Bronchoscopy and tracheotomy removal of bronchial foreign body

On rare occasions, endoscopic extraction of airway foreign bodies is not feasible or may be associated with large risk for the patient; in those situations, open surgery is indicated. The authors report a case of an 8-year-old boy presenting with an airway foreign body that was too large to be extracted through the subglottic region. After several attempts, extraction was accomplished through a tracheotomy with bronchoscopic control. After removal, the cervical opening was closed. Since the tracheal suture was firm and without air leaks, a tracheostomy cannula was not placed. The tracheal tube was removed after 3 days. Follow-up 1 month after the procedure showed that all respiratory symptoms had disappeared. J Pediatr Surg 37:1239-1240.     

Outcomes of children after bronchial foreign body inhalation

Bronchial foreign body inhalation is a frequent and potentially serious accident in children. It can provoke long-term complications such as bronchiectasis. These complications occur especially if the delay between inhalation and extraction is long (above 7 days) and in case of vegetal foreign body. To decrease the risk of complications, one must emphasize the importance of early diagnosis and the potential role of fiberoptic bronchoscopy to help the diagnosis in case of suspected inhalation without clinical or radiological signs. Rigid bronchoscopy is the only procedure that allows diagnosis and removal of the foreign body.     

Spontaneous expulsion of a bullet via the urethra

The rare clinical occurrence of the spontaneous passage of bullet which was not found during an operation after a gunshot wound to the bladder in a 28-year-old man is described.     

Spontaneous expulsion of intravesical bullet

The first reported case of spontaneous explusion per urethra of an intravesical bullet which initially entered through the left flank is presented. Recognition of the true location of the missile might have been facilitated had lateral and/or oblique films been obtained under emergency conditions. as advocated by the authors.     

Dislodgement of bronchial foreign body during retrieval in children

Foreign body aspiration is a leading cause of death in children aged less than 1 year. The removal of a foreign body poses a great challenge to the skill of the anaesthetist. Four cases are presented, analysing the part played by modes of respiration in the dislodgement of a bronchial foreign body during its retrieval.     

Laser-assisted removal of a foreign body in the bronchial system of an infant

Background and Objective: Foreign body aspiration is an important cause of acute respiratory distress in children. Removal by use of rigid tracheo-bronchoscopy under general anesthesia is usually the treatment of choice, but this technique is sometimes unsuccessful. Thoracotomy in these instances often cannot be avoided. Study Design/Patients and Methods: Case report with review of the literature. The patient was 19 months old with an aspirated foreign body. A Neodym:YAG laser with a special small-size delivery system was inserted into the rigid “baby” bronchoscope. The NeodymiumrYAG laser with a wavelength of 1,064 nm and a Helium-Neon 630 nm light guide provided an aiming beam to weaken and cut the aspirated chicken bone. Results: The foreign body could be easily removed with a regular biopsy forceps. Conclusion: We discuss a patient in whom laser-assisted rigid tracheobronchoscopy obviated the need for thoracotomy. © 1995 Wiley-Liss, Inc.     

Severe bronchial synechia after removal of a long-standing bronchial foreign body: a case report to support control bronchoscopy

The authors report the case of a child who had severe bronchial synechia of the left main bronchus after removal of a pistachio shell embedded in granulation tissue. Histology finding of the removed granulation tissue at initial bronchoscopy showed an Actinomyces bacterial invasion. It was decided not to treat this local contamination and to perform a control bronchoscopy to verify the disappearance of local bacterial invasion. The control bonchoscopy performed 4 weeks after the foreign body (FB) removal disclosed a large central left main bronchus synechia producing a 70% reduction of the lumen, although the child had become asymptomatic except for a slight residual cough. The resection of the synechia restored a normal bronchial lumen. The performance of a systematic control bronchoscopy after removal of long standing FB is discussed and recommended.     

Laparoscopic removal of a pancreatic foreign body.

We present a case report of a laparoscopically retrieved foreign body that migrated into the pancreas. The patient is a 44-year-old man who presented with epigastric pain and was subsequently found by computed tomographic scan to have a foreign body in the head of the pancreas. After attempted endoscopic retrieval, we successfully removed the foreign body laparoscopically, thus avoiding laparotomy. Laparoscopy is an effective tool for pancreatic exploration.     

Spontaneous expulsion of large vesicle calculi in a woman with paraparesis

INTRODUCTION: Urolithiasis is a common but preventable complication of Spinal Cord Disorders (SCD). CASE REPORT: We report a 25-year-old woman with paraparesis who spontaneously passed two large calculi perurethra without pain and developed urethral scarring. Detrusor hyperreflexia, absence of sensations and lack of sphincter tone could have contributed to painless expulsion of the large calculi in this patient. CONCLUSION: Dysuria, a prominent symptom of urolithiasis may not be present in subjects with SCD. Awareness about urolithiasis among health professionals involved in the care of SCD patients is necessary for prevention and early intervention.     

Tracheobronchial foreign body aspiration: a continuing challenge.

OBJECTIVE: The aim was to present the features and outcomes for 140 cases of foreign body aspiration and to discuss specific problems and new management recommendations. STUDY DESIGN AND SETTING: Records were retrospectively reviewed and the following data were recorded for each patient: age, sex, symptoms, duration of symptoms, findings on physical examination and chest radiography, location and type of foreign body, complications related to aspiration itself or to extraction, and outcome. RESULTS: Seventy-eight (55.7%) patients presented within 24 hours of aspiration. The most common symptoms and findings were cough, dyspnea-stridor, decreased breath sounds, radiopaque foreign body, air trapping, and atelectasis. All 140 patients underwent rigid bronchoscopy, and 110 had the foreign material extracted via the scope. No foreign body was detected bronchoscopically in 25 cases. In the other 5 cases, the material was visualized but could not be removed via the scope, and 3 of these patients required thoracotomy for removal. Eleven patients developed morbidity after bronchoscopy. CONCLUSIONS: History suggestive of foreign body aspiration is a definite indication for bronchoscopy, and bronchoscopic extraction should only be performed by experts. Each case tends to present different challenges, and endotracheal intubation and tracheotomy may be required.     

Lung cancer with bronchial stenosis due to foreign body and Entoameba gingivalis infection

Oral cavity infection by protozoarian agents may lead to pathologies such as stomatitis and gengivitis. An higher incidence has been reported in immunocompromised patients and in patients with dental disorders. Entoameba gingivalis localizes into oral cavity and in particular into interstitial and interdental spaces. Infection propagation to bronchial or lung parenchyma represents a complication. In this report the Authors, starting from a recently treated case, discuss on the incidence, complications and surgical management of lung infection by Entoameba gingivalis.     

Spontaneous expulsion of intact germinative membrane of liver hydatid cyst in a child

A 10-year-old girl presented with an acute abdomen because of spontaneous rupture of a liver hydatid cyst (HC) and associated pelvic cystic mass. The pelvic cyst was found to be an intact germinative membrane of the ruptured HC of the liver at operation. This is the first pediatric case presenting with expulsion of an intact germinative membrane of a spontaneously ruptured HC. Intact germinative membrane should be included in the differential diagnosis of intraabdominal and pelvic cystic masses in children. The liver should be evaluated for ruptured cyst, and the lungs should also be evaluated to detect accompanying pulmonary hydatid disease (HD) especially in children living in countries in which the HD is endemic.