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.

Nasal congestion caused by long-term retention of a nasal foreign body near the orbit:A case report

BACKGROUND Nasal trauma presents a risk of foreign body invasion into the nasal cavity.However,in the early treatment stage of nasal trauma,patients and doctors are not always aware of possible foreign body invasion,resulting in delayed detection.We describe the case of an adult patient admitted to the hospital due to left nasal congestion accompanied by yellow,purulent,and bloody discharge.CASE SUMMARY Consultation with the patient revealed a history of nasal trauma 30 years prior that did not receive thorough examinations and imaging during treatment,resulting in a glass fragment retained in the nasal cavity adjacent to the orbit.After admission,computerized tomography(CT)confirmed the presence of the foreign body in the patient’s left nasal–maxillary sinus.The nasal foreign body led to symptoms such as chronic sinusitis,nasal polyps,fungal infection,and deviated nasal septum.The foreign body was successfully removed by nasal endoscopy,polypectomy,sinus fungal removal,left middle turbinate conchoplasty,fenestration via the right inferior meatus,nasal endoscopic maxillary sinus cystectomy,and septolplasty.The operation was successful and without any complications.CONCLUSION CT scans should be performed in addition to necessary debridement sutures to avoid possible foreign body invasion during nasal trauma.Surgical planning should be tailored to the patient’s specific situation.The surgical method should be carefully selected,and sufficient preparation should be undertaken before the surgery to avoid possible displacement of the nasal foreign body.

Combined laparoscopic and endoscopic method for foreign body removal from descending colon: A case report

BACKGROUND The majority of published reports on foreign bodies(FBs)involve the rectum and applied a transanal retrieval.Usually,patients with FB above the rectum are subjected to laparotomy for removal.Here,we illustrate the case of a man with an FB that had migrated into the descending colon,and its successful removal via a laparoscopic approach.CASE SUMMARY A 43-year-old man,who had the habit of FB insertion into his anus to aid defe-cation,presented upon experience of such an FB slipping through and migrating upward to the distal colon.Plain abdominal radiograph revealed a bottle-shaped FB,positioned in the left iliac fossa region.The FB was successfully removed via a laparoscopic-assisted procedure in which we combined diagnostic laparoscopic and endoscopic techniques during surgery.The patient was monitored for 2 d postoperatively and subsequently discharged home.CONCLUSION A minimally invasive approach should be adopted to aid extraction of colorectal FB as it is effective and safe.

Surveilling Russell body Helicobacter pylori-negative gastritis: A case report and review of literature

BACKGROUND Russell body gastritis(RBG)is very rare type of chronic inflammation of gastric mucosa.The pathologic hallmark of the disease is Russell bodies(RB)which represent accumulation of eosinophilic cytoplasmic inclusions in endoplasmic reticulum of mature plasma cells(Mott cells).Most published cases are associated with Helicobacter pylori(H.pylori)infection because of correlation between plasma cell activation and antigenic stimulation.There are insufficient data about H.pylori-negative RBG and very little is known about the natural course of the disease.CASE SUMMARY A 51-year-old male patient underwent endoscopic screening for mild iron deficiency anemia.Gastroscopy revealed diffuse hyperemia,edema and nodularity of the fundic and corpus mucosa.Due to non-specific endoscopic findings and iron-deficiency anemia our preliminary diagnosis was diffuse type of gastric carcinoma or gastric lymphoma.Biopsy specimens of gastric mucosa showed inflammatory infiltrate rich in Mott cells,consisting entirely of cytoplasmic RB.Absence of nuclear atypia and mitosis of the plasma cells,polyclonal pattern of the Mott cells and negative staining for cytokeratins favored diagnosis of RBG.The patient was treated with proton-pump inhibitor for 8 wk.Long-term clinical and endoscopic surveillance was scheduled.Albeit,there was no improvement in endoscopic features of the gastric mucosa in three consecutive gastroscopies,histopathological findings demonstrated that the chronic inflammatory infiltrate in the fundic mucosa is less pronounced,rich in plasma cells,with almost absent RB and Mott cells.CONCLUSION The prognosis of this entity is uncertain,that is why these patients are subjects of continuous follow up.

Large carotid body tumor successfully resected in hybrid operating theatre: A case report

BACKGROUND Surgical treatment for large carotid body tumor (CBT),particularly the Shamblin III type,is challenging and rarely reported.CASE SUMMARY In July 2014,a 63-year-old woman presented to our hospital with a large CBT (130 mm × 60 mm × 70 mm).The lesion was hypervascular,spanned from the first to the seventh cervical vertebra,and adhered to the right common carotid artery (CCA),internal carotid artery (ICA) and external carotid artery (ECA).The resection was carried out in a hybrid operating theatre.First,we used Onyx gel to embolize the feeding artery.An ICA balloon was used to prevent gel entry into the ICA.After shrinkage and hardening of the CBT,we quickly resected the CBT as well as a part of the ECA that adhered to the CBT.A vascular shunt was inserted between CCA and ICA,and the part where the ICA was cut off from the CCA was directly sutured.A follow-up at four years later showed no neurological damage.CONCLUSION For large hypervascular CBT,embolization of the feeding artery prior to resection is helpful.The hybrid operating theatre is the ideal platform to carry out such operations.

Dynamic biomechanical effect of lower body positive pressure treadmill training for hemiplegic gait rehabilitation after stroke: A case report

BACKGROUND Lower body positive pressure(LBPP)treadmill has potential applications for improving the gait of patients after stroke,but the related mechanism remains unclear.CASE SUMMARY A 62-year-old male patient suffered from ischemic stroke with hemiplegic gait.He was referred to our hospital because of a complaint of left limb weakness for 2 years.The LBPP training was performed one session per day and six times per week for 2 wk.The dynamic plantar pressure analysis was taken every 2 d.Meanwhile,three-digital gait analysis and synchronous electromyography as well as clinical assessments were taken before and after LBPP intervention and at the 4-wk follow-up.During LBPP training,our patient not only improved his lower limb muscle strength and walking speed,but more importantly,the symmetry index of various biomechanical indicators improved.Moreover,the patient’s planter pressure transferring from the heel area to toe area among the LBPP training process and the symmetry of lower body biomechanical parameters improved.CONCLUSION In this study,we documented a dynamic improvement of gait performance in a stroke patient under LBPP training,which included lower limb muscle strength,walking speed,and symmetry of lower limb biomechanics.Our study provides some crucial clues about the potential dynamic mechanism for LBPP training on gait and balance improvement,which is related to rebuilding foot pressure distribution and remodeling symmetry of biomechanics of the lower limb.

Idiopathic tenosynovitis of the wrist with multiple rice bodies: A case report and review of literature

BACKGROUND Multiple rice bodies in the wrist is a rare disorder that requires surgery,and there are still many uncertainties regarding its diagnosis and treatment.CASE SUMMARY We described a rare case of chronic idiopathic tenosynovitis with rice bodies of the wrist in a 71-year-old man and reviewed similar topics in the literature.A total of 43 articles and 61 cases were included in the literature review.Our case had a usual presentation:it was similar to those in the literature.The affected population was mainly older adults,with an average age of 59.43(range,3 to 90)years.The male-to-female ratio was 1.54:1(37/24).Most of them showed limited swelling and pain,only 23.0%had carpal tunnel symptoms,and the average disease duration was 18.03(0.5-60)mo.Wrist flexor tendon sheath involvement was the most common(95.1%,58/61),and only 3 cases had extensor tendon sheath involvement.The main causes were tuberculosis(34.4%,21/61),nontuberculous mycobacteria(24.6%,15/61),idiopathic tenosynovitis(31.1%,19/61),and others(9.84%,6/61).There were 10 patients with recurrences;in 6 of them,were due to non-tuberculous mycobacterial infections.CONCLUSION We reported a case of wrist idiopathic tenosynovitis with rice body formation,and established a clinical management algorithm for wrist tenosynovitis with rice bodies,which can provide some reference for our clinical diagnosis and treatment.The symptoms of rice-body bursitis of the wrist are insidious,nonspecific,and difficult to identify.The aetiology is mainly idiopathic tenosynovitis and mycobacterial(tuberculosis or non-tuberculous)infections;the latter are difficult to treat and require long-duration systemic combination antibiotic therapies.Therefore,before a diagnosis of idiopathic tenosynovitis is made,we must exclude other causes,especially mycobacterial infections.

Postoperative secondary aggravation of obstructive sleep apneahypopnea syndrome and hypoxemia with bilateral carotid body tumor:A case report

BACKGROUND Carotid body tumor(CBT)is a chemoreceptor tumor located in the carotid body,accounting for approximately 0.22%of head and neck tumors.Surgery is the main treatment method for the disease.CASE SUMMARY We reviewed the diagnosis and treatment of one patient who had postoperative secondary aggravation of obstructive sleep apnea–hypopnea syndrome(OSAHS)and hypoxia after surgical resection of bilateral CBTs.This patient was admitted,and relevant laboratory and imaging examinations,and polysomnography(PSG)were performed.After the definitive diagnosis,continuous positive airway pressure(CPAP)treatment was given,which achieved good efficacy.CONCLUSION This case suggested that aggravation of OSAHS and hypoxemia is possibly caused by the postoperative complications after bilateral CBTs,and diagnosis by PSG and CPAP treatment are helpful for this patient.

Nasal septal foreign body as a complication of dental root canal therapy: A case report

BACKGROUND Currently,there have been no reports on foreign bodies found in the nasal septum after dental root canal therapy.Herein,we present an unusual case of a foreign body found in the nasal septum,which occurred after dental root canal therapy and two unsuccessful surgeries.CASE SUMMARY A 55-year-old man was referred to our department due to slight nasal discomfort that persisted for about 1 wk.Before consulting our department,the patient visited three different hospitals/clinics and underwent two surgeries that were not successful in removing a foreign body completely.A computed tomography scan was performed to detect the shift of the foreign body from dental root to the nasal septum,which resulted in the healing of oral inflammation and nasal septum discomfort.An endoscopic foreign body extraction surgery(3rd removal surgery)was then successfully performed,using a needle as the reference.No nasal reconstruction was required after the operation.Postoperative healing was uneventful.CONCLUSION Medical healthcare professionals should consider past medical history when dealing with foreign body cases.During septal foreign body extraction surgery,a needle could be used as a helpful reference.

Endoscopic extraction of a submucosal esophageal foreign body piercing into the thoracic aorta:A case report

BACKGROUND Aorto-esophageal injury is a rare but life-threatening complication of esophageal foreign bodies,which typically requires open surgery.The best way to treat patients with this condition remains unclear.To date,few reports have described an aortic wall directly penetrated by a sharp foreign body.Here,we present a rare case of a fishbone completely embedded in the esophageal muscularis propria and directly piercing the aorta,which was successfully treated by endoscopy and thoracic endovascular aortic repair(TEVAR).CASE SUMMARY We report the case of a 71-year-old man with a 1-d history of retrosternal pain after eating fish.No abnormal findings were observed by the emergency esophagoscopy.Computed tomography showed a fishbone that had completely pierced through the esophageal mucosa and into the aorta.The patient refused to undergo surgery for personal reasons and was discharged.Five days after the onset of illness,he was readmitted to our hospital.Endoscopy examination showed a nodule with a smooth surface in the middle of the esophagus.Endoscopic ultrasonography confirmed a fishbone under the nodule.After performing TEVAR,we incised the esophageal mucosa under an endoscope and successfully removed the fishbone.The patient has remained in good condition for 1 year.CONCLUSION Incising the esophageal wall under endoscope and extracting a foreign body after TEVAR may be a feasible option for cases such as ours.

Hepatocellular carcinoma effective stereotactic body radiotherapy using Gold Anchor and the Synchrony system:Two case reports and review of literature

BACKGROUND Radiotherapy for hepatocellular carcinoma(HCC)is considered to have limited efficacy because of treatment intensity considering that the irradiated area includes the liver,which is highly radiosensitive.In this report,we present two cases in which tumor control by surgical resection,radiofrequency ablation,transcatheter arterial chemoembolization(TACE),and lenvatinib administration was difficult,but stereotactic body radiotherapy(SBRT)using the Synchrony system by Radixact?and Gold Anchor?(GA)was effective.CASE SUMMARY A 60-year-old man had a single 10-cm HCC in the right lobe.Viable lesions remained after TACE,and levels of alpha-fetoprotein and protein induced by vitamin K antagonists II(PIVKA-II)decreased and quickly re-elevated.We performed SBRT with GA.Three weeks after implantation,localized radiotherapy(SBRT;40 Gy/5 fractions)was performed using the Synchrony system by Radixact?.Four weeks later,the viable lesion had disappeared,and the PIVKA-II levels decreased.A 77-year-old man had a single 12-cm HCC in the right lobe.The patient experienced recurrence after hepatectomy.Further recurrence occurred after TACE,and we performed SBRT with GA.Because of the proximity of the HCC to the gastrointestinal tract,localized radiotherapy(SBRT;39 Gy/13 fractions)to the HCC was performed 3 wk after implantation using the Synchrony system by Radixact?.Four weeks later,the viable lesion had disappeared on computed tomography,and the PIVKA-Ⅱlevels decreased.CONCLUSION SBRT using the Synchrony system and GA can deliver a large dose accurately and safely,and could have a high therapeutic effect.

Misdiagnosis of food-borne foreign bodies outside of the digestive tract on magnetic resonance imaging:Two case reports

BACKGROUND Patients with foreign bodies in the digestive tract are often encountered,but complete penetration of a foreign body through the gastrointestinal tract is rare,and the choice of imaging method is very important.Improper selection may lead to missed diagnosis or misdiagnosis.CASE SUMMARY An 81-year-old man was diagnosed as having a liver malignancy after he took magnetic resonance imaging and positron emission tomography/computed tomography(CT)examinations.The pain improved after the patient accepted gamma knife treatment.However,he was admitted to our hospital 2 mo later due to fever and abdominal pain.This time,he received a contrast-enhanced CT scan,which showed fish-boon-like foreign bodies in the liver with peripheral abscess formation,then he went to the superior hospital for surgery.It lasted for more than 2 mo from the onset of the disease to the surgical treatment.A 43-year-old woman with a 1 mo history of a perianal mass with no obvious pain or discomfort was diagnosed as having an anal fistula with the formation of a local small abscess cavity.Clinical perianal abscess surgery was performed,and fish bone foreign body was found in perianal soft tissue during the operation.CONCLUSION For patients with pain symptoms,the possibility of foreign body perforation should be considered.Magnetic resonance imaging is not comprehensive and that a plain computed tomography scan of the pain area is necessary.

Foreign body granuloma in the tongue differentiated from tongue cancer:A case report

BACKGROUND Embedded foreign bodies in the tongue are rarely seen in clinical settings.An untreated foreign body can cause a granuloma which often presents as an enlarged tongue mass.However,if foreign body ingestion status is unknown,physical examination and magnetic resonance imaging(MRI)tend to lead to suspicion of tongue cancer,especially in older patients.Thus,differential diagnosis of an enlarged tongue mass is important,especially because it is closely related to the choice of treatment method.CASE SUMMARY A 61-year-old woman was admitted to the hospital with pain and noticeable swelling in the tongue that had persisted for over 1 mo.She had no previous medical history.MRI revealed abnormal signal intensities that were indicative of a neoplasm.Thus,the oral surgeon and radiologist arrived at a primary diagnosis of tongue cancer.The patient visited the Ear Nose and Throat Department for further consultation and underwent an ultrasound examination of the tongue.The ultrasonography was consistent with a linear hyperechoic foreign body which was indicative of an embedded foreign body(bone)in the tongue,even though the patient denied any history of foreign body ingestion.Complete surgical enucleation of the lesion was conducted.The mass which included a fish bone was completely removed.The post-operative pathological examination confirmed that the mass was a granuloma containing collagen fibers,macrophages and chronic inflammatory cells.The patient recovered without complications over a 2 mo follow-up period.CONCLUSION We report a rare case of foreign body granuloma in the tongue that was primarily diagnosed as tongue cancer.The MRI and ultrasound examinations revealed a piece of bone in the left lateral aspect of the tongue.The granuloma,which contained a fish bone,was completely removed via surgery and confirmed via biopsy.Differential diagnosis of the enlarged tongue mass was critical to the selection of treatment method.

Hepatic abscess caused by esophageal foreign body misdiagnosed as cystadenocarcinoma by magnetic resonance imaging:A case report

BACKGROUND Foreign bodies stuck in the throat and esophagus can be discharged through the digestive tract.Esophageal-lodged foreign bodies can cause secondary injury or detrimental response,with hepatic abscess being one such,albeit rare,outcome.Review and discussion of the few case reports on such instances will help to improve the overall understanding of such conditions and aid in differential diagnosis to improve patient outcome.CASE SUMMARY A 51-year-old female patient with pre-existing diabetes visited our hospital following a 15-d experience of chills and fever.Both plain and enhanced magnetic resonance imaging and color Doppler ultrasound examination of the liver and gallbladder revealed a space-occupying lesion in the caudate lobe of the liver(7.8 cm×6.0 cm×5.0 cm).Initially,a malignant tumor was suspected,but differential diagnosis was unable to exclude the possibility of hepatic abscess.Conservative anti-infection therapy produced a less than ideal outcome.Additional examination by hepatobiliary imaging with computed tomography suggested a foreign body present in the upper abdomen and hepatic abscess,and subsequent endoscopy revealed a sinus tract in the anterior wall of the duodenal bulb.Therefore,surgery was performed to remove the object(fishbone)and drain the abscess.After a 2-wk uneventful recovery,the patient was discharged.The final diagnosis was foreign body-induced hepatic abscess of the caudate lobe.CONCLUSION Differential diagnosis is important for hepatic masses,and systematic examination and physician awareness can aid in diagnosing and curing such rare conditions.

Neck and mediastinal hematoma caused by a foreign body in the esophagus with diagnostic difficulties:A case report

BACKGROUND Esophageal foreign body(FB)is a common clinical emergency.Clinically,computed tomography(CT)scans are important in the diagnosis of FBs in the esophagus.Here,we report a case of esophageal perforation and cervical hematoma,caused by a FB,whose uniqueness made rapid diagnosis difficult.CASE SUMMARY A 42-year-old man was transferred to our hospital with esophageal perforation,which was accompanied by cervical and mediastinal hematoma.CT scans only revealed a black shadow,approximately 2.5 cm in diameter,in the upper esophagus.After multidisciplinary discussion,he was quickly subjected to mediastinal hematoma resection,peripheral nerve compression release,esophageal FB removal and esophagectomy.Eventually,we removed a small crab with a pointed tip from his esophagus.CONCLUSION This was an unusual case of occurrence of sharp polygonal esophageal FBs caused by a small crab.Rapid diagnosis of this FB was difficult,mainly due to its translucent nature.Occurrence of sharp FBs,with cavities that sometimes only appear as black shadows on CT scans,can easily be mistaken for esophageal lumens.More attention should be paid to such sharp polygonal FBs.

Wooden foreign body impalement through the right shoulder region–an unusual penetrating injury:A case report

BACKGROUND Impalement of the body is a rare injury and comes with varied presentation.There is no set classification or defined protocols for managing this injury.This case report aims to create awareness among trauma surgeons about unusual presentation and management of such case.CASE SUMMARY A 45-year-old man presented to the emergency department with a sharp penetrating wooden plank at right clavicular region between the neck and shoulder following a road traffic accident.The vehicle had crashed into a roadside wooden hut,thus causing an impalement injury.He was meticulously worked up and taken to emergency theatre.The wooden plank was removed and the wound healed uneventfully.Postoperatively,he had fairly good shoulder function and was able to return back to work successfully.CONCLUSION Each impalement injury brings in challenges in management as no two cases are the same.The varied presentation and risks involved should be known to medical professionals handling the emergency.Coordinated multidisciplinary team approach is needed for successful outcome.

Disappeared intralenticular foreign body:A case report

BACKGROUND Intralenticular foreign body is rarely encountered in ophthalmic practice.In most cases,subsequent traumatic cataract requires cataract surgery for visual rehabilitation.CASE SUMMARY A 35-year-old man was injured by iron filings in his left eye.After the injury,the patient tried to draw the object out by himself using a magnet;however,the foreign body(FB)was pushed to the equator of the lens.The FB was removed by a magnet through the anterior chamber accessed through the original capsular wound.Since most of the lens was transparent and only partially opaque after the operation,the lens was kept under close observation.After the surgery,the patient’s visual acuity reached 20/20 from 2/20,visual function recovered very well,and local opacity of the lens remained stable.CONCLUSION For intralenticular FB in the anterior cortex under the capsule,magnet may be a more advantageous way to remove the object.

Choroidal and ciliary body tubercle: a case report

Dear Editor,I am Bing Li from the Department of Ophthalmology,Peking Union Medical College Hospital in Beijing, China,and I write to present a case report of choroidal and ciliary body tubercles.Ocular tuberculosis (TB) is an extrapulmonary tuberculous condition with variable manifestations[1].

Unusual cervical foreign body-a neglected thermometer for 5 years:A case report

BACKGROUND Foreign body in the deep neck is mostly associated with accidental ingestion of the animal spiculate bone which penetrates the full-thickness of the aerodigestive tract into the fascial spaces of the neck.In general,perforation of the esophagus often results in periesophagitis and even fatal abscesses.The presence of a giant foreign body in the neck without obvious symptoms or complications for many years is rare.CASE SUMMARY We present the case of a 32-year-old man who intentionally swallowed a thermometer which was unable to be located by endoscopy at his initial visit.He had no remarkable symptoms for 5 years other than paresthesia and limited movement of the left neck until 7 d before this admission.The foreign body was removed successfully by the surgery.CONCLUSION The presence of a giant foreign body in the neck without obvious symptoms or complications for many years is rare.Both endoscopic and radiological examinations are essential for the diagnosis of alimentary foreign bodies.

Foreign body granulomas mimic peritoneal dissemination caused by incarcerated femoral hernia perforation:A case report

BACKGROUND Foreign body granuloma(FBG)is a well-known type of granulomatous formation,and intraabdominal FBG(IFBG)is primarily caused by surgical residues.Multifocal IFBGs caused by gastrointestinal perforation is an extremely rare and interesting clinicopathological condition that resembles peritoneal dissemination.Here,we present a case of IFBGs mimicking peritoneal dissemination caused by bowel perforation and describe the value of intraoperative pathological examinations for rapid IFBG diagnosis.CASE SUMMARY An 86-year-old woman with an incarcerated femoral hernia was admitted to the hospital and underwent operation.During the operation,the incarcerated ileum was perforated during repair due to hemorrhage necrosis,and a small volume of enteric fluid leaked from the perforation.The incarcerated ileum was resected,and the femoral hernia was repaired without mesh.Four months later,a second operation was performed for an umbilical incisional hernia.During the second operation,multiple small,white nodules were observed throughout the abdominal cavity,resembling peritoneal dissemination.The results of peritoneal washing cytology in Douglas’pouch and the examination of frozen nodule sections were compatible with IFBG diagnosis,and incisional hernia repair was performed.CONCLUSION IFBGs can mimic malignancy.Intraoperative pathological examinations and operation history are valuable for the rapid diagnosis to avoid excessive treatments.