The Snare Technique: A Novel Atraumatic Method for the Removal of Difficult Nasal Foreign Bodies

Background

Nasal foreign bodies (NFBs) are a common occurrence, particularly in children between 2 and 4 years old. Many techniques have been developed to remove NFBs, though intranasal batteries, in particular, possess characteristics such as round shape, smooth surface, and limited visibility that make attempts at removal significantly more difficult. In the context of intranasal batteries, a considerable local soft tissue reaction and potential necrosis may exist to further complicate removal.

Objective

To present a technique for removal of difficult intranasal foreign bodies that may be utilized by health care practitioners, particularly in the Emergency Department setting.

Case Report

We present a case of a 4-year-old child presenting with intranasal battery with mucosal necrosis. After conventional techniques failed, we utilized a novel wire snare technique to dissect the NFB free from the nasal mucosa safely and in an atraumatic fashion.

Conclusion

This technique is noted to be a rapid, atraumatic, and effective means for the removal of difficult NFBs.     

Expansile Superabsorbent Polymer Ball Foreign Body in the Ear

BackgroundSuperabsorbent polymers (SAPs) are materials that can absorb large quantities of water. Small spherical SAPs are commonly marketed as toys for children.Case ReportWe report the case of a 4-year-old female who presented to a pediatric emergency department with a small, marble-sized SAP that was placed in her ear by herself during the course of play at daycare. On examination, the object was translucent and difficult to visualize. After multiple attempts at removal, the object was partially removed using an ear curette. The patient sustained a small tympanic membrane perforation. During a follow-up operative intervention by otorhinolaryngology, the remainder of the object was removed using a suction device and the tympanic membrane was repaired.Why Should an Emergency Physician be Aware of This?While large SAPs associated with intestinal obstruction have been removed from the market, smaller SAPs can present a health risk when placed in orifices such as the ear or nose. Cases of foreign body SAPs have been misdiagnosed as ear infections and treated with topical antibiotics, which can lead to enlargement of the foreign body. Irrigation techniques and topical medications should not be used. SAPs are friable and can break into multiple pieces during removal attempts. Blunt tools, such as ear curettes, may be best suited for their removal. If the item breaks up during removal or if removal fails, urgent consultation with an otorhinolaryngologist is recommended.     

A Child With an Unusual Retained Oral Foreign Body

Background

Pediatric foreign-body ingestions are common. Oral foreign bodies are rare but can be life-threatening. Management of their extraction requires knowledge and careful consideration of removal techniques, pharmacology, and potential complications.

Ophthalmologic Procedures in the Emergency Department—Part III: Slit Lamp Use and Foreign Bodies

The emergency physician (EP) must be familiar with carrrying out ophthalmologic procedures for evaluation and treatment of a multitude of eye complaints. This article is the last of three articles addressing ophthalmologic procedures of use by the EP. This article reviews the indications and the techniques for slit lamp examination of the eye and techniques of foreign body removal. Criteria for consultation also are addressed.     

Ant Bites Conjunctival Tissue: The ABCs of Removing an Ocular Ant Foreign Body

BackgroundA variety of insect-related ocular injuries have been reported in the literature. However, no reports have been published documenting injuries resulting from exposure of the ocular surface to ants. This is surprising, given the relatively ubiquitous presence of ants. This is the first known case report to describe various techniques utilized in the removal of ants from the ocular surface.Case ReportThis case report details the presentation of a distressed 24-year-old woman who presented to the Emergency Department with an ocular foreign body associated with pain and increased lacrimation. She was identified to have an ant adherent to her conjunctiva. Various techniques of removal were performed, with the ant finally removed without any trauma to underlying tissues.ConclusionThis is the first case report to detail various techniques utilized in the removal of ants from the ocular surface, and discusses salient features that treating physicians should be aware of in managing patients presenting with ant bites.     

Small Rare Earth Magnets Adhered to Pharyngeal Tissue in a Pediatric Emergency Department Patient

BackgroundSmall rare earth magnets pose a known health risk to children and many cases of ingestion and aspiration with associated complications have been described. More unusual, but also seen in children, are retained foreign bodies in the oropharynx that require extraction.Case ReportWe present the case of a 3-year-old boy with persistent left-sided sore throat 1 h after ingestion of several 3-mm spherical rare earth magnets. No foreign bodies were visible in the oropharynx on examination; however, a chest radiograph revealed two adjacent magnets within the lower pharyngeal space, as well as four magnets linearly clumped within the small intestine. The patient was taken to the operating room, where visual inspection under general anesthesia revealed two magnets adhered to the pharyngoepiglottic folds (one on the laryngeal surface and one on the glottic surface). They were removed in full without issue, preventing aspiration.Why Should an Emergency Physician Be Aware of This?Given the recent increase in incidence of rare earth magnet ingestion, emergency providers ought to be aware of the risks and complications associated with magnetic foreign body ingestion in children and the workup and considerations involved in their removal. Providers should also advocate for improved safety controls of these products, which have been found to be effective in the past.     

Removal of nasal foreign bodies using the Fogarty catheter

Patients with nasal foreign bodies frequently present to emergency departments. Nasal foreign bodies are often difficult to remove and may require referral to an ENT surgeon or admission to hospital for removal under general anaesthetic. This study reviews patients with nasal foreign bodies who presented to the Gosford District Hospital Emergency Department over a three and a half year period. The results indicate that a technique for the removal of nasal foreign bodies in the emergency department using a Fogarty catheter may be successful.     

Accuracy of bedside ultrasound for the detection of soft tissue foreign bodies by emergency doctors

Objective: To assess the ability of emergency physicians and emergency trainees to detect soft tissue foreign bodies using typical ultrasound equipment. Methods: Following a 20 min interactive training session, emergency physicians and emergency trainees were assessed on ability to identify subcutaneous foreign bodies (wood, glass, plastic, gravel and metal) embedded in an experimental model containing both sham and real entry point incisions. In the second phase of the experiment accuracy of detection of multiple foreign bodies was assessed in a similar sonographic phantom. Results: Six emergency physicians and 14 emergency trainees performed a total of 400 individual sonographic examinations. Emergency physicians correctly identified 29 of 30 foreign bodies and returned sensitivity, specificity, positive predictive value and negative predictive value of 96.7%, 70%, 76.3% and 95.5%, respectively. Trainees correctly identified 60 of 70 foreign bodies and returned sensitivity, specificity, positive predictive value and negative predictive value of 85.7%, 82.9%, 83.3% and 85.3%. Correct identification of the number of foreign bodies present, when multiple, was low (25% physician vs 36% trainee). Conclusion: These data suggest ultrasound in the hands of emergency doctors might be useful as an initial screening tool for detection of soft tissue foreign bodies.     

Bedside Ultrasound Aids Identification and Removal of Cutaneous Foreign Bodies: A Case Series

Background

Soft tissue injury with a retained foreign body (FB) is a common emergency department (ED) complaint. Detection and precise localization of these foreign bodies is often difficult with traditional plain radiographic imaging or computed tomography (CT).

Case Report

We present three cases in which bedside ultrasound was used to identify and guide management of retained soft tissue foreign bodies. Comparison of ultrasound vs. plain radiography and CT, as well as techniques for FB identification and removal, are discussed.

Why should an emergency physician be aware of this?

Bedside ultrasound is an invaluable tool in the localization of foreign bodies in relation to other anatomic structures, and aids in the decision to remove them in the ED.     

急诊医生用床边B超在浅表软组织异物取出中的价值

目的:总结急诊医生主导床旁B超声技术在浅表异物取出术中的应用价值。方法:采用便携式迈瑞型彩色超声诊断仪BD177921对65例外伤后浅表软组织内异物存留患者行超声诊断定位,引导手术实施,探取异物。结果:结合患者病史,B型超声在异物存留患者的诊断定位中准确率高,能引导手术取出异物。结论:急诊医生主导床旁B超声技术方便、安全、高效,在浅表软组织内异物的诊断定位及引导手术取出异物中有重要的临床价值。     

Deflate to Extricate: A Technique for Rectal Foreign Body Removal of Inflatable Ball

Background

Rectal foreign bodies are commonly encountered in the emergency department (ED). Three techniques are well described in literature, including using a Foley catheter, “scooping” the object out, or grasping the object directly with ring forceps. We present a novel extraction method for an inflatable foreign body.

A review of gastrointestinal foreign bodies

Gastrointestinal tract (GIT) foreign bodies represent a significant clinical problem in the Emergency Department, causing a high degree of financial burden, morbidity and mortality. A large variety of foreign bodies are accidentally ingested or inserted into the GIT in different age groups. This a retrospective review of 38 patients who presented to the Emergency Department with GIT foreign bodies between January 2001 and December 2004. Computer database and case note search of patients' personal data, nature of the foreign objects and mode of entry to the GIT were recorded. There were 30 males and eight females (M : F ratio of 3.75:1) with an age range of 10 months to 87 years (median age 25.5 years). Foreign body ingestion/insertion was accidental in 14 patients, deliberate in 11, for anal erotism in 11 and as a result of assault in two cases. The median time before presentation was 12 h, and the mean length of hospital stay was 1.7 days. Treatment was conservative in 15 patients; five patients had gastroscopic retrieval; 15 patients underwent examination under anaesthetic, retrieval and proctosigmoidoscopy and three patients underwent laparotomy for impacted foreign bodies. GIT foreign body ingestion or insertion is common; however, majority of cases can be successfully managed conservatively.     

Fournier Gangrene from a Thirty-Two-Centimeter Rectosigmoid Foreign Body

Background

Medical and surgical problems associated with rectal foreign bodies are rare. Although most rectal foreign bodies can be removed without subsequent sequelae, they pose significant risk of infection.

Objectives

We report a patient with a 32-cm rectosigmoid foreign body and subsequent development of Fournier gangrene despite successful removal of the foreign body.

Case Report

A 63-year-old Caucasian man with past medical history of diabetes mellitus and depression presented with a chief complaint of “something stuck in my intestine.” He admitted that he placed a foreign body in the rectum. Abdominal X-ray study and computed tomography of the abdomen/pelvis showed a conical-shaped 32-cm rectosigmoid foreign body. The foreign body was removed manually and follow-up colonoscopy was done. The patient's condition deteriorated in the first 2 days of hospital stay and he was diagnosed with Fournier gangrene. He required multiple surgeries and received broad-spectrum antibiotic coverage for mixed bacterial flora grown from deep tissue.

Conclusion

Rectal foreign bodies can cause Fournier gangrene. A close observation and follow-up is important after removal of rectal foreign bodies.     

Sonographic localization of a retained urethral foreign body in an elderly patient

A retained urethral foreign body is an uncommon presentation in the Emergency Department. The diagnosis and treatment of retained urethral foreign bodies are determined by their size, location, shape, and mobility and often require specialty consultation and operative intervention. In this case of a 74‐year‐old man with a self‐inserted, retained urethral foreign body, we present the utility of a bedside ultrasound to detect the depth, size, and distance from the meatus of the object to guide the approach to extraction of the object at the bedside in the Emergency Department. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46 :296–298, 2018     

My patient is injured: identifying foreign bodies with ultrasound

Patients commonly present to the emergency department with a suspected retained foreign body, following penetrating injury. While plain radiography is often the first line in identifying radio-opaque foreign bodies, radiolucent foreign bodies such as wood and plastic can easily be missed. Furthermore, real-time visualization of such a foreign body can assist in its removal. This article evaluates the use of point-of-care ultrasound by emergency physicians in the identification and removal of soft-tissue foreign bodies along with describing the appropriate technique and highlighting the potential pitfalls. An illustrated case example is presented that highlights the benefits of point-of-care ultrasound foreign body detection and guided removal.     

Prevalence,Clinical Features and Management of Pediatric Magnetic Foreign Body Ingestions

Background

Foreign body (FB) ingestions are frequent in children. Whereas the majority of FBs pass spontaneously through the gastrointestinal tract, ingestion of magnetic FBs pose a particular risk for obstruction due to proximate attraction through the intestinal wall.

Study Objectives

We aimed to identify the prevalence, clinical presentation, and management of magnetic FB ingestions at our tertiary care institution.

Methods

We performed a retrospective chart review of medical records of patients presenting to the pediatric Emergency Department (ED) or admitted to the hospital with FB ingestions from June 2003–July 2009. From those cases, patients with magnetic FB ingestions were identified.

Results

During the study period, 337,839 patients presented to the ED; 38 cases of magnetic FB ingestion were identified (prevalence 0.01%). Abdominal radiography was obtained in all cases. Ingestion of a single magnet occurred in 30 of 38 cases (79%). Of those, 4 patients underwent endoscopic removal due to signs of FB impaction in the esophagus or pylorus; no complications were noted. Ingestion of multiple magnets (range 2–6) occurred in 8 of 38 cases. Four of the 8 patients with multiple magnetic FBs (50%) presented with signs of peritonitis and required operative repair of multiple intestinal perforations. No deaths were identified.

Conclusion

Although ingestion of a single magnetic FB may, in most cases, be managed as a simple FB ingestion, the ingestion of multiple magnetic FB is associated with a high risk of complication and requires aggressive management. We propose an algorithm for management of children with magnetic FB ingestions.     

经镇静/麻醉胃镜异物取出术在精神病患者中的应用

目的总结镇静/麻醉胃镜异物取出术在精神病患者应用中的治疗体会。方法回顾性分析2006年10月-2017年10月该院消化内镜中心通过镇静/麻醉胃镜诊治的上消化道异物急诊及病房精神病患者78例的临床资料。结果上消化道异物顺利取出78例,镇静/麻醉胃镜治疗前、治疗中及治疗后患者的生命体征[血压(BP)、心率(HR)、呼吸(R)、动脉血氧饱和度(SaO_2)]均平稳。结论对于精神病患者的上消化道异物的治疗可通过镇静/麻醉胃镜下的异物取出术治疗,该术具备成功率高、安全性好的特点。     

Fistula Formation to the Bladder and to a Corpus Alienum as a Rare Complication of Diverticulitis: A Case Report

Background: Fistula formation is a known complication of diverticulitis. Treatment of a diverticular fistula depends on the comorbidity of the patient and the severity of the disease. Case report: A 59-year-old man presented to the Emergency Department with chronic lower back pain that was being treated with a neurostimulator. He presented with severe sepsis, and an abscess formation near the neurostimulator. An abdominal and pelvic computed tomography scan revealed diverticulitis complicated by fistula formation to the neurostimulator and bladder. He was successfully treated by a two-stage procedure: first, exploration and drainage of the abscess, with removal of the foreign body, followed by a sigmoid resection 1 week later. Conclusion: In rare but severe presentations of diverticular disease, it is very important to limit initial treatment to the most threatening disorder.     

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

BACKGROUNDCurrently, 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 SUMMARYA 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 (3^rd removal surgery) was then successfully performed, using a needle as the reference. No nasal reconstruction was required after the operation. Postoperative healing was uneventful.CONCLUSIONMedical 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.     

Duodenal perforation and right hydronephrosis due to toothpick ingestion

We report a case of a 36-year-old man who was admitted to the Emergency Department with right flank pain. The clinical presentation was suggestive of renal colic. However, a computed tomography scan showed the presence of a foreign body in the inferior duodenal flexure. Upper gastrointestinal endoscopy demonstrated a 6.5-cm wooden toothpick deeply embedded in the duodenal wall; this was removed via endoscopy. The peri-duodenal inflammatory reaction had encased the right ureter, resulting in hydronephrosis. The patient did well and was discharged on post-operative day 7. He did not recall toothpick ingestion. When evaluating patients with acute abdominal pain, foreign body ingestion should be considered. In patients with a history of toothpick ingestion, immediate diagnosis with endoscopic management should be performed.