trauma. A small foreign body, which had been overlooked by the primary ophthalmologist, was detected by gonioscopy, embedded in the anterior chamber angle. It was successfully surgically removed and visual results were good. Discussion In any patient with unilateral unexplained corneal edema, it is necessary to rule out the presence of a foreign body in the anterior chamber.

Iatrogenic foreign body embolization in the pulmonary artery

A 41-year-old patient who had been undergoing treatment for leukemia was admitted for sepsis. CT-scanning revealed a small intravascular foreign body located peripherally in the right lower lobe, c...

Do residual foreign bodies in terminal bronchioles require removal?

We aimed to discuss whether residual foreign bodies in terminal bronchioles require further treatment. This retrospective study includedpatients younger than 13 years diagnosed with residual airway foreign bodies in terminal bronchioles during a 6-year-period(from May 2008 to December 2014). Parents were asked to complete questionnaires about complications caused by long-standingforeign bodies when followed-up. Thin-layer computed tomography (CT) images of the chest were analyzed before and after rigidbronchoscopy. There were 23 children (12 girls), mean age 17.17±6.35 (range 6-29) months, with residual foreign bodies incarceratedor wrapped in terminal bronchioles. The follow up after initial bronchoscopy ranged from 6 to 72 (mean 43.04±20.83) months. Fourpatients were lost during follow up. Nineteen children available for follow up experienced chronic recurrences of cough and fever,haemoptysis, chest tightness or dyspnoea after sports, or stridor and pain in the chest or back before operation. Initial chest thinlayerCT scan evaluations revealed that foreign bodies in the bronchus were frequently associated with pulmonary hyperinfl ation(14/19). Presenting symptoms and signs resolved after therapy, with statistically signifi cant improvement. On follow up, the imagesof all children were normal. In conclusion, one or two small residual foreign bodies can potentially be spontaneously eliminated orprobably coated by granulation tissue; thus, it may not be necessary to perform further invasive treatments. However, all suchchildren need long time follow up.Key words: ch ildren; foreign body aspiration; terminal bronchiole; ri gid bronchoscopy; chest thin-layer computed tomography images

摘出にナビゲーションシステムが有用であった小児副咽頭間隙異物の1例

症例は2歳5か月男児，菜箸の口腔外傷から副咽頭への先端遺残が疑われ紹介となった。軟口蓋に裂創があり，CTにて頭蓋底から環椎右側にかけて含気を有する裂創を認めた。遺残の可能性があると判断して，内視鏡を用い探索したが，異物の同定はできなかった。その後の経過で右副咽頭間隙の小領域にCT値の変化を認めた。ナビゲーションシステムを使用し，受傷後26日目に異物を内視鏡下に摘出することができた。幼小児の体内異物は診断が難しく，特に箸などのX線透過性異物はCTでは同定しづらいが，その経時的変化により確認できることがある。微小な咽頭異物摘出にはナビゲーションシステムの使用が有用であり，考察を含め報告する。

Straight to the Kidney: Small Bowel Foreign Body Penetrating through Jejunal Loops Causing Renal Artery Thrombosis and Renal Infarct

Straight to the Kidney: Small Bowel Foreign Body Penetrating through Jejunal Loops Causing Renal Artery Thrombosis and Renal Infarct

Lanthanum deposition in the gastrointestinal mucosa and regional lymph nodes in dialysis patients: Analysis of surgically excised specimens and review of the literature

Lanthanum carbonate (LC) is one of the most potent phosphate binders currently used to reduce serum phosphate levels in dialysis patients with end-stage renal disease (ESRD). LC forms insoluble complexes with dietary phosphate that pass through the gastrointestinal (GI) tract with little absorption. GI lesions due to lanthanum deposition in biopsy specimens or those in endoscopic submucosal dissection (ESD) in dialysis patients have been recently identified. Here, we describe more detailed histopathological findings in the gastroduodenal mucosa and regional lymph nodes in three patients with gastric cancer. Three patients with ESRD, two elderly women and one man, underwent dialysis and were treated with LC for 3–36 months. The patients underwent laparoscopic distal gastrectomy and lymph node dissection due to gastric cancer. Many subepithelial histiocyte aggregates or small foreign body granulomas, which contained gray or brown pigments or crystal-like structures, were mostly present in non-neoplastic areas of the upper GI. Lanthanum accumulation was noted in the duodenal mucosa and the antral and body mucosae of the gastric lesser curvature. Lanthanum was also deposited in the regional lymph nodes of the three patients. Electron microscopy with energy dispersive X-ray spectroscopy confirmed lanthanum and phosphorus deposits in histiocytes. Long-term prognosis of patients and the excretion or the metabolic pathway of accumulated lanthanum remain unclear.

Edema corneal unilateral causado por un cuerpo extraño oculto

Case reportA middle-aged adult male was referred to our institution due to unilateral corneal edema for a possible corneal transplant. At first, the patient denied a history of trauma. A small foreign body, which had been overlooked by the primary ophthalmologist, was detected by gonioscopy, embedded in the anterior chamber angle. It was successfully surgically removed and visual results were good. DiscussionIn any patient with unilateral unexplained corneal edema, it is necessary to rule out the presence of a foreign body in the anterior chamber.

Religious Discourse in Modern Japan: Religion, State, and Shintō by Isomae Jun’ichi

Reviewed by: Religious Discourse in Modern Japan: Religion, State, and Shintō by Isomae Jun’ichi Jolyon Baraka Thomas Religious Discourse in Modern Japan: Religion, State, and Shintō. By Isomae Jun’ichi. Translated by Galen Amstutz and Lynne E. Riggs. Leiden: Brill, 2014. 501 pages. Softcover $209.00. When I was a visiting research student in the Department of Religious Studies at the University of Tokyo between 2006 and 2007, Isomae Jun’ichi’s 2003 monograph Kindai Nihon no shūkyō gensetsu to sono keifu: Shūkyō, kokka, shintō was indispensable reading. In that Japanese-language predecessor of the book under review here, Isomae refreshingly traced the adventitious process whereby shūkyō came to be the default translation for the English word “religion.” He also showed how the discursive structures of the religious studies field—including the assumed naturalness of the very word “religion”—shape the research questions scholars have been inclined to ask. Isomae’s willingness to critically examine religious studies was a stimulant for the field in general, and it would be no overstatement to say that his treatment of the political effects of the “R word” provided inspiration for my own current research on religious freedom in modern Japan. The sharp critiques that follow must be read with this indebtedness and profound respect for Isomae’s pathbreaking work in mind. Although the titles are similar, the English-language edition departs in significant ways from Isomae’s 2003 work, incorporating several new sections that reflect his voluminous output in the intervening years. While its topic is of indisputable importance to those of us who professionally study “Japanese religions” (a phrase I use here out of convenience), frankly the book would have benefited from some ruthless editing, a clearer framing of the argument, and a more rigorous chronological presentation. The introduction, for example, is a literature review of the sort one expects to find in some doctoral dissertations but cannot be justified in an academic monograph. Subsequent chapters are redundant, retracing the same material several times rather than providing a cogent presentation from start to finish. Translators Galen Amstutz and Lynne E. Riggs deserve congratulations for rendering Isomae’s text with fidelity to his idiosyncratic tone. Isomae habitually writes in the passive voice or—when using more active verbs—speaks of objects or institutions as if they were agents: “Shinto succeeded in prescribing its acts of religiosity as the public [End Page 186] duty of all the people of the state regardless of what beliefs they might hold as private individuals” (p. xix). He also speaks unhesitatingly about what Japanese people felt or believed without offering any evidence to support his claims. This creates the unavoidable impression that Isomae’s rigid binary between “the West” and “the non-West” and his sharp division of Japanese history into pre- and post-“religion” are premised on a rather naïve assumption that premodern Japanese people were somehow more noble or pure for lacking the modern concept of religion. Indeed, in Isomae’s telling the concept of religion becomes a sort of polluting agent or irritant. It is the small foreign body around which modern Japanese identity, the field of religious studies, and the religion/secular distinctions of the modern Japanese state cohered. This last claim that the foreign category of religion constructed modern Japanese governance is not dissimilar to Trent Maxey’s recent argument in The “Greatest Problem”: Religion and State Formation in Meiji Japan (Harvard University Asia Center, 2014). In contrast with Maxey’s stolid historical approach, however, Isomae advances an activist project that aims to recuperate a romanticized Japanese past while dreamily idealizing a different future for the study of religion. Isomae is on slightly firmer ground when he turns to actual historical data in part 1, “The Formation of the Concept of ‘Religion’ and Modern Academic Discourse.” Chapter 1 provides a sweeping overview of the introduction of the category “religion” to Japan and the diplomatic difficulties and domestic policy implications it engendered. Isomae sees the introduction of religion as a problem of the imposition of “Western logic” on Japan. But because he never clearly defines the “Japanese logic” against which he juxtaposes this (similarly undefined) “Western logic,” the reader...

Unique Case of Glass Piece Injury to Cervical Spinal Cord: A Very Rare Presentation

Foreign bodies inside the cervical spinal canal causing injury to spinal cord are seen very rarely. Very few cases of glass fragments in the cervical spinal canal were reported till date. In this report, a 17-year-old boy, who was accidentally injured by a glass piece, which penetrated into the cervical spinal cord, was operated upon and, he recovered dramatically. This case report is to emphasize the morbidity caused by small foreign bodies accidentally introduced by trivial injuries.

Use of a slit-lamp microscope for treating impacted facial foreign bodies in the emergency department.

Identifying, locating, diagnosing, and treating small foreign bodies (FBs) in soft tissues is a challenge for emergency physicians in the emergency department. Additionally, potential complications owing to the remnant FBs are medico-legally significant. The efficacy of conventional imaging methods such as radiography, computed tomography, and ultrasonography are largely limited in visualizing FBs<2-mm. The slit-lamp microscope, still unfamiliar to some emergency physicians, could be used to facilitate the treatment of FBs impacted in soft tissues. In this paper, we present a case that would have been difficult to treat without the help of the slit-lamp microscope; the patient presented with numerous particulate facially impacted FBs that were too small to be observed under plain sight or with radiography. Based on our experience, the slit-lamp microscope could be a useful tool for treating patients with miniscule and stubborn impacted FBs in the emergency department.

Combined anterior and posterior segment surgery in the treatment of penetrating eye injuries with small intraocular foreign body

Objective To investigate the clinical efficacy of combined anterior and posterior segment surgery in early treatment of penetrating eye injuries with small intraocular foreign body. Methods Twenty-two eyes of 22 patients suffered penetrating eye injuries with small intraocular foreign bodies underwent the combined operations of anterior and posterior eye segment 2-4 days after emergent debridement and suturing and according to their conditions different surgical procedures were preformed. Anterior segment surgery included anterior chamber forming, iris suture laceration, cataract extraction and intraocular lens implantation and posterior segment surgery included vitrectomy, foreign body removal, retinal laser photocoagulation around the injury site and C3F8 gas or silicone oil tamponade. The surgery efficacy and the complications were analyzed from 3months to 12 months. Silicone oil was removed 4-5month after operation. Results Intraocular foreign bodies were removed in once operation in all cases. All the patients got the intraocular lens implantation at the same time during the surgery. No serious complication happened, such as endophthalmitis, intraocular lens shift, uveitis, retinal detachment, choroidal detachment or secondary glaucoma. All the cases got the best corrected visual acuity improved from light perception -0.1 before operation to 0.05-0.8. Conclusion Combined anterior and posterior segment surgery in early treatment of penetrating eye injury with small intraocular foreign body can achieve good clinical efficacy. Key words: Foreign body, intraocular; Injury, ocular, penetrating; Cataract, traumatic; Lens, intraocular; Vitrectomy

Foreign body in ocular coats causing a pseudo optic nerve head shadow

Small intraocular foreign body in the outer coats of the eye may be wrongly interpreted as optic nerve head on ultrasound imaging. Such errors can be avoided by performing multiple sonography scans in different axes.

Double balloon enteroscopy is a safe and effective procedure in removing entrapped foreign objects in the small bowel for up to 3 months.

Recent case series have shown that enteroscopy is safe and effective to remove entrapped small bowel foreign bodies. However, the optimal timing for the foreign body retrieval in terms of duration of entrapment and when to consider surgical intervention are unknown. In this case series, we report that antegrade and retrograde enteroscopy can be used safely to retrieve foreign bodies entrapped in the small bowel for longer than 70 days. In total, 20 patients (mean age, 48 years; 11 females) with entrapped foreign bodies in the small intestine underwent antegrade, retrograde, or combined double balloon enteroscopy for retrieval of objects. Symptoms prompted removal of entrapped, nonsharp objects in all patients and included abdominal pain, nausea, and vomiting. The mean time of entrapment was 83 days (range, 4-272 days). There were 15 cases of retained video capsule endoscopy (VCE) with a mean entrapment time of 106 days (range, 7-272 days). Two VCEs could not be removed safely with enteroscopy. Other retained small bowel objects included in this study were nails and fish hooks. Their average entrapment time was 13 days (range, 4-43 days). Of the 30 enteroscopies, there was only 1 case (3%) with a complication (perforation). According to this case series, experienced endoscopists can safely and effectively retrieve foreign bodies in the small bowel, particularly VCE, that are retained for extended periods of time.