Management of Vulnating Esophageal Foreign Bodies in Burkina Faso

Introduction: Esophageal foreign bodies (EFB) are a diagnostic and therapeutic emergency because of the serious complications they can cause. Aim: This paper aimed to study the vulnating esophageal foreign bodies in the ENT and Head and Neck Surgery departments of the Yalgado Ouedraogo and Bogodogo University Hospital. Methodology: This was an analytic cross-sectional study with retrospective data collection over 10 years (2012-2021). Results: We collected 91 cases of vulnating esophageal foreign bodies, i.e. 9.1 cases/year (4.7%). The mean age of the patients was 14 ± 19 years. The sex ratio was 1.6. The circumstances of occurrence were dominated by accidental ingestion of vulnating esophageal foreign bodies (98.9%). The average time to consultation was 7.5 hours. Dysphagia was the dominant symptom (64.8%). Cervico-thoracic radiography found dual contour radiopaque images in 71.4%. Esophagoscopy with rigid tube was performed in 97.8%. The average time for extraction of the vulnating esophageal foreign bodies was 8 hours. Vulnerating esophageal foreign bodies were non-organic in 84.6%. The button cell represented 64.8%. Their location was cervical in 61.5% intraoperatively. The lesion assessment found ulcerative lesions in 42.9% (p Conclusion: Vulnating esophageal foreign bodies are relatively frequent in our ENT practice. Although their diagnosis is often easy, their treatment is still difficult and requires multidisciplinary management. Thus, for us, prevention remains the first effective weapon.

Endoscopic retrieval of 28 foreign bodies in a 100-year-old female after attempted suicide

Foreign body ingestion is a common emergency situation in children with one or a few objects having been ingested. Here we report our experience using endo-scopic retrieval in a female centenarian with dyspnea and foreign bodies in the esophagus. She attempted suicide by swallowing 26 coins and two other foreign bodies. A gastroscope was used to remove all foreign bodies in the lower esophagus. In total, 26 coins, one ferrous ring and one cylindrical plastic object were retrieved. To our knowledge, this is the first clinical report on retrieval of so many foreign bodies in a single case.

Clinical characteristics and prognostic factors for visual outcome in 669 patients with intraocular foreign bodies

AIM: To describe the clinical characteristics and analyze prognostic factors that influence visual outcome in 669 patients with intraocular foreign bodies(IOFBs).METHODS: Medical records of 669 patients with IOFBs from West China Hospital were reviewed. Best corrected visual acuity(BCVA) values were recorded using standard Snellen acuity chart and were converted to logarithm of the minimum angle of resolution(log MAR) scale for statistical analysis. The visual outcome was defined by the final BCVA(excellent visual outcome: final BCVA of 20/40 or better;poor visual outcome: final BCVA less than 20/200). Statistical analysis of collected data was performed using IBM SPSS Statistics version 23. A 2-tailed P value of less than 0.05 was considered statistically significant throughout the study. RESULTS: The average age ranged from 1 to 79 years old(mean age, 34.8±12.7 SD) and the majority of patients were men(626, 93.6%). The major cause of ocular injury was hammering(383, 57.2%). Almost all the patients(97.8%) underwent surgeries(97.8%) and the average time interval between injury and surgery was 26.4±322.3 d(0-7300), while 327 patients received surgeries within 24 h(48.9%) and 590 patients received surgeries within seven days(88.2%) after IOFBs injury. The poor BCVA was associated with older age(P=0.013), larger IOFBs size(P<0.001), presence of complications(P<0.001) and worse presenting BCVA(P<0.001). On the contrary, younger age(P=0.005), smaller IOFBs size(P<0.001), absence of complications(P<0.001) and better presenting BCVA(P<0.001) were considered to relate to excellent BCVA.CONCLUSION: Multiple prognostic factors may influence the final visual outcome, including age, size of IOFBs, complications and presenting BCVA. Meanwhile, further education and promotion on eye protection should be taken for the improvement on self-protection and selfhealth awareness.

Clinical Efficacy of Surgical Removal of Deep Corneal Plant Foreign Bodies

Purpose:To describe a technique for removing deep corneal plant foreign bodies. Methods:Twelve patients (7 males and 5 females, aged 5 to 56 years).with plant foreign bodies embedded in the deep cornea were treated between July 2011 and December 2012. The course of disease ranged from 1 to 11 d. Four of the patients had wooden foreign bodies, 3 had bamboo foreign bodies, and 5 had flower thorns; all underwent surgical removal. During the surgery,a novel suture needle was used to remove the foreign bodies.For injuries with a deep tunnel caused by the foreign bodies,the tunnel was cut open with a keratome. The foreign bodies were then removed and necrotic tissue was thoroughly debrided.Incisions were closed with interrupted sutures. The corneal foreign bodies were collected postoperatively for fungus and bacterial culture and appropriatemedical treatment was provided. Results: Bacteria were identified in 3 cases, fungus in 3 cases, and no bacteria or fungus in 6 cases.All corneal foreign bodies were embedded deep in the corneal stroma without incidence of full-thickness corneal penetration or intraocular infection. Conclusion:Plant foreign bodies embedded in the deep cornea should be removed immediately. During the surgery, the foreign bodies and surrounding necrotic corneal stroma should be completely removed. The injured cornea should be cut open to eliminate necrotic tissues when necessary. (Eye Science 2013; 28:30-33)

Endoscopic removal of multiple duodenum foreign bodies:An unusual occurrence

Deliberate single foreign body ingestion is a scenario that many gastroenterologists commonly see in psychiatric units and prisons.However,multiple foreign body ingestions,especially located in the duodenum,provide the endoscopist with unique challenges for management and treatment.Although most foreign objects pass spontaneously,one should have a low threshold of intervention for multiple objects,especially those that are wide,sharp and at risk of perforation.Diagnosis is typically made when there is a history of ingestion coupled with corresponding radiographic verification.The symptoms tend to be non-specific although some patients are able to delineate where the discomfort level is,correlating with the site of impaction.Most foreign bodies pass spontaneously;however when multiple sharp objects are ingested,the gastroenterologist should perform endoscopic procedures to minimize the risks of bowel perforation.We describe here a successful case of multiple ingested foreign bodies retrieved across the C-loop of the duodenum and the pharynges-esophageal curve via endoscopy and review the literature of multiple foreign body ingestion.

Unusual Foreign Bodies of Surgical Discovery on a Traumatic Spine

Introduction: Para-spinal non-metallic foreign bodies (fabrics or plastics) are rare and poorly documented. They are often unknown and discovered at the stage of infectious complications and present big therapeutic challenges. We report a rare case of three para-spinal foreign bodies (fabric, plastic and postoperative gauze) discovered during surgery of a traumatic thoracic spine. Case report: A 32-year-old man admitted for a polytrauma (collision motorcycle-cart). The admission examination noted closed trauma of the thoracic spine, an ASIA score of A, dyspnea, a penetrating wound of the left side of the chest. The CT scan showed a compressive left pleural effusion, multiple ribs fractures, pulmonary contusion, unstable fracture of fifth and sixth thoracic vertebrae associated with posterior epidural hematoma responsible for medullar compression. There was a rounded, para-spinal image, dotted with small areas of low density, air bubbles. We lifted the vital emergency by draining the left pleural effusion, debriding the penetrating chest wound, and administering broad-spectrum antibiotic therapy. Fourteen days later, we decided to stabilize the spine. After a posterior approach, we discovered free pus and para-vertebral three foreign bodies. Enterobacter spp.was isolated in pus susceptible to imipenem. The immediate operative follow-up was simple. Conclusion: The best treatment remains preventive by simple measures, exploration of penetrating wounds, repeated count and careful verification of gauze, because the infectious complications that they generate are source of mortality and serious medico-legal implications.

Surgical Removal of Numerous Foreign Bodies from the Foot Caused by Sea Urchin Spines

Injury from sea urchin spines is not rare, especially during summer holidays in the sea side. Failure to remove these spines or inability to remove them completely can lead to long-term squeal of pain and impaired function. Treatment methods include alternative medicine, LASER and surgery. We describe the surgical removal of 102 sea urchin spines from the foot of a 36-year-old man. The wounds healed completely. Although, he initially complained of a mild discomfort on weight bearing, the symptoms disappeared 2 weeks later.

General anesthesia with endotracheal intubation ensures the quick removal of magnetic foreign bodies:A case report

BACKGROUND The incidence of ingestion of magnetic foreign bodies in the gastrointestinal tract has been increasing year by year.Due to their strong magnetic attraction,if multiple gastrointestinal foreign bodies enter the small intestine,it can lead to serious complications such as intestinal perforation,necrosis,torsion,and bleeding.Severe cases require surgical intervention.CASE SUMMARY We report a 6-year-old child who accidentally swallowed multiple magnetic balls.Under timely and safe anesthesia,the magnetic balls were quickly removed through gastroscopy before entering the small intestine.CONCLUSION General anesthesia with endotracheal intubation can ensure full anesthesia under the condition of fasting for less than 6 h.In order to prevent magnetic foreign bodies from entering the small intestine,timely and effective measures must be taken to remove the foreign bodies.

Endoscopic management of foreign bodies in the upper gastrointestinal tract:A review

Foreign body ingestion is a common condition, es-pecially among children who represent 80% of these emergencies. The most frequently ingested foreign bodies in children are coins, toys, magnets and batter-ies. Most foreign body ingestions in adults occur while eating, leading to either bone or meat bolus impaction. Flexible endoscopy is the therapeutic method of choice for relieving food impaction and removing true foreign bodies with a success rate of over 95% and with mini-mal complications. This review describes a comprehen-sive approach towards patients presenting with foreign body ingestion. Recommendations are based on a review of the literature and extensive personal experi-ence.

Risk factors for complications associated with upper gastrointestinal foreign bodies

AIM: To investigate predictive risk factors associated with complications in the endoscopic removal of foreign bodies from the upper gastrointestinal tract.METHODS: We retrospectively reviewed the medical records of 194 patients with a diagnosis of foreign body impaction in the upper gastrointestinal tract,confirmed by endoscopy,at two university hospital in South Korea.Patient demographic data,including age,gender,intention to ingestion,symptoms at admission,and comorbidities,were collected.Clinical features of the foreign bodies,such as type,size,sharpness of edges,number,and location,were analyzed.Endoscopic data those were analyzed included duration of foreign body impaction,duration of endoscopic performance,endoscopic device,days of hospitalization,complication rate,30-d mortality rate,and the number of operationsrelated to foreign body removal.RESULTS: The types of upper gastrointestinal foreign bodies included fish bones,drugs,shells,meat,metal,and animal bones.The locations of impacted foreign bodies were the upper esophagus(57.2%),mid esophagus(28.4%),stomach(10.8%),and lower esophagus(3.6%).The median size of the foreign bodies was 26.2 ± 16.7 mm.Among 194 patients,endoscopic removal was achieved in 189,and complications developed in 51 patients(26.9%).Significant complications associated with foreign body impaction and removal included deep lacerations with minor bleeding(n = 31,16%),ulcer(n = 11,5.7%),perforation(n = 3,1.5%),and abscess(n = 1,0.5%).Four patients underwent operations because of incomplete endoscopic foreign body extraction.In multivariate analyses,risk factors for endoscopic complications and failure were sharpness(HR = 2.48,95%CI: 1.07-5.72; P = 0.034) and a greater than 12-h duration of impaction(HR = 2.42,95%CI: 1.12-5.25,P = 0.025).CONCLUSION: In cases of longer than 12 h since foreign body ingestion or sharp-pointed objects,rapid endoscopic intervention should be provided in patients with ingested foreign bodies.

Emergency admissions due to swallowed foreign bodies in adults

AIM:To study a retrospective analysis of patients who presented to the emergency departments(ED)with complaints related to foreign body ingestions.METHODS:Patients older than 16 years of age who presented to the ED between January 1stand December 31stof 2010 with complaints related to swallowed foreign bodies were identified from electronic health records and patient charts.RESULTS:A total of 100 patients presented with a complaint of foreign body ingestion during the study period.Overall,an X-ray was performed on 75 patients,and a fiberoptic evaluation was performed on45 patients.A foreign body was detected in 46(46%)patients.The diagnostic yield of the X-ray was 27(36%)out of 75 patients,while the diagnostic yield of the fiberoptic evaluations was 21(47%)out of 45 patients.The detected foreign bodies were mostly located in the esophagus(17 out of 46 foreign bodies detected).When the types of ingested foreign bodies were evaluated,52(52%)patients reported ingesting food,and19(19%)patients reported swallowing pins.An X-ray was performed on 33 patients with accidental food ingestions but yielded a positive result in only two cases.In 12 out of 21 patients with accidental food ingestion who underwent fiberoptic evaluation,the foreign material was detected and removed.CONCLUSION:Plain radiography is helpful in the localization of radiopaque swollen foreign bodies,while fiberoptic methods are useful as both diagnostic and therapeutic tools,regardless of radiopacity.

Increasing trend in retained rectal foreign bodies

AIM To highlight the rising trend in hospital presentation of foreign bodies retained in the rectum over a 5-year period.METHODS Retrospective review of the cases of retained rectal foreign bodies between 2008 and 2012 was performed.Patients' clinical data and yearly case presentation with data relating to hospital episodes were collected.Data analysis was by SPSS Inc.Chicago,IL,United States.RESULTS Twenty-five patients presented over a 5-year period with a mean age of 39(17-62) years and M: F ratio of 2:1.A progressive rise in cases was noted from 2008 to 2012 with 3,4,4,6,8 recorded patients per year respectively.The majority of the impacted rectal objects were used for self-/partner-eroticism.The commonest retained foreign bodies were sex vibrators and dildos.Ninty-six percent of the patients required extraction while one passed spontaneously.Two and three patients had retrieval in the Emergency Department and on the ward respectively while 19 patients needed examination under anaesthesia for extraction.The mean hospital stay was 19(2-38) h.Associated psychosocial issues included depression,deliberate self-harm,illicit drug abuse,anxiety and alcoholism.There were no psychosocial problems identified in 15 patients.CONCLUSION There is a progressive rise in hospital presentation of impacted rectal foreign bodies with increasing use of different objects for sexual arousal.

Management of rectal foreign bodies: Description of a new technique and clinical practice guidelines

A number of techniques have been described to remove rectal foreign bodies. In this report, a novel endoscopic technique using a pneumatic dilatation balloon normally used in achalasia patients is presented. In addition, a systematic review of the literature was performed for non-operative methods to remove foreign bodies from the rectum. These results are summarised, presented as a practical at-a- glance overview and a flow chart is offered to guide the clinician in treatment decisions. The design of the flow chart was based on the aims to treat the patient preferably on an outpatient basis with minimally invasive techniques and if possible under conscious sedation rather than general anaesthesia.

Western view of the management of gastroesophageal foreign bodies

The best modality for foreign body removal has beenthe subject of much controversy over the years.We have read with great interest the recent article by Souza Aguiar Municipal Hospital,Rio de Janeiro,Brazil,describing their experience with the management of esophageal foreign bodies in children.Non-endoscopic methods of removing foreign bodies(such as a Foley catheter guided or not by fluoroscopy)have been successfully used at this center.These methods could be an attractive option because of the following advantages:Shorter hospitalization time;easy to perform;no need for anesthesia;avoids esophagoscopy;and lower costs.However,the complications of these procedures can be severe and potentially fatal if not performed correctly,such as bronchoaspiration,perforation,and acute airway obstruction.In addition,it has some disadvantages,such as the inability to directly view the esophagus and the inability to always retrieve foreign bodies.Therefore,in Western countries clinical practice usually recommends endoscopic removal of foreign bodies under direct vision and with airway protection whenever possible.

Airway foreign bodies: A critical review for a common pediatric emergency

BACKGROUND:Airway foreign bodies(AFBs)is an interdisciplinary area between emergency medicine,pediatrics and otolaryngology.It is a life-threatening condition that is not infrequently seen;however,it is poorly covered in medical literature.Accidental aspiration of an element into airways is a widespread clinical scenario among children under 3 years,predominantly males.Moreover,it is the leading cause of infantile deaths and the fourth one among preschool children.DATA RESOURCES:A systemic search was conducted in July 2015 using Pub Med/Pub Med Central Database of The National Center for Biotechnology Information(NCBI)(http://www.ncbi.nlm.nih.gov/).A total of 1 767 articles were identified and most of them were meta-analyses,systematic reviews,and case series.Those thoroughly discussing assessment and management of AFBs were retrieved.RESULTS:AFBs episodes may be either witnessed or missed.Presence of a witness for the inhalation is diagnostic.The later usually present with persistent active cough.A classical triad of paroxysmal cough,wheezing,and dyspnoea/decreased air entry was reported,though many presentations have inconsistent findings.Hence,diagnosis requires high index of clinical suspicion.Flexible fibro-optic bronchoscopy is the gold standard of diagnosis,whereas inhaled objects are best retrieved by rigid bronchoscopes.CONCLUSIONS:Close supervision of pediatrics is the hallmark of prevention.Caregivers should ensure a safe surrounding milieu,including the toys their offspring play with.Immediate complications result from direct obstruction or injury by the inhaled object.Alternatively,prolonged lodging traps air and induces inflammatory response causing atelectesis and pneumonia,respectively.

Endoscopic removal of foreign bodies:A retrospective study in Japan

BACKGROUND The ingestion of foreign bodies(FBs)and food bolus impaction(FBI)in the digestive tract are commonly encountered clinical problems.Methods to handle such problems continue to evolve offering advantages,such as the avoidance of surgery,reduced cost,improved visualization,reduced morbidity,and high removal success rate.However,to date,no studies have evaluated the endoscopic management of FBs in Japan.AIM To elucidate level of safety and efficacy in the endoscopic management of FBs and FBI.METHODS A total of 215 procedures were performed at Keio University Hospital between November 2007 and August 2018.Data were collected from medical charts,and endoscopic details were collected from an endoscopic reporting system.Procedures performed with a flexible gastrointestinal endoscope were only taken into account.Patients who underwent a technique involving FB or FBI from the digestive tract were only included.Data on patient sex,patient age,outpatient,inpatient,FB type,FB location,procedure time,procedure type,removal device type,success,and technical complications were reviewed and analyzed retrospectively.RESULTS Among the 215 procedures,136(63.3%)were performed in old adults(≥60 years),180(83.7%)procedures were performed in outpatients.The most common type of FBs were press-through-pack(PTP)medications[72(33.5%)cases],FBI[47(21.9%)],Anisakis parasite(AP)[41(19.1%)cases].Most FBs were located in the esophagus[130(60.5%)cases]followed by the stomach[68(31.6%)cases].AP was commonly found in the stomach[39(57.4%)cases],and it was removed using biopsy forceps in 97.5%of the cases.The most common FBs according to anatomical location were PTP medications(40%)and dental prostheses(DP)(40%)in the laryngopharynx,PTP(48.5%)in the esophagus,AP(57.4%)in the stomach,DP(37.5%)in the small intestine and video capsule endoscopy device(75%)in the colon.A transparent cap with grasping forceps was the most commonly used device[82(38.1%)cases].The success rate of the procedure was 100%,and complication were observed in only one case(0.5%).CONCLUSION Endoscopic management of FBs and FBI in our Hospital is extremely safe and effective.

In situ formation of the loop snare technique for retrieval of foreign bodies from vessels

Purpose: To investigate the feasibility and effectiveness of in situ formation of the loop snare technique for retrieval of foreign bodies from vessels. Materials and methods: We retrospectively reviewed in situ formation of the loop snare technique for retrieval of foreign bodies in 6 patients. After placing the guide wire and the loop of the gooseneck snare on each side of the tubes, the soft tip of the guide wire was caught with the gooseneck snare to form a new loop structure. The foreign body was retrieved with the new loop snare by combining the gooseneck snare and the guide wire. We reviewed the application of this technique in 6 patients with fractured central venous catheters without free ends. Results: With in situ formation of the loop snare technique, the internal ruptured catheter was successfully removed from all of the 6 patients in about 2 to 4 min. There were no complications such as arrhythmia or heart valve injury in the 6 patients with the distal end of the fragment in the pulmonary artery or right atrium. Conclusion: The in situ formation loop snare technique is an effective and fast means of retrieving tubular foreign bodies without free ends from vessels. Further research is needed to investigate the practical utility of the method for retrieval of all kinds of foreign bodies.

Medical Foreign Bodies in Urinary Bladder: a Case Report

RETAINED foreign bodies in the urinary tract after surgical or diagnostic procedure, named iatrogenic foreign bodies, are rarely reported, though the estimated incidence was as high as 1/1500 cases.1 Prompt and proper retrieval is required due to potential complications. We report a case of iatrogenic foreign body into the bladder.

Complication rates in emergent endoscopy for foreign bodies under different sedation modalities:A large single-center retrospective review

BACKGROUND Foreign object ingestion(FOI)and food bolus impaction(FBI)are common causes of emergent endoscopic intervention.The choice of sedation used is often dictated by physician experience.Many endoscopists frequently prefer to use monitored anesthesia care(MAC)and general anesthesia(GA)as opposed to conscious sedation(CS)due to the concern for inadequate airway protection.However,there is insufficient data examining the safety of different sedation modalities in emergent endoscopic management of FOI and FBI.AIM To investigate the complication rates of emergent endoscopic extraction performed under different sedation modalities.METHODS We conducted a retrospective chart review of patients presenting with acute FBI and FOI between 2010 and 2018 in two hospitals.A standardized questionnaire was utilized to collect data on demographics,endoscopic details,sedation practices,hospital stay and adverse events.Complications recognized during and within 24 h of the procedure were considered early,whereas patients presenting with a procedure-related adverse event within two weeks of the index event were considered delayed complications.Complication rates of patients who underwent emergent endoscopic retrieval were compared based on sedation types,namely CS,MAC and GA.Chi-square analysis and multiple logistic regression were used to compare complication rate based on sedation type.RESULTS Among the 929 procedures analyzed,353 procedures(38.0%)were performed under CS,278 procedures(29.9%)under MAC and the rest(32.1%)under GA.The median age of the subjects was 52 years old,with 57.4%being male.The majority of the procedures(64.3%)were FBI with the rest being FOI(35.7%).A total of 132 subjects(14.2%)had chronic comorbidities while 29.0%had psychiatric disorders.The most commonly observed early complications were mucosal laceration(3.8%)and bleeding(2.6%).The most common delayed complication was aspiration pneumonia(1.8%).A total of 20 patients(5.6%)could not adequately be sedated with CS and had to be converted to MAC or GA.Patient sedated with MAC and GA were more likely to require hospitalization,P<0.0001.Analysis revealed no statistically significant difference in the complication rate between patients sedated under CS(14.7%),MAC(14.7%)and GA(19.5%),P=0.19.CONCLUSION For patients who present with FOI or FBI and undergo emergent endoscopic treatment,there is no significant difference in adverse event rates between CS,MAC and GA.

A New Method of 3-Dimensional Localization of Intraocular Foreign Bodies Using CT Imaging:A Role of Optic Nerve

Computed tomography（CT） is considered the most sensitive method for the detection of intraocular foreign bodies（IOFBs）. The purpose of this study was to evaluate a new method of 3-dimentional（3D） localization of IOFBs that takes advantage of the anatomical structure of the optic nerve and to assess the clinical outcomes using this new method. Twenty-two trauma patients with IOFBs or suspected IOFBs admitted to our hospital were scanned with multislice CT（MSCT） between July and December 2003. All scanning was performed with a 16-row spiral CT in axial plane using a sequential scanning protocol. During the scanning, the eyeball of the patient was kept stable and was not allowed to rotate internally or externally. Section collimation was set at 16 mm × 0.75 mm. Table feed was 12 mm. Reconstruction index was 0.75 mm. After scanning, the reconstructed images were loaded into a workstation to create the multiplanar reconstruction images with the aid of the 3D software. We compared the localization results with the operative findings. Multiplanar reconstruction images showed IOFBs in all 22 patients. IOFBs occurred in the eyeball of 14 patients, in the wall of the eyeball of 5 patients and in the posterior orbits of 3 patients. Different surgical procedures were designed according to the localization by this new method and all IOFBs were successfully removed. All of these foreign bodies were metallic and the localization of IOFB using MSCT was consistent with that found by operative findings. It was suggested that MSCT is a simple and effective imaging modality for the localization of IOFBs. In our study, we localized the IOFBs more quickly and accurately by taking advantage of the fixed position of the intraocular segment of the optic nerve, and determined the necessary surgical parameters.