Foreign bodies in the rectum and colon]

On the basis of analysis of treatment of 80 patients with foreign bodies of the rectum and colon, the volume and character of the therapeutic measures required were defined. The endoscopic methods for removal of the foreign bodies, peculiarities of extraction of the large foreign bodies are presented. The cases of penetration of the foreign bodies into the colon via a natural, or artificial intestinal fistula are described.     

Removal of foreign bodies from the superior vena cava and right atrium without thoractomy

Foreign bodies lost in the circulation and producing embolism in the heart are a recognized source of morbidity and mortality. Two patients are discussed in whom transjugular removal of intravenous catheter fragments with endoscopic foreign body forceps was accomplished under local anesthesia and fluoroscopic control. The technique is easy, safe, and reliable, and it avoids thoracotomy and atriotomy for this iatrogenic complication.     

A Broken Fruit Knife: Half in the Bronchus and Half in the Duodenum

Foreign bodies in the airway, as well as those in the upper gastrointestinal tract, are life-threatening conditions and require prompt intervention. We report on a 44-year-old male patient who presented with 4 days of intermittent cough. A computed tomography was performed showing two metallic foreign bodies located in the right main bronchus and the duodenum. The knife blade was successfully removed by upper gastrointestinal endoscopy. However, the broken end of the blade was incarcerated in the right main bronchus and was removed via thoracotomy after the failure of endoscopic treatment. Endoscopy, such as flexible/rigid bronchoscopy or gastroscopy, is the first choice for removing foreign bodies for its minimal invasiveness. Nevertheless, removal of foreign bodies might be technically difficult when incarcerated, and surgical treatment is indicated after unsuccessful endoscopic treatment.     

The diagnostics and treatment of the foreign bodies of the gastrointestinal tract

We have analyzed the results of treatment of 542 patients with the foreign bodies of the gastrointestinal tract. 359 of patients were hospitalized. All patients were somatically healthy. The majority of the foreign bodies (502 (92.6%)) were radio-opaque. 423 (78%) patients had swallowed single foreign body, the rest demonstrated multiple substunses. In 285 (52.6%) cases the foreign bodies left the organism naturally within 7 days. 230 (24%) cases required the endoscopic removal. The surgical removal of the foreign body was performed in 25 (4.6%) cases.     

复杂食管异物的诊治(附64例报告)

目的总结复杂食管异物的诊治经验. 方法回顾性分析我院1994年1月～2004年7月64例复杂食管异物的临床资料,分析异物种类和停留部位. 结果动物骨类异物占50.0%(32/64),义齿占20.3%(13/64),枣核占14.1%(9/64),其它异物占15.6%(10/64).异物停留在第一、二、三狭窄区分别占68.7%(44/64)、26.6%(17/64)、1.6%(1/64),2例(2/64,3.1%)停留在食管癌术后吻合口上方.与50岁以下患者相比,50岁以上患者义齿类异物及第二狭窄区异物比例增高,分别为30.0%(9/30)与43.3%(13/30),差异有显著性(P<0.05);59例经内镜取出异物治愈,3例颈侧切开治愈,2例转院治疗.食管穿孔6例,4例由食管异物本身造成,2例取异物时手术所致;5例异物取出经保守治愈,1例异物未取出转院治疗. 结论详细询问病史,了解异物种类、停留部位和对周围组织损伤的程度,选择适当麻醉、内镜与操作手法,对安全取出异物以及预防并发症极为重要.     

Endoscopic removal of an ingested foreign body--indications and choice of procedure

The majority of ingested foreign bodies does not cause problems for the patients and leaves the gastrointestinal tract spontaneously without complications. However the low risk of modern fiberendoscopy allows a safe approach of endoscopic extraction. In children and all other cases, where general anesthesia is required for the extraction procedure, indication for endoscopic extraction should be limited. From 1980-1986 we followed a concept, which differentiated for emergency, early-elective or elective extraction, depending on localisation and nature of the foreign bodies as well as the necessity for general anesthesia. In 88 endoscopic extractions (22 emergency, 66 elective) no complications were observed.     

Use of Holmium:YAG laser to facilitate removal of intravesical foreign bodies

BACKGROUND AND PURPOSE: Foreign bodies in the bladder present a challenge to the urologist. Previously, endoscopic extraction, with or without perineal urethrotomy, or open cystotomy were the only treatment choices. We describe a novel use of the Ho:YAG laser for the removal of intravesical foreign bodies. We further tested the laser on objects that have been reported in the literature to necessitate open cystotomy to determine their suitability for endoscopic removal. MATERIALS AND METHODS: The Ho:YAG laser is introduced through the cystoscope and used to cut large foreign bodies into a size that can be extracted through the urethra. We tested the Ho:YAG laser ex vivo on other objects that have been reported as intravesical foreign bodies. RESULTS: We removed a large complex foreign body with the laser that would otherwise have necessitated open cystotomy. No injury or sequela was observed. Many commonly reported intravesical foreign objects seem amenable to similar treatment. CONCLUSION: The Ho:YAG laser should be considered for use to facilitate removal of foreign bodies from the bladder.     

Foreign bodies in the female urinary bladder: 20-year experience in Ramathibodi Hospital

OBJECTIVE: Foreign bodies in the female urinary bladder may occur by self-insertion or migration from adjacent organs. The most common reason for this is sexual in nature, but hygienic behaviour and attempts to relieve voiding problems have been reported. Only small case series were found in the literature devoted to foreign bodies in the urinary bladder. Therefore, we reviewed our experience regarding foreign bodies in the female urinary bladder in our hospital. METHODS: Medical records of female patients who were diagnosed with a foreign body in the urinary bladder during 1985-2005 were reviewed. Demographics, causes, type of object found, clinical presentation, treatment and outcomes were noted. RESULTS: Seventy-eight patients with a mean age of 38 years were identified. The major route for ingress of foreign bodies was via the urethra. The objects found self-inserted were cotton swabs, tampons, paper clips and pen casings. As most of Thailand is an agricultural environment, some small living organisms such as leeches could be found as foreign bodies in the bladder. The majority of the cases presented with haematuria associated with frequency, urgency and pelvic pain. Almost all cases could be managed by endoscopic removal with minimal complications. Four cases were treated by open surgery. CONCLUSION: Foreign bodies in the urinary bladder represent a urological challenge that requires prompt management. The suspected history and presenting symptoms are crucial and lead to further investigations. Gentle endoscopic management is the main treatment with a high success rate.     

Clinical diagnosis and treatment of intraorbital wooden foreign bodies

Purpose: The intraorbital wooden foreign body is often misdiagnosed or missed on computed tomography (CT) scan, due to the invisible or unclear images. The residual foreign bodies often occur during surgical removal. The clinical manifestations, imaging features and treatment of intraorbital wooden foreign bodies were discussed in this study. Method: We retrospectively analyzed 14 cases of intraorbital wooden foreign bodies managed at our hospital between January 2007 and May 2015. All patients underwent orbital CT examination before surgery, and surgery was performed under general anesthesia with orbital wound debridement and suture, as well as exploration and removal of wooden foreign bodies. Results: At first, 11 cases underwent removal of foreign bodies, including 1 case with incomplete removal and then receiving a secondary surgery. Foreign bodies were not found in three cases with preoperative misdiagnosis and orbital MRI found residual foreign bodies in the orbit. Operations were performed via primary wound approach in eight cases, conjunctival approach in two cases, and anterior orbitotomy in four cases. Postoperatively, one case was complicated with eye injuries, three cases with ocular muscle injuries, eight cases with visual loss, and eight cases with orbital abscess. The length of foreign bodies ranged from 1.8 cm to 11.0 cm. The maximum of four foreign bodies were removed at the same time. Conclusion: Because the imaging of orbital wooden foreign bodies is complex and varied, MRI should be combined when they are invisible on CT scan. At the same time injuries trajectory and clinical manifestations of patients should be taken into account. Surgical exploration should be extensive and thorough, and foreign bodies and orbital abscess must be cleared.     

上尿路医源性异物的腔内处理

目的：探讨使用腔内技术处理上尿路异物的有效性与安全性。方法：采用逆行输尿管镜术或结合微创经皮肾技术共处理28例上尿路医源性异物，均为放置双J管引起，其中双J管石垢形成12例，双J管远端上移8例，拔管困难3例，双J管断端残留于肾内5例。结果：21例采用逆行输尿管镜术取出异物，7例结合微创经皮肾技术处理成功，手术成功率100％。随访4～21个月，平均7个月，无手术相关并发症发生。结论：腔内技术处理上尿路异物安全、有效，对患者的创伤小。     

Colonoscopic extraction of foreign bodies from above the rectum

There has been a considerable amount of experience with removal of rectal foreign bodies inserted transanally. Until recently removal of objects above the rectosigmoid junction has required laparotomy. A literature review reveals that since 1975 there have been 29 cases of colonoscopic removal of a variety of objects reported in fourteen publications. The authors have had experience with three cases of retained colonic foreign bodies (greater than 7 days) extracted using the colonoscope. All patients received preprocedure antibiotics and bowel preparation from below. All objects were removed using either the Olympus CF LB3R colonoscope or the Fujinon EVC-M videocolonoscope. The authors conclude that colonoscopic retrieval of foreign bodies is technically feasible, safe, less morbid, and less costly than laparotomy. This technique should be considered as the first step in management of these patients by endoscopic surgeons.     

Diagnosis, management and complications of oesophageal and airway foreign bodies

A five-year experience at the University of Ilorin Teaching Hospital with 52 patients with oesophageal foreign bodies, six patients with airway foreign bodies and two patients with both oesophageal and airway obstruction from foreign bodies is presented. Our use of jet anaesthetic ventilation for endoscopic removal of airway foreign bodies, clinical features and management problems of foreign body patients are also presented. Oesophageal diameters at six levels including those known conventionally as constrictions and dilatations were measured at autopsy in 40 foetuses and neonates constituting a randomized quarter of a larger series. Oesophageal diameters were found to be wider just below the cricopharyngeus muscle than at the bronchoaortic constriction or midway between this constriction and the cricopharyngeus. The conclusion is drawn that the frequent impaction of foreign bodies at the so-called superior oesophageal constriction has little or no anatomical basis referrable to oesophageal diameters as measured in the cadaver.     

Management of foreign body ingestion

Management of ingested foreign bodies (FB) is a common clinical problem. A 10-year experience of 101 foreign body ingestions is reported. The experience suggests that endoscopic removal of foreign bodies is curative for objects located in the cricopharynx or upper esophagus. Foreign bodies which pass into the stomach can be observed for development of symptoms, as 80% of FB which reach the stomach spontaneously pass. Only 12% of patients required operation, which was done without mortality.     

Foreign bodies of the rectum

During the 22 years period there were 26 patients (23 men and 3 women) aged from 18 to 71 with foreign bodies in the rectum introduced through the anal canal. The main causes of the appearance of foreign bodies in the rectum were anal masturbation (in 12 patients) and forced introduction of the objects by other people (in 10 patients). Among the foreign bodies prevailing were plastic and glass bottles, cucumbers and carrots, wooden and rubber objects in the from of the phallus. Typical were large sizes of the most objects introduced (the diametrical size more than 6 cm and the length more than 15 cm) which was responsible for the development of complications and made the removal difficult. The symptoms of the presence of foreign bodies in the rectum were determined as well as the optimum methods of diagnosis. A classification of rectal foreign bodies is proposed for the solution of medico-tactical tasks. The transcanal removal of the foreign bodies was fulfilled in 23 patients. The standardized technique of the transcanal removal of the objects is thought by the authors to include 10 principal propositions. Open operative interventions (removal of the foreign body, suturing the rupture, drainage of the abdominal cavity or of the perirectal space, sigmostomy) were performed in 4 patients with penetrating injuries of the rectum wall. The results of the treatment including removal of all foreign bodies were good, without lethal outcomes.     

Surgical policy in gastrointestinal tract foreign bodies]

66 patients (45 males and 21 females) who have swallowed 157 foreign bodies (fragments of wire, nails, needles, hafts of spoons, et were treated). If the objects were located in the stomach and the duodenum in the absence of complications endoscopic method of treatment was preferable, with the help of which 31 objects were successfully removed and the terms of treatment were significantly decreased. Conservative treatment (diet rich in fiber and protective substances, barium sulfate administration) resulted in elimination of 58 objects by vias naturals, 53 from which were not more that 8 cm long. Evacuation of the foreign bodies was carried out only during the first 3 weeks after the swallowing. Operative treatment was carried out in 21 patients, in whom 68 foreign bodies were extracted. An urgent operation in the first 6 hours in complications due to foreign bodies (perforation, incarceration, gastrointestinal bleeding) was carried out in 13 patients. An urgent operation in terms from 6 to 24 hours of hospitalization was carried out in 6 patients with large (more that 8 cm) swallowed objects, conglomerates and bunches of foreign bodies. Early removal of these objects prevented development of complications. Elective operation was carried out in failure of conservative treatment as was in 2 patients. No lethality was registered.     

Sequelae of foreign bodies in the wrist and hand

Background

Penetrating injuries to the hand are a common occurrence in the emergency room, and embedment of foreign bodies is suspected in many of these cases. The existing literature offers little information on retained foreign bodies. The aim of this study was to identify characteristics, determine prevalence, and observe outcomes for retained foreign bodies in the wrist and hand.

Methods

Four hundred thirty-seven consecutive hand and wrist radiographs in 437 patients from the emergency department of a level 1 trauma center were reviewed for the presence of retained foreign bodies. Location, size, number, and type of foreign body were recorded. Patient demographics, mechanism of injury, associated injuries, and treatment were obtained from medical records. All subsequent hospital and outpatient encounters were reviewed. Follow-up period was 18 months (range, 1–40).

Results

Of 437 cases, 65 patients (15 %) had at least one retained foreign body. Nineteen patients underwent removal of foreign body at initial presentation. The average size of foreign bodies removed was 6 mm, compared to 3 mm for those retained. Of 46 patients where the foreign body was left in situ, two (4 %) developed symptoms directly related to the retained foreign body. One of these patients underwent removal.

Conclusions

This study supports the safe removal of foreign bodies which are easily accessible or when part of a broader procedure to repair injured structures. Otherwise, we advocate expectant management for all other patients, as the likelihood of persistent symptoms is low and only 2 % of retained foreign bodies required removal later.     

Foreign bodies in the gastrointestinal tract

The authors describe their experience of surgical treatment of 133 patients with foreign bodies in the gastro-intestinal tract under conditions of an urgent twenty-four-hour clinic. A careful clinico-rentgenological and endoscopic examination of patients with foreign bodies in the gastro-intestinal tract in the dynamics of surgical treatment give good results. Special attention was given to the treatment methods (active or actively expecting) of patients with such pathology.     

儿童和青少年误吞磁性异物致消化道损伤的文献分析

目的研究儿童误吞磁性异物致消化道损伤的诊断及处理措施。方法通过Google、Medline、ISIWebofKnowledge、0vid、万方、维普、CNKI、学位论文、会议论文数据库及申请文献传递等方式收集1987年6月至2010年4月国内外所有以英文、中文、日文和韩文发表的关于误吞磁性异物而导致相应消化道并发症的文献。研究内容包括发病年龄、性别、国家和地区分布、磁性异物的数量、磁性异物来源、临床表现、诊断及取除异物的方法等。结果共收集了来自17个国家和地区的98例吞咽磁性异物病例。其中18岁以下未成年人94例．5岁以下儿童占62．2％（61／98）．高发年龄为3岁（16．3％,16／98）。所吞咽的磁性异物来源玩具73例（74．5％）,医疗仪器8例（8．2％）,饰品4例（4．1％）,其他13例（6．2％）：异物数量2-100枚．其中11例（11．2％）伴有异食癖或孤癖症等精神症状。所有病例均存在不同程度延误诊治的情况．其中1例因严重感染而死亡。开腹探查发现．消化道损伤包括从食管至结肠不同部位的穿孔和肠瘘,其中小肠损伤占51．0％,其次是小肠．结肠瘘占15．3％。除2例患儿急诊经内镜取除异物外．其余患儿行肠切除吻合术和肠瘘修补术。结论2枚以上的磁性异物会导致严重消化道损伤．需要早期明确诊断并手术治疗。对5岁以下儿童需要更多的预防措施。     

Foreign body aspiration in children. The advantages of emergency endoscopy and foreign body removal

In the last 15 years, 124 children with a history and clinical signs of aspiration have been managed by emergency rigid endoscopy under general anesthesia. In 115 (93%) of them a foreign body could be identified, which was successfully removed by forceps extraction in 114. Only 1 patient required a thoracotomy for removal of a distally located aspirated needle. The remaining 9 patients (7%) had a typical history and clinical signs of an aspiration, but no aspirated foreign body was found on endoscopy. Most of the children (102, or 82%) were admitted within 12 h after aspiration, while 22 (18%) had a history of foreign body aspiration between 2 days and 5 weeks before. Complications occurred in only 3% (3 children) of the 102 who underwent endoscopy within 12 h as against 50% (11 patients) of the 22 children in whom this was delayed. In all cases of foreign body aspiration and endoscopical removal within 12 h, the patients were discharged after a plain chest X-ray the following day. In children with chronic endotracheal foreign bodies, in 80% a second endoscopy after 48 h was indicated, and the mean stay in hospital was extended to 7 days. Emergency rigid tracheobronchoscopy and forceps removal of aspirated foreign bodies under general anesthesia and with meticulous perioperative monitoring is a safe and effective procedure with no mortality. Even in suspected aspiration or chronic bronchopulmonary infections, liberal use of endoscopy is recommended.     

Foreign bodies in the gastro-intestinal tract.

Between 1971 and 1990, 70 patients with foreign bodies in the gastro-intestinal tract were admitted to our service. There were 35 children and 35 adults. Foreign bodies were found in the pharynx and the oesophagus in 22 patients, with 1 perforation; and in the stomach and intestines in 27, with 14 perforations. Fifteen foreign bodies were swallowed and defecated, 6 were inserted into the rectum. Coins were found in 8 patients, toys in 3, pins and needles in 6, chicken bones and fish bones in 15, and toothpicks, shaving blades, cutlery, dentures, plastic bag containing cocaine, parts of a foam rubber mattress and other items in the remainder. Foreign bodies retained in the oesophagus must be removed promptly lest obstruction and perforation occur. Many foreign bodies that have passed the oesophagus progress uneventfully to defaecation. Others become retained and should be removed. If retained in the stomach, endoscopic removal may be attempted before resorting to a laparotomy. Perforation is an urgent indication for operation. Those patients inclined to swallow foreign bodies intentionally and those who insert items into the rectum should undergo psychiatric evaluation.