Colonoscopy-assisted removal of an impaction foreign body at the rectosigmoid junction: A case report

BACKGROUND When an anorectal foreign body is found,its composition and shape should be evaluated,and a timely and effective treatment plan should be developed based on the patient's symptoms to avoid serious complications such as intestinal perforation caused by displacement of the foreign body.CASE SUMMARY A 54-year-old male was admitted to our outpatient clinic on June 3,2023,due to a rectal foreign body that had been embedded for more than 24 h.The patient reported using a glass electrode tube to assist in the recovery of prolapsed hemorrhoids,however,the electrode tube was inadvertently inserted into the anus and could not be removed by the patient.During hospitalization,the patient underwent surgery,and the foreign body was dragged into the rectum with the aid of colonoscopy.The anus was dilated with a comb-type pulling hook and an anal fistula pulling hook to widen the anus and remove the foreign body,and the local anal symptoms were then relieved with topical drugs.The patient was allowed to eat and drink,and an entire abdominal Computed tomography(CT)and colonoscopy were reviewed 3 d after surgery.CT revealed no foreign body residue and colonoscopy showed no metal or other residues in the colon and rectum,and no apparent intestinal tract damage.CONCLUSION The timeliness and rationality of the surgical and therapeutic options for this patient were based on a literature review of the clinical signs and conceivable conditions in such cases.The type,material and the potential risks of rectal foreign bodies should be considered.

Nursing Practice for a Case of Acute Left Heart Failure Complicated with Colonic Impaction

Research Background: Heart failure is a type of organic heart disease caused by excessive ventricular load, leading to insufficient myocardial contractility and decreased cardiac output in the body. With the progression of the patient's condition, gastrointestinal dysfunction is frequently complicated. At the same time, the accumulation of feces in the body (colonic impaction) can also increase the burden on the patient’s heart, triggering or exacerbating the occurrence or progression of heart failure. Purpose: this article focuses on the correlation between colonic impaction and heart failure, using the nursing experience of a case of acute left heart failure complicated by colonic impaction as an example, in order to provide clinical evidence for the care of patients with colonic impaction combined with heart failure in the future. Method: By using innovative thinking, the stomach tube is used to replace the enema tube, which is inserted through the anus to reach the end of the colon. By combining acupressure at points such as Zhongwan, Tianzhu, and Guanyuan, it helps promote the elimination of fecal impaction. Conclusion: This case reflects the innovative thinking and adaptability of nurses, providing a new clinical approach for the aggravation of the condition of long-term heart failure patients due to constipation issues. Further research in clinical practice is warranted.

High attenuation mucoid impaction in allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis(ABPA) is a complex hypersensitivity syndrome triggered against antigens of Aspergillus fumigatus,a fungus that most commonly colonizes the airways of patients with bronchial asthma and cystic fibrosis.It presents clinically with refractory asthma,hemoptysis and systemic manifestations including fever,malaise and weight loss.Radiologically,it presents with central bronchiectasis and recurrent episodes of mucus plugging.The mucus plugs in ABPA are generally hypodense but in up to 20% of patients the mucus can be hyperdense on computed tomography.This paper reviews the literature on the clinical significance of hyperattenuated mucus in patients with ABPA.

Results of the open surgery after endoscopic basket impaction during ERCP procedure

AIM:To report the results of open surgery for patients with basket impaction during endoscopic retrograde cholangiopancreatography(ERCP) procedure.METHODS: Basket impaction of either classical Dormia basket or mechanical lithotripter basket with an entrapped stone occurred in six patients.These patients were immediately operated for removal of stone(s) and impacted basket.The postoperative course,length of hospital stay,diameter of the stone,complication and the surgical procedure of the patients were reported retrospectively.RESULTS: Six patients(M/F,0/6) were operated due to impacted basket during ERCP procedure.The mean age of the patients was 64.33 ± 14.41 years.In all cases the surgery was performed immediately after the failed ERCP procedure by making a rightsubcostal incision.The baskets containing the stone were removed through longitudinal choledochotomy with the stone.The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients.All patients were also performed cholecystectomy additionally since they had cholelithiasis.In patients with T-tube placement it was removed on the 13 th day after a normal T-tube cholangiogram.The patients remained stable at postoperative period and discharged without any complication at median 7 d.CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.

Food impaction in older age:Think about an eosinophilic esophagitis

Eosinophilic esophagitis is an inflammatory condition of esophagus.It is generally seen in childhood and young population.Men are more commonly affected than women.However,it is not common in an advanced age.Eosinophilic esophagitis decreases the ability of the esophagus to stretch and accommodation against foods.Therefore,the major symptom in adults with eosinophilic esophagitis is difficulty in swallowing solid food(dysphagia).Specifically,the food gets stuck in the esophagus after it is swallowed.Less common symptoms include heartburn and chest pain.Because of this,it may be incorrectly diagnosed as a gastroesophageal reflux disease.Here,we reported a case presented with food impaction at advanced age.As a conclusion,eosinophilic esophagitis is a rare entity that must be remembered in advance aged patients presenting with food impaction.

Acetabular Reconstruction with Massive Allograft Shaped to the Cavity and Kerboull-Type Acetabular Reinforcement Device for Multiple Failures of Impaction Bone Graft: A Case Report

Acetabular component revision in the presence of severe bone loss is difficult for reconstructing an acetabular component in the anatomical hip center. Various treatment options are available, although often the acetabular defect cannot be corrected with a single option alone. Precise assessment of the bone loss and a suitable combination of methods are needed. Here we report a case of multiple failures with impaction bone grafting reconstruction for an acetabular bone defect of American Academy of Orthopedic Surgeons classification type III. We finally reconstructed the acetabulum with three femoral head allografts and a Kerboull-type acetabular reinforcement device. The allograft was a casted, jet-type helmet-like shape. A year later the patient was able to walk without a cane and perform light agricultural work. Accurate evaluation of the acetabular bone loss and appropriate reconstruction is important.

Femoral impaction grafting

Femoral impaction grafting is a reconstruction option applicable to both simple and complex femoral component revisions. It is one of the preferred techniques for reconstructing large femoral defects when the isthmus is non-supportive. The available level of evidence is primarily derived from case series, which shows a mean survivorship of 90.5%, with revision or re-operation as the end-point, with an average follow-up of 11 years. The rate of femoral fracture requiring re-operation or revision of the component varies between several large case series, ranging from 2.5% to 9%, with an average of 5.4%.

Is metaphyseal ulnar shortening osteotomy superior to diaphyseal ulnar shortening osteotomy in the treatment of ulnar impaction syndrome?A meta-analysis

BACKGROUND Although metaphyseal ulnar shortening osteotomy(MUSO)is safer for the treatment of ulnar impaction syndrome(UIS)than diaphyseal ulnar shortening osteotomy(DUSO),DUSO is widely used for UIS treatment.AIM To evaluate the effectiveness of DUSO and MUSO for UIS treatment and determine the factors that should be considered when choosing surgical treatment for UIS.METHODS Articles comparing the effectiveness of DUSO and MUSO for UIS treatment were systematically retrieved from MEDLINE(Ovid),PubMed,EMBASE,and Cochrane Library.The demography,incidence of complications,secondary operation rate,postoperative DASH score,wrist pain on the visual analogue scale,and grip strength improvement were also evaluated.In addition,the correlation between the improvement of grip strength and the shortening of osteotomy length of ulna was analyzed.The outcome of the patient was discontinuous,and the odds ratio,risk ratio(RR),and 95%CI were calculated and analyzed via RevMan5.3 software.RESULTS Six studies,including 83 patients receiving MUSO(experimental group)and 112 patients receiving DUSO(control group),were included in the meta-analysis.The second operation rate was significantly higher after DUSO than after MUSO.The DASH scores were slightly lower in the MUSO group than in the DUSO group.The patients receiving MUSO had slightly better pain relief effect than patients receiving DUSO.However,the incidence of complications and improvement of grip strength were not significantly different between the two groups.CONCLUSION Although DUSO and MUSO provide similar effects for UIS,MUSO is associated with a lower secondary operation rate,slightly lower postoperative DASH scores and slightly better pain relief effect than DUSO,indicating that MUSO can effectively be used for UIS treatment.

Mandibular changes associated with maxillary impaction and molar intrusion

We report a case series of ten patients who presented with anterior open bite. The initial evaluation included clinical pictures, lateral cephalometric radiographs and dental casts. They were assessed according to the severity of the open bite and the cause (skeletal or dental). They all underwent orthodontic treatment as an initial step. Five patients with dental open bite underwent molar intrusion using titanium screws and five patients underwent maxillary Le Fort I impaction. We report the mandibular changes associated with these different treatment modalities with improved esthetics.

The Utility of Diagnostic Imaging in Fish Bone Impaction

Objectives: The purpose of this pilot study was to obtain an Australian perspective on evaluating the utility of plain film radiography and computed tomography (CT) to rule out fish bone impaction in the upper aerodigestive tract in the emergency department (ED) setting. Methods: A retrospective multicentre cohort study was conducted. A total of 73 patients met the inclusion criteria. A subgroup of patients underwent CT. We studied the sensitivity and specificity of x-ray and CT along with other demographic variables to determine the likelihood of true fish bone impaction. Results: Out of the 73 patients, 28 patients had true bone impaction. The sensitivity for x-ray was 42.9% and specificity was 73.3%. The sensitivity of CT was 87.5% and specificity was 71.4%. We found a significant difference in the mean age of presentation for true bone and false bone impaction, P = 0.02. Conclusion: Due to the low sensitivity of x-ray we do not recommend the utilisation of plain film radiography to rule out bone impaction Advances in low dose radiation multidetector CT scanners may replace plain film radiography as a screening tool.

Prevalence of Canine Impaction among Saudi Population at Al Qassim Area in the Kingdom of Saudi Arabia

Background: One of the most reported dental problems is a tooth impaction which is defined as the infraosseous position of the tooth after the estimated time of eruption [1]. Thus, the most notable tooth impaction is canine impaction which is a frequently encountered clinical problem. Aim: This study aimed to determine the prevalence of impacted canines among Saudi people from the 5-year period of 2013-2018 in Al Qassim area in the KSA. Methodology: A retrospective research designed was utilized in the study. A retrospective study simply means to “look back” in the past and usually done by obtaining data from medical records of the targeted population with common characteristics [2]. Results: This 5-year study covered year 2013 to 2018. In this study, there were 1500 who seek dental health in King Fahd Specialist Hospital. Thus, out of these clients, only 89 were identified with cases of impacted canine using the OPG with a prevalence rate of 5.9 %. In addition, it was found that out of 89 patients identified, the patients have impacted canines in different locations: maxillary, mandible, right side and left side. It was found that there were 187 impacted teeth in different locations among 89 clients affected. There were 48 cases (25.7%) of impacted canines on the right side while 64 cases (34.2%) were reported on the left side of the total group. Moreover, impacted maxillary canine were 68 cases (36.4%) and mandibular impacted canine were only 7 cases (3.7%) of the total group. Conclusion: The early detection and treatment approach of impacted canines among affected individuals is vital in order to prevent different problems that may arise during impaction of canine teeth. Awareness, early detection, proper diagnostic test and multiple treatment approaches are needed to prevent different sequelae due to canine impaction.

Application of 3D Projection Profilometry in the High Speed Impaction Surface Deformation Measurement Research

In order to study the strength of the composite material plate problems, need to adopt a nondestructive testing method to obtain the specimen surface under the effect of high-speed impact regularity of shape. The projection profilometry was used to measure the surface profile or the full field deformation. Furtherly, by using the Fourier transform algorithm, there is only one frame of captured image which is needed in the measurement, so that it can be introduced into the high speed impaction procedure measurement. An experimental system, which was contained with an impact setup and the projection profilometry measurement part, was constructed for the impaction action characteristic research. The metallic impact object can be launched by a gas gun or a spin fan, respectively. The detected object is manufactured by composite materials. In order to increase the surface deformation measurement accuracy, the calibration method and the error was discussed with different calibration specimen. And then, the proposed profilometry measurement method is proved by the gas gun and spin fan projectile test. The surface deformation of the manufactured composite plates and fan case are measured in the impaction procedure. So that the impact action details can be described much more clearly than the traditional video monitoring method.

Novel use of esophageal overtube and water flushes as a safety indicator and facilitator for the push technique in esophageal food impaction

Esophageal food impaction requires urgent endoscopic intervention either by extraction or pushing into the stomach.Due to risks of perforation,controversy exists between when to extract verses when to push the food bolus.There are no clear guidelines on when it is safe to push a food bolus;endoscopists rely on their subjective experiences and judgment.We present a case with a novel use of an esophageal overtube and water flushes to determine the safety of pushing a food bolus and facilitate passage into the stomach.

Clinical observation of bone graft impaction on posterior intervertebral body fusion for lumbar spondylolisthesis

Objective To investigate the clinical effect of bone graft impaction on posterior intervertebral fusion for lumbar spondylolisthesis.Methods From January 2001 to July 2008,36 patients with lumbar spondylolisthesis were treated by

Impaction of a lithotripsy basket during endoscopic lithotomy of a common bile duct stone

The treatments for common bile duct (CBD) stones are being continually developed. Impaction of the lithotripsy basket during endoscopic removal of CBD stones was seen in 5.9% patients. We report the case of a 66-yearold woman who underwent surgery for the removal of an impacted biliary basket. She was admitted to our hospital with a complaint of right upper abdominal pain. Magnetic resonance cholangiopancreatography revealed a CBD stone (20 mm × 15 mm). We diagnosed her with choledocholithiasis and performed endoscopic retrograde cholangiopancreatography to remove the stone. However, unfortunately, the retrievable basket around the stone became impacted. An endotriptor along with forceps could not be used owing to the entrapment of the basket, and thus we performed urgent surgery. The basket containing the stone was removed through a longitudinal choledochotomy. The wires leading to the basket were cut, and the basket containing the stone was removed via the incision. A T-tube was inserted,and the choledochotomy was closed. The postoperative course was uneventful. In conclusion, if the diameter of a CBD stone is more than 20 mm, then the risk of basket impaction increases, and surgery may be necessary as the initial treatment of the CBD stone.

Vertical direction impaction of kissing molars:A case report

BACKGROUND Kissing molars(KMs)are a scarcely reported form of molar impaction in which the occlusal surfaces contact each other within a single dental follicle and the roots point in opposite directions.The direction of KMs impaction is generally tilted.KMs with vertical direction impaction have not been reported in the literature.CASE SUMMARY A 25-year-old female visited a dentist for right maxillary wisdom teeth extraction and was diagnosed with two vertically impacted KMs in the left mandible on panoramic radiography.After cone-beam computed tomography examination confirmed no secondary complication,the patient chose to undergo observation and regular follow-up.A literature review of KMs revealed that vertical impacted KMs are rare;high-quality evidence regarding their prevalence is still lacking.At present,the causality of KMs is controversial.In this study,we have tried to provide a detailed definition of KMs to allow an accurate evaluation of their prevalence and classification based on their impaction direction which may be related to their pathogenesis.The treatment plan of KMs depends on the condition and location of the affected teeth and associated complications;they may be either directly extracted or treated using a multidisciplinary approach including maxillofacial surgeons and orthodontists.CONCLUSION KMs are a rare clinical condition of impacted teeth with unclear pathogenesis.Vertically impacted KMs were seldom reported.Reasonable definition and classification of KMs can help in the understanding of their causes and prevalence.

Selection of allografts for impaction bone grafting for bone defect reconstruction on the acetabular side

Objective To review the choices of allografts for bone defect reconstruction in acetabular revision surgery using the technique of impaction bone grafting.Data sources The data cited in this review were mainly obtained from articles listed in PubMed that were published from January 1993 to July 2009. The search terms were ＂impaction bone grafting＂, ＂particle size＂, ＂mechanical property＂and ＂biological behavior＂.Study selection Articles relevant to the choices of allografts and their results for bone defect reconstruction on the acetabular side were selected.Results Different choices of allografts, including the particle size, process of irradiation or fat reduction, composition and particle grade, are made to improve the survival rate of a prosthesis in acetabular revision surgery. This review,which compares both mechanical and biological factors, summarizes the experimental and clinical results for different techniques.Conclusions Fresh frozen cancellous allografts with particle sizes ranging from 7 to 10 mm are a favorable choice for reconstruction of bone defects of American Academy of Orthopedic Surgeons （AAOS） types Ⅱ （cavitary defect） and Ⅲ（combined cavitary and segmental defect） on the acetabular side. A fat-reducing procedure with saline or solvent/detergent is controversial. Adding autologous marrow into irradiated allografts, which provides reliable mechanical stability and biological safety, may be a substitute for fresh frozen allografts. Cortical bone can be a supplementary material in cases of insufficiency of cancellous allografts. Cartilage should be excluded from the graft material. Further research is required to demonstrate the best particle grade, and randomized controlled trials in clinical practice are required to obtain more information about the selection of allografts.

Esophageal intramural pseudodiverticulosis,a rare cause of food impaction:case report and review of the literature

Esophageal intramural pseudodiverticulosis(EIPD)is a rare,benign condition of uncertain etiology and pathogenesis,which usually presents with either progressive or intermittent dysphagia.Acute presentation with food impaction,requiring emergency esophago-gastroduodenoscopy(EGD),is rare.We report a case of EIPD presenting as food bolus impaction in an elderly black female.The patient had no previous history of dysphagia or odynophagia.Currently accepted risk factors,such as diabetes mellitus,chronic alcoholism,and reflux esophagitis,were not present in our patient.Emergency EGD established the diagnosis and also dislodged the food bolus.Histopathological evaluation of the mucosa diagnosed co-existent acute candidal infection.Medical treatment with proton pump inhibitor and azole antifungal led to resolution of her symptoms.Review of the literature revealed that stenosis,strictures,perforation,gastro-intestinal bleed,and fistula formation are potential complications of EIPD.Multiple motility abnormalities have been described but are not consistent.Treatment of the underlying inflammatory and or infectious condition is the mainstay of management of this unusual condition.

Effect of impaction on gene-modified cells seeded on granular bone allografts in vitro and in vivo

Background While attempting to restore bone stock, impaction bone grafting employed during revision joint surgery may result in slow and limited allograft incorporation into host bone. A new approach including gene-modified bone marrow stromal cells （BMSCs） in combination with impaction bone grafting may effectively restore bone stock and improve allograft incorporation. This study aimed to investigate the effect of impaction on gene-modified BMSCs seeded on granular bone allografts in vitro and in vivo.Methods Deep-frozen, granular, cancellous bone allografts from canines were prepared to serve as cell delivery scaffolds and were seeded with green fluorescent protein （GFP） genetically-modified BMSCs to construct cell-allograft composites. The composites were impacted in a simulative, in vitro impaction model and cultured for further analysis under standard conditions. Four Beagle dogs, treated with bilateral, uncemented proximal tibial joint hemiarthroplasty with a prosthesis, were implanted with autologous GFP gene-modified cell-allograft composites to repair the bone cavity around each prosthesis.Results A significant reduction in cell viability was observed after impaction by fluorescence microscopy in vitro.However, there remained a proportion of GFP-positive cells that were viable and functionally active, as evidenced by the secretion of GFP protein in vitro and in vivo.Conclusions Gene-modified BMSCs seeded on granular allografts were able to withstand the impaction forces and to maintain their normal functions in vitro and in vivo, in spite of a partial loss in cell viability.

Esophageal food impaction during cultural holidays and national athletic events

Background:Although intrinsic risk factors contributing to esophageal food impaction are well established,whether social behavior affects its occurrence has not yet been examined.Methods:We conducted a retrospective review of the gastroenterology endoscopy procedural documentation software for the period of 2001–2012 to identify all patients who presented to our emergency department for esophageal foreign-body removal at the time of national athletic events and holidays associated with dietary indiscretions.Results:We found that adults undergoing emergent esophagogastroduodenoscopy during periods celebrating cultural holidays and national athletic events were more likely to experience esophageal food impaction compared with those undergoing emergent endoscopy during periods not associated with these events(36.8% vs 3.6%;P<0.001):a 10-fold increase.During a national holiday/athletic event period,the most common impacted food item was turkey(50%)followed by chicken(29%)and beef(21%).Conclusions:Esophageal food impaction is more likely to occur on American holidays and national athletic events and is associated with large meals.Patients with intrinsic risk factors should be advised to modify their diet during cultural events associated with tachyphagia and large meals to prevent esophageal food impaction.