Hepatic Abscess That Formed Secondary to Fish Bone and Had a Fistula With the Ascending Colon

We present the case of a liver abscess that formed secondary to foreign bodies and formed a fistula the ascending colon and was successfully treated with percutaneous abscess drainage and colonoscopic removal of foreign bodies. A 64-year-old man presented with right upper and lower quadrant pain of 2 weeks' duration. Abdominal computed tomography was performed, demonstrating a single 3.5×1.9-cm abscess of the liver's right lobe and eccentric thickening of the colon wall at hepatic flexure. A percutaneous hepatic drainage catheter was placed under ultrasound guidance. Colonoscopic examination revealed multiple diverticula of the ascending colon and two 1.5-cm long fish bones at the ascending colon near the hepatic flexure. One end of each fish bone had impacted the edematous colonic mucosa and was surrounded by exudate polypoid inflammatory tissue. The fish bones were extracted with forceps. The patient was feeling well and was discharged after 12 days of treatment.     

Management of Retained Colorectal Foreign Bodies: Predictors of Operative Intervention

PURPOSE This study was designed to review experience at our hospital with retained colorectal foreign bodies.METHODS We reviewed the consultation records at Los Angeles County + University of Southern California General Hospital from October 1993 through October 2002. Ninety-three cases of transanally introduced, retained foreign bodies were identified in 87 patients. Data collected included patient demographics, extraction method, location, size and type of foreign body, and postextraction course.RESULTS Of 93 cases reviewed, there were 87 individuals who presented with first-time episodes of having a retained colorectal foreign body. For these patients, bedside extraction was successful in 74 percent. Ultimately, 23 patients were taken to the operating room for removal of their foreign body. In total, 17 examinations under anesthesia and 8 laparotomies were performed (2 patients initially underwent an anesthetized examination before laparotomy). In the eight patients who underwent exploratory laparotomy, only one had successful delivery of the foreign object into the rectum for transanal extraction. The remainder required repair of perforated bowel or retrieval of the foreign body via a colotomy. In our review, a majority of cases had objects retained within the rectum; the rest were located in the sigmoid colon. Fifty-five percent of patients (6/11) presenting with a foreign body in the sigmoid colon required operative intervention vs. 24 percent of patients (17/70) with objects in their rectum (P = 0.04).CONCLUSIONS This is the largest single institution series of retained colorectal foreign bodies. Although foreign objects located in the sigmoid colon can be retrieved at the bedside, these cases are more likely to require operative intervention.Reprints are not available.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, New Orleans, Louisiana, June 21 to 26, 2003Poster presentation at the Digestive Diseases Week, Orlando, Florida, May 17 to 22, 2003.     

Management of Ingested Foreign Bodies within the Appendix: A Case Report with Review of the Literature

A case is reported of an elective appendectomy in a patient with known ingestion of a sharp foreign body. The metal drill bit was ingested unintentionally 3 months before presentation at our institution. Plain abdominal films demonstrated the foreign body in the right lower abdominal quadrant. Because the gold dental drill bit was sharp and thought to be lodged in the terminal ileum or cecum, an attempt was made to remove the object during colonoscopy. This attempt was unsuccessful because no drill bit could be detected in the colon or terminal ileum. A laparoscopic exploration was performed, and the foreign body was found to lie in the appendix, after bowel manipulation under fluoroscopic guidance and with direct laparoscopic visualization. A laparoscopic assisted appendectomy was performed. On pathologic examination the drill bit was embedded in the tip of the appendix with signs of intramucosal acute inflammation.
Management and indication for surgery of foreign bodies in the appendix are discussed, and we review the related literature. This is the second reported case of a dental drill bit in the appendix causing appendicitis.     

Removal of a foreign body from the distal colon using a combined laparoscopic and endoanal approach

PURPOSE: We describe the case of a of 53-year-old homosexual male, from whom a cigar container (22 cm in length and 3.5 cm in diameter), which was introduced into the rectum and migrated upwards to the distal colon, was successfully extracted by combining laparoscopic and anal approaches. METHODS: The foreign body was mobilized laparoscopically, pushed down the rectum, and then extracted transanally with the aid of a dilator anoscope. CONCLUSIONS: Combining the laparoscopic and anal approaches in selected cases of colorectal foreign bodies is useful.     

Intracolonic multiple pebbles in young adults： Radiographic imaging and conventional approach to a case

INTRODUCTION The frequency of foreign body detection in gastrointes- tinal system is less in adulthood compared to childhood. Accidentally swallowed pins account for most of the for- eign bodies found in adult gastrointestinal systems. Oral dental implant…     

Impacted foreign body in the sigmoid colon presenting as recurrent diverticulitis

We report on a patient with left-sided abdominal pain thought to be caused by recurring diverticulitis. Computed tomography of the sigmoid colon revealed diverticulosis without the presence of a foreign body. During colonoscopy, a phytobezoar in the form of a vegetable stem was discovered transversely impacted within two diverticular openings in the lumen of the sigmoid colon. A localized inflammatory reaction was present without obstruction or perforation. After endoscopic removal of the phytobezoar, the abdominal pain resolved. The patient’s presumed diverticulitis was an inflammatory reaction caused by the phytobezoar. This case highlights the importance of early detection and endoscopic removal of a colonic foreign body to prevent abscess formation, fistulas, obstruction, perforation, or peritonitis. Foreign bodies masquerading as colonic diverticulitis should be considered in the absence of more common diseases.     

Endoscopic management of foreign bodies in the upper-GI tract: experience with 1088 cases in China

BACKGROUND: Reports on endoscopic management of ingested foreign bodies of the upper-GI tract in China are scarce. OBJECTIVE: To report our experience and outcome in the management of ingestion of foreign bodies in Chinese patients. SETTING AND PATIENTS: Between January 1980 and January 2005, a total of 1088 patients (685 men and 403 women; age range, 1 day to 96 years old) with suspected foreign bodies were admitted to our endoscopy center. INTERVENTIONS: All patients underwent endoscopic procedure after admission. MAIN OUTCOME MEASUREMENTS: Demographic and endoscopic data, including age, sex, and referral sources of patients, types, number and location of foreign bodies, associated upper-GI diseases, endoscopic methods, and accessory devices for removal of foreign bodies were collected and analyzed. RESULTS: A total of 1090 foreign bodies were found in 988 (90.8%) patients. The types of foreign bodies varied greatly: mainly food boluses, coins, fish bones, dental prostheses, or chicken bones. The foreign bodies were located in the pharynx (n = 12), the esophagus (n = 577), the stomach (n = 441), the duodenum (n = 50), and the surgical anastomosis (n = 10). The associated GI diseases (n = 88) included esophageal carcinoma (33.0%), stricture (23.9%), diverticulum (15.9%), postgastrectomy (11.4%), hiatal hernia (10.2%), and achalasia (5.7%). A rat-tooth forceps and a snare were the most frequently used accessory devices. The success rate for foreign-body removal was 94.1% (930/988). CONCLUSIONS: Ingestion of foreign bodies is a common clinic problem in China. Endoscopy procedures are frequently performed, and a high proportion of patients with foreign bodies require endoscopic intervention.     

Bronchoscopic removal of foreign bodies in adults: experience with 62 patients from 1974-1998.

The authors reviewed their experience with therapeutic bronchoscopy for removal of tracheobronchial foreign bodies in the adult. Bronchoscopy records and collection of foreign bodies in the endoscopic department were retrospectively examined. Among 37,466 bronchoscopies performed between 1974-1998, 62 (0.2%) were performed for the removal of tracheobronchial foreign bodies. Medical history was suggestive of foreign body aspiration in 33 patients and the chest radiograph was suggestive in 10 patients. The procedure was performed with the flexible bronchoscope in 42 patients (68%), rigid bronchoscope in 4 (6%), and with both in 16 (26%) patients. Foreign bodies were found in the right bronchial tree on 42 occasions, in the left on 20 and in the trachea once. In 39 patients, inflammatory granulations were found around the foreign body. The origins of the foreign bodies included: bone fragments (n=31), vegetable (n=10), broncholith (n=8), a part of dental prosthesis (n=7), endodontic needle (n=2), a metallic (n=2), or plastic (n=1) particle, a tracheostomy tube (n=1) and a match (n=1). In one patient, 2 foreign bodies were found. The foreign bodies were successfully removed in all but 2 patients (3%). The most useful instruments for removal were alligator forceps and the wire basket. Foreign bodies in the tracheobronchial system are rare in adults. They can be successfully removed in the majority of patients under either flexible or rigid bronchoscopy.     

Foreign bodies in sigmoid colon diverticulosis

This review addresses the management of sigmoid colon diverticular disease associated with foreign bodies. In addition, two novel cases are presented. One case describes the management of diverticular bleeding secondary to a chicken bone and the other case reports retrieval of a retained EndoRings? Device. The review identified 40 relevant publications including 50 subjects. Foreign bodies within sigmoid diverticular disease may be associated with inflammation, perforation, abscess and fistula. In current practice, diagnosis is often achieved with CT scan. Patients with colonic perforation or fistula generally require colonic resection. Patients with inflammation may merit conservative management, including colonoscopic foreign body retrieval. Chicken bones, tooth picks, and biliary stents have been reported in patients with inflammation, perforation and fistula, whereas all published patients with fish bone related diverticulosis complications experienced inflammation. Treatment might be best guided by the consequences of the foreign body rather than the nature of the underlying retained object. Diverticular bleeding secondary to a chicken bone was diagnosed at CT angiography and treated with colonoscopic snare retrieval of the bone and clipping of the bleeding diverticulum. The EndoRings? Device was retrieved with a colonoscopic balloon.     

Percutaneous retrieval of intravascular foreign bodies: experience with 19 cases

From April 1994 to June 2002, 17 catheter fragments and two guidewires became intravascular foreign bodies during venous catheterization at our hospital. Retrievals of these 19 foreign bodies were performed percutaneously with loop snare techniques (10 cases), Dormia basket retrievers (eight cases) and grasping forceps (one case). The percutaneous retrieval procedures were successful in 18 of 19 cases. A broken Port-A catheter fragment anchored and entrapped in the vascular wall of the right brachiocephalic vein failed to be removed. No complication was noted during or after these percutaneous procedures. Our experience indicates that intravascular foreign bodies can be removed easily, safely, and successfully with currently available percutaneous methods. As a result, major surgical procedures can be avoided if interventional radiologists are familiar with a variety of techniques for the removal of the expanding spectrum of intravascular foreign bodies currently encountered.     

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.     

Foreign body in the tricuspid valve with valvular insufficiency and right-left shunt

We present the case of a 50-year old man who progressively developed tricuspid valve insufficiency with opening of a patent foramen ovale responsible for right-to-left shunt with polycythaemia. The tricuspid valve insufficiency was due to a foreign body, probably of surgical origin as suggested by its radiological image and by the patient's previous history. It would have been introduced, far away from the tricuspid valve (compound fracture of the wrist), several years previously. At surgery, we found the foreign body embedded in the valve system. As a possible mechanism for the mutilation, an undiagnosed endocarditis was suspected but could not be confirmed. Three cases tricuspid endocarditis (with foreign bodies in the right ventricle) and 3 cases of asymptomatic tricuspid valve foreign bodies have been published. Fifty-five cases of foreign bodies introduced peripherally and migrated into the heart, the pericardium and the pulmonary artery are reviewed.     

Presentation and management of nasal foreign bodies in a Chinese metro area

Nasal foreign bodies in children are common complaints encountered by pediatric otolaryngologists. We investigated clinical features, diagnosis, and treatment of nasal foreign bodies in children in a Chinese metro area.Six hundred sixty eight children with nasal foreign bodies presented to Shenzhen Children''s Hospital, diagnosed and treated by the authors were enrolled from January 2016 to October 2019, causes for medical consultation, age, sex, duration, types, locations, removal, and complications were recorded and analyzed.Nasal foreign bodies were common in children between 1 and 5 years of ages (96.8%). The right nasal cavity (61.4%) was the most common site for foreign body insertion (61.4%). Most of the children (89.4%) presented for a complaint of nasal discomfort or foreign body insertion themselves, or for foreign body impaction discovered by the caregivers. Most of the foreign bodies (85.0%) were discovered within 1 day. The most nasal foreign bodies were the whole toys and toy parts (34.1%). The majority of nasal foreign bodies (99.1%) located in the antero-inferior portion of the nasal cavities and could be removed with simple instruments. The occurrence of complications in nasal foreign bodies (10.2%) was not common.The present study objectively exhibited clinical features, diagnosis, and treatment of nasal foreign bodies in a Chinese metro area.     

多层螺旋CT联合支气管镜诊治老年患者支气管异物的临床分析

目的探讨多层螺旋CT联合支气管镜对老年患者支气管异物的诊治价值。方法回顾性分析28例老年患者支气管异物的临床表现、肺部CT影像表现、支气管镜下特征及治疗方法。结果主要临床表现为发热、咳嗽、咳脓痰、喘鸣、胸闷、咯血。常误诊为肺炎、肺癌、肺结核、支气管扩张等疾病,误诊时间1m～5年。17例肺部多层螺旋CT检查可见异物的直接表现,28例均经支气管镜成功钳出异物。23例镜下直接见到异物,2例异物被肉芽组织包埋,3例吸净脓性分泌物夹除脓苔后见到异物,3例经第2次气管镜检查取出异物,1例异物合并支气管肺癌。结论联合多层螺旋CT及支气管镜检查有助于老年患者支气管异物的诊治。     

10年气管、支气管异物诊治回顾性分析

目的探讨气管、支气管异物发生的人群特征、临床特点及支气管镜诊治经验。 方法以"异物"一词对唐都医院支气管镜报告系统中的镜下描述及结论部分进行检索，起止时间：2008年9月至2018年8月，对检索出的有效病例的一般资料、异物种类、诊疗方法、异物存在部位、病变特点进行回顾性分析。 结果共检索出有效病例171例；其中男性117例，女性55例，平均年龄50.8岁(7～84岁)；病史最短1 h，最长18年；仅35例有明确异物吸入病史，占20.47%；58.48%的异物发生在41～70岁人群；食物是最常见的气管、支气管异物种类，占本组病例的70.17%，包括干辣椒皮、骨头、坚果等，其次为各种工业制品及牙齿(主要为假牙)；84.21%的异物在局麻下使用支气管镜经口或经鼻腔取出；右肺下叶是异物最常发生的部位，占39.18%(67/171)，65.38%(34/52)的辣椒皮位于右肺下叶；常用的异物钳取工具为异物钳、活检钳和冷冻方式，分别占45.78%、25.9%和24.7%，仅17例患者使用2种或2种以上工具取出异物；本组60.82%的患者异物局部伴有明显的肉芽组织增生。 结论异物的发生与性别和年龄有关，且具有地域特色，症状往往不典型，易误诊；异物最易发生在右肺下叶，大多数异物可使用异物钳、活检钳或冷冻等单一工具取出，对复杂性异物需要联合支气管镜下其他治疗手段，肉芽组织增生是最常见的并发症；支气管镜检查是确诊和治疗气管及支气管异物最直接而有效的办法。     

Removal and management of esophageal foreign bodies

Esophageal foreign bodies and food bolus impaction occur frequently and are a common endoscopic emergency. Though the vast majority of gastrointestinal (GI) bodies do not result in serious clinical sequelae or mortality, it has been estimated that 1500-2750 patients die annually in the United States because of the ingestion of foreign bodies. More recent studies have suggested the mortality from GI foreign bodies to be significantly lower, with no deaths reported in over 850 adults and 1 death in approximately 2200 children with a GI foreign body. As a result of the frequency of this problem and the rare but possible negative consequences it is important to understand the best method for diagnosis, the patients in need of treatment, and the correct techniques for the management of GI foreign bodies. Flexible endoscopy has become the diagnostic and treatment method of choice for both esophageal food impaction and true esophageal foreign bodies because of high success rates and low complication rates. This review covers and focuses on the techniques needed to diagnose and effectively treat esophageal food impaction and true foreign bodies     

Removal of distal airway foreign body with the help of fluoroscopy in a child

Most foreign bodies are located in the central airways and can be reached and removed with either a flexible or rigid bronchoscope or a combination of the two methods. The removal of more distal foreign bodies can present a significant challenge. We describe a case of an 11‐year‐old child, who aspirated a sewing needle that lodged in a distal subsegment of the medial segment of the right lower lobe. As a result, it was visible only with the 2.8 mm flexible bronchoscope (FOB). Mono‐planar fluoroscopic guidance was useful for confirming the placement of the 2.8 mm bronchoscope and allowing for a biopsy forceps to grasp the needle and move it to a larger airway, where it could then be removed safely using a larger FOB. Removal of radiopaque foreign bodies in the distal airways is possible with the aid of fluoroscopy and a small bronchoscope. This report also highlights the risk of aspirating sharp objects when they are placed into the mouth, especially by children, and the dangers posed by sharp object foreign body aspiration.     

成人下呼吸道异物20例临床分析

目的总结及分析成人下呼吸道异物的临床特点,评价纤维支气管镜(纤支镜)对下呼吸道异物的诊治价值。方法回顾性分析本院近12年收治的成人下呼吸道异物患者的临床资料。结果其中男16例、女4例;年龄28～73岁;左侧2例,右18例。12例明确下呼吸道异物;8例误诊,误诊率40%。在常规纤支镜检查确定为异物后使用异物钳分别对20例患者下呼吸道的异物进行钳取,均获得成功,治愈率达100%,无1例出现并发症。结论部分患者因病史诉说不清,临床缺乏特异性,易误诊为其它呼吸系统疾病,纤支镜可作为对下呼吸道异物诊断和钳取的重要工具,具有重要价值。     

Extraction of hollow gastric foreign bodies by flexible upper endoscopy assisted by a through-the-scope balloon catheter for anchoring

BACKGROUND: Various methods have been used to remove foreign bodies; hollow foreign bodies deserve special consideration. The main difficulty encountered in such situations is the anatomic obstacle of the lower and upper esophageal sphincters along with a risk of perforation. OBJECTIVE: We describe a unique approach by using an esophageal balloon dilator to anchor a hollow foreign body onto an endoscope, which allows for the successful extraction of such objects with minimal risk. DESIGN: Case series. SETTING: Shands Jacksonville and University of Florida/Jacksonville, Jacksonville, Florida. PATIENTS: Two consecutive patients with hollow foreign bodies in the stomach that required removal. INTERVENTIONS: A combined approach by using an endoscope and a 20-mm by 8-cm esophageal balloon dilator to remove hollow foreign bodies from the stomach. MAIN OUTCOME MEASUREMENTS: Nonsurgical removal of hollow gastric foreign bodies. RESULTS: Both foreign bodies were successfully removed from the stomach and extracted by mouth with this technique. There were no complications after both procedures. CONCLUSIONS: The inflated esophageal balloon that anchors a hollow foreign body onto a flexible endoscopic technique is a safe and effective alternative to previously described methods for removal of such foreign bodies in the gastric cavity. This method may be applicable to the removal of other hollow objects within the gastric lumen.     

Esophageal foreign bodies causing obstructive sleep apnea in a patient with Sturge-Weber syndrome

We report the case of a severely mentally handicapped 30-year-old woman with Sturge-Weber syndrome who developed obstructive sleep apnea syndrome (OSA) following esophageal aspiration of two foreign bodies, which were discovered incidentally during a neck CT scan. Initial polysomnography findings revealed significant OSA with an apnea-hypopnea index (AHI) of 40.8 events per hour. Repeat polysomnography following endoscopic removal of the foreign bodies revealed marked improvement of her OSA with a decrease of AHI to 15.6 events per hour. Our report highlights the importance of considering foreign body aspiration as a cause for OSA in mentally handicapped patients.