Vesicorectal fistula due to pelvic foreign body: a case report

We report a case of vesicorectal fistula caused by a pelvic foreign body. An 84-year-old woman presented with urinary tract infection and bladder stone. During transurethral lithotripsy, a foreign body was observed in the stone. CT and colonoscopy revealed a vesicorectal fistula due to a foreign body. After continuous bladder washout over a period of one month, resection of the foreign body, fistulectomy, and sigmoidostomy were performed. The foreign body was suspected to be a medical mesh from a sling operation. After the surgery, the patient's course was uneventful. This is the second patient with vesicointestinal fistula due to a foreign body in the Japanese literature.     

Foreign body in the bladder: A case report

Foreign bodies are occasionally reported in the bladder. In most cases, the foreign body is removed via the transurethral approach. A 57-year-old male patient was referred to our hospital to undergo the retrieval of a foreign body from his bladder. However, the foreign body had become severely calcified and could not be removed transurethrally. Thus, an open bladder wall incision was necessary to remove it. We herein report a case of a foreign body in the bladder that had become calcified and which was successfully removed using a higher bladder incision approach. A careful preoperative examination should be performed to detect the characteristics of the foreign body and avoid the risk of bladder wall perforation.     

Sponge Rubber Revealed Two Years After Penetrating Injury: A Case Report

The present report illustrates a very rare case report of a foreign body granuloma of the foot associated with a 2-year period of a retained spongeous rubber foreign body after a penetrating injury. Because it appeared almost 2 years after the injury, the history of trauma was minimized, the foreign body had migrated from the plantar to the dorsal side of the foot, and the radiographic appearance resembled a malignant process, it was difficult to rule out the possibility of a malignant tumor. This case shows the weakness of magnetic resonance imaging in detecting spongeous rubber in the body. Also, a bone osteoblastic reaction to the foreign body has very rarely been noted. To the best of our knowledge, just 5 cases have been previously reported. Provided suspicion exists of previous trauma with an embedded foreign body, the differential diagnosis of a bone neoplasm should consider the possibility of a foreign body reaction. Biopsy proved to be the best diagnostic tool.     

由嵌顿性声门异物演变为气管异物的抢救一例并文献复习

目的 探讨声门异物的临床表现、诊断及治疗方法。方法 结合文献复习,回顾性分析2018年6月12收治的一例由嵌顿性声门异物演变为气管异物患者资料。患者女,1岁3个月。因“误食鱼骨后咳嗽、拒食10天”入院。入院前予抗炎、雾化治疗未见好转,后经纤维喉镜检查提示声门异物。予全麻下行气管镜探查术,术中患者出现喉痉挛,血氧饱和度下降,行紧急气管插管后演变为气管异物,并再次在全麻下行气管镜探查取出术,手术过程顺利,取出异物。结果 术后第一天拔除气管插管,第13天患者无发热,无咳嗽咳痰,无声嘶气促,面色红润,听诊双肺呼吸音清,复查胸片提示肺炎基本痊愈及未见异物残留,予顺利出院。结论 喉异物、气管异物较常见,但由嵌顿性声门异物演变成气管异物罕见。有异物误吞史的患儿应考虑喉异物的可能,需完善相关检查及进一步明确诊断,并且选择适宜的麻醉方法及掌握手术技巧。     

由嵌顿性声门异物演变为气管异物的抢救一例并文献复习

目的 探讨声门异物的临床表现、诊断及治疗方法。方法 结合文献复习，回顾性分析2018年6月12收治的一例由嵌顿性声门异物演变为气管异物患者资料。患者女，1岁3个月。因“误食鱼骨后咳嗽、拒食10天”入院。入院前予抗炎、雾化治疗未见好转，后经纤维喉镜检查提示声门异物。予全麻下行气管镜探查术，术中患者出现喉痉挛，血氧饱和度下降，行紧急气管插管后演变为气管异物，并再次在全麻下行气管镜探查取出术，手术过程顺利，取出异物。结果 术后第一天拔除气管插管，第13天患者无发热，无咳嗽咳痰，无声嘶气促，面色红润，听诊双肺呼吸音清，复查胸片提示肺炎基本痊愈及未见异物残留，予顺利出院。结论 喉异物、气管异物较常见，但由嵌顿性声门异物演变成气管异物罕见。有异物误吞史的患儿应考虑喉异物的可能，需完善相关检查及进一步明确诊断，并且选择适宜的麻醉方法及掌握手术技巧。     

Re-sternotomy as an unwelcome side-effect of unknown effervescent tablet intake?

Four hours after surgery for aortic valve stenosis and tricuspid valve regurgitation, an unknown foreign body was present on the routine chest X-ray. We performed re-sternotomy in order to retrieve this foreign body. The foreign body was easy to move on fluoroscopy but we could not extract it. We concluded that the foreign body was in a subdiaphragmatic location. As a consequence, we performed gastroscopy. A white, frothy mass (similar to an undissolved effervescent tablet) within an ulcerated lesion was seen and partially extracted.     

Risk factors predicting the development of complications after foreign body ingestion

BACKGROUND: The aim of this study was to determine the predictive risk factors for complications resulting from foreign body ingestion. METHODS: A consecutive series of 1338 patients with suspected foreign body ingestion presenting from 1996 to 2000 were studied retrospectively. The potential risk factors for complications after foreign body ingestion were analysed by multivariate logistic regression and included concurrent medical illness, age, duration and types of symptoms, types of foreign body ingested, positive cervical radiographic findings and the level of foreign body impaction. RESULTS: Fish bone (62.7 per cent) was the commonest type of foreign body ingested. Most of the objects were impacted at or above the cricopharyngeus, the commonest site being the valleculae (31.4 per cent). Multivariate analysis showed that presentation delayed for more than 2 days (P < 0.001), positive cervical radiographic findings (P < 0.001) and foreign body impacted at the cricopharyngeus (P = 0.009) or upper oesophagus (P = 0.005) were significant independent risk factors associated with the development of complications after foreign body ingestion. CONCLUSION: In patients with a foreign body seen on plain cervical radiography, presentation delayed for more than 2 days after ingestion, and foreign body impacted at the level of the cricopharyngeus or oesophagus there is a high degree of correlation with the occurrence of complications. Awareness should be raised when these risk factors are present.     

Detection of orbital and intraocular foreign bodies by computerized tomography.

Localization of intraocular and orbital foreign bodies with computerized tomography (CT) was evaluated in eight patients and an experimental model. CT examination was particularly helpful in cases with multiple similar foreign bodies and in identifying foreign bodies too radiolucent to be seen by standard skull x-rays. Limitations of CT technique included insufficient resolution to localize a foreign body immediately adjacent to the sclera as either intraocular or extraocular, and obscuration of a small foreign body by artifacts from an adjacent, larger foreign body.     

Large radiolucent tracheal foreign body found by CT scan caused dyspnea

A 25-year-old male patient with a sharp, large, and radiolucent tracheobronchial foreign body which was inhaled at the time of a traffic accident is reported on. CT scan was quite useful in finding this radiolucent foreign body. The patient had no respiratory disturbance because the foreign body was located in the level between bifurcation and left main bronchus; however, a flexible fiberscopic procedure performed to remove the body caused an airway obstruction and a dyspnea because the foreign body lodged in the subglottis. Remarkable progress has been made in the development of the flexible fiberscope system. Almost all medical facilities in Japan have flexible systems. However, the opportunities for young physicians to learn about rigid systems may now become limited. This case may warn us not to have too much confidence in the ability of flexible fiberscope system to remove this kind of large foreign body and remind us of the need to continue adequate training in the rigid systems.     

Statistical analysis of tracheobronchial foreign bodies

Incidence of foreign body aspiration in tracheobronchial tree is rare, however the foreign body aspiration can lead to severe illness and even death if not diagnosed and treated promptly. We retrospectively analyzed forty five patients who underwent ventilation bronchoscope under general anesthesia for suspected aspirated foreign bodies in our hospital. In thirty eight patients, foreign body was confirmed in tracheobronchial tree, while in seven patients foreign body was not confirmed with bronchoscope. The thirty eight patients ranged in age from 10 months to 73 years; the peak incidence of foreign body aspiration occurred in children under 3 years of age. Twenty five of thirty eight patients were male. Food or food derivatives were the causative agents in 68% of the patients, with 65% due to a portion of peanut. The foreign body was located in the right and left bronchus with almost equal frequency. The main symptoms were coughing (72%), wheezing (53%), and dyspnea (25%). The radiographic abnormality was seen in eighteen of thirty eight patients. A radio-opaque material was seen in 18%. Children at age 6 years of younger (90%) had been witnessed to choke on identifiable foreign body, but only 40% were diagnosed within 24 hours. Twelve of these children were treated unnecessarily for asthma, pneumonia, or so on. We conclude that it is most important to take history carefully considering the possibility of foreign body aspiration in the patients with coughing, wheezing, or dyspnea.     

A foreign body lodged in the ethmoid sinus 3 years previously: A case report

Introduction and importanceEthmoid sinus foreign body is a rare condition. We describe an unusual case of an intra-ethmoid foreign body that was diagnosed late, we have reported this case to makeover fellow readers aware of the need to carefully examine the patient victim of a road traffic accident and the imaging performed.Case presentationA radio-opaque foreign body was detected at CT- scan of a 70- year-old man, who was the victim of a road traffic accident three years previously. The metallic foreign body was removed from the nasal cavity endoscopically without complications.DiscussionThe presence of foreign bodies in the paranasal sinuses is extremely rare, especially following a road traffic accident, and has a lower incidence compared to facial injuries. The Symptoms are vague, which Paranasal computed tomography is the examination of choice to locate the foreign body. The best ethmoidal sinus surgical approach is endoscopy.ConclusionIt is important to make a diagnosis and include foreign objects with a recurrence of symptoms especially from an accident on a public road and early removal with extensive debridement results in minimal tissue destruction.     

Occult plastic intraocular foreign body

A 34-year-old man was evaluated for posttraumatic endophthalmitis with hypopyon. A previous CT scan of the orbit along with B-scan ultrasonogram failed to confirm the presence of an intraocular foreign body. Nevertheless, at the time of vitrectomy, a polyvinyl chloride (PVC) plastic foreign body was encountered. The atypical posttraumatic uveitis that developed was apparently secondary to the PVC material, as the inflammation cleared rapidly following removal of the foreign body. This case illustrates the necessity for maintaining a high level of suspicion for the possibility of an intraocular foreign body in the event of ocular trauma, even in the presence of unconfirming ancillary tests.     

Laparoscopic removal of an intragastric foreign body with endoscopic assistance

We report the successful laparoscopic removal of an intragastric foreign body. A 57-year-old woman who had accidentally swallowed her own partial denture was referred to our hospital for its removal. Laparoscopic removal of the foreign body was urgently performed with the assistance of oral endoscope, following an earlier failed endoscopic removal associated with subcutaneous and mediastinal emphysema. The foreign body was removed from the stomach through a gastrotomy. There were no perioperative complications. The patient was uneventfully discharged on the ninth postoperative day. Laparoscopic removal of an intragastric foreign body is a feasible and safe treatment, and can be an alternative choice following failed endoscopic removal.     

Denture mimicking vocal cords--a rare entity. A case report

Laryngeal foreign bodies are not uncommon. A common difficulty encountered is a delay in diagnosis. The clinical features of a laryngeal foreign body may simulate asthma in an adult. The differentiation is necessary in the initial stages as the laryngeal foreign body can lead to sudden death due to airway obstruction. Sudden onset of wheeze in a non-asthmatic patient should arouse its suspicion. A case is reported where patient was transferred to respiratory intensive care unit for respiratory distress with wheeze which was later diagnosed as foreign body larynx.     

Bullet embolus to the heart after gunshot wound to the neck: a case report

A 43-year-old woman presented with gunshot wounds to the neck, chest, and left thigh. Computed tomography of the neck and chest with intravenous contrast revealed a left common carotid pseudoaneurysm and a foreign body in the right atrium. Preoperative chest x-ray and CT scan confirmed a metallic foreign body in the right heart. At median sternotomy, the intracardiac foreign body could not be located using fluoroscopy. The foreign body (bullet) was subsequently removed in the cardiac catheterization laboratory using a percutaneous transvenous basket extraction through a right femoral vein cutdown.     

A dual approach to tracheobronchial foreign bodies in children

From 1974 to 1980, 57 consecutive cases of children with tracheobronchial foreign bodies were treated by a new protocol in which peripherally located foreign bodies were treated nonoperatively and centrally located foreign bodies were removed bronchoscopically. Bronchoscopic removal was ultimately successful in all of the 29 children in whom the foreign body was located in the trachea or mainstem bronchus. There were eight minor complications, and in three instances it was necessary to repeat the bronchoscopy for retained fragments. In the other 28 children the foreign body was located in the segmental or lobar bronchi, and initial treatment consisted of a program employing inhalation bronchodilators, pulmonary drainage, and thoracic percussion. Treatment was successful (foreign body coughed out) in 18 patients (64%). Of the other 10 children subsequent bronchoscopy was successful in eight and failed in two patients. Of the latter patients, one required bronchotomy, and the other coughed out the foreign body. There were no deaths, major complications, or permanent pulmonary damage in either treatment series.     

Flexible fiberoptic bronchoscopy in the management of tracheobronchial foreign bodies in children: the value of a combined approach with open tube bronchoscopy

Fifty-two pediatric patients suspected of having a pulmonary foreign body but in whom there was insufficient evidence to warrant open tube bronchoscopy. In 19% of these patients, foreign bodies were found. Twenty-six percent of patients who had previously had foreign bodies removed and who subsequently underwent flexible bronchoscopy for a variety of indications were found to have residual foreign bodies. Clinically unsuspected foreign bodies were found in 1% of 1,054 additional patients who had flexible bronchoscopy for other reasons. The diagnostic use of the pediatric flexible bronchoscope is a safe, definitive, and cost-effective method for the identification of patients with pulmonary foreign bodies when other techniques yield equivocal or negative results. Patients known to have a foreign body should undergo open tube bronchoscopy for foreign body removal.     

Pericardial foreign body

The authors describe the case of an inhaled foreign body unusually located in the pericardium. An initial chest skiagram was misinterpreted leading to a negative bronchoscopy. Correct anatomic localization of the foreign body only was established at surgical exploration, despite preoperative computerized tomography scan of the chest. Recognition of the propensity of sharp foreign bodies to migrate is essential in treating these patients. A tracheobronchial foreign body migrating to the pericardium has not been reported previously in the literature. J Pediatr Surg 36:936-938.     

Ultrasound-guided Kopans' needle location and removal of a retained foreign body

Penetrating injury with retained foreign body is a common problem. Location of the foreign body and surgical excision may be difficult. Ultrasound can be a sensitive and cost-effective tool in both the detection and surgical removal of retained foreign bodies in soft tissue. We report a case in which ultrasound-guided needle localization was used for removal of a wooden foreign body     

An appropriate negative bronchoscopy rate in suspected foreign body aspiration

Aspiration of foreign bodies in children can lead to illness and even death if not recognized and treated promptly. Seventy-six patients were referred to our hospital for suspected foreign body aspiration. The following is a retrospective review of their diagnosis and treatment. There was no foreign body found at bronchoscopy in seven patients (9 percent), and there were nine patients (12 percent) with bronchial foreign bodies who had a delay in diagnosis of foreign body aspiration. The delay averaged 35 days. These children, as a result of a prolonged period before diagnosis, were treated unnecessarily for pneumonia and asthma. Once correctly diagnosed, they had a significantly longer hospital stay. We propose that some negative bronchoscopies are necessary in order to prevent the morbidity that occurs from a missed foreign body aspiration.