Eighteen years lasting bronchial foreign body: A case report in Cameroon,sub-Sahara Africa

IntroductionForeign body aspiration represents an important cause of morbidity and mortality during childhood. A neglected aspirated foreign body can last for years, leading to complications that are sometimes difficult to manage, dramatically affecting the quality of life of the patient.Case ReportWe report the case of a 29-year-old female who presented with eighteen-year history of recurrent cough, choking, and respiratory infections following a foreign body aspiration. The course was complicated by a chronic secondary lung abscess, successfully managed by combined medical and surgical treatment.DiscussionIn low-income countries like ours, foreign body aspiration is often misdiagnosed. The often delayed management due to low socioeconomic status can lead to serious complications. To the best of our knowledge, it is the longest period of bronchial foreign body retention reported in the medical literature in Africa.ConclusionForeign body aspiration is common in childhood and requires early recognition and treatment, in order to avoid complications that can be very serious or even fatal.     

Delayed diagnosis of esophageal foreign body: A case report

IntroductionForeign body (FB) ingestion, a common and serious problem in children, can present with a wide variety of symptoms. This paper describes and discusses the case of an esophageal foreign body (EFB), in which the patient presented with primarily respiratory clinical signs causing delayed diagnosis.Presentation of caseA six month old boy presented with three months history of harsh cough, stridor and pulmonary congestion. He was repeatedly treated with steroids and antibiotics. His symptoms worsened progressively. On examination, he was tachypneic with suprasternal recession, scattered crepitations, diffuse wheeze and a continuous stridor. Chest X-ray was normal. The flexible bronchoscopy showed a posterior external compression on the middle wall of the trachea. The CT scan was normal. The contrast X-ray study of the esophagus revealed an endoluminal filling defect. The esophagoscopy revealed narrowing at 12 cm of dental arch, and a bourgeoning yellow mass easily bleeding on contact. Esophageal biopsies were obtained, and histology was inconclusive. A surgical exploration was planned, but the infant forced out a pistachio shell after a chest physiotherapy session.DiscussionIngestion of FB by small children is a common problem. The majority of EFBs pass harmlessly through the gastrointestinal tract; however, some EFBs can cause significant morbidities. The diagnosis may be delayed leading to several complications especially if the ingestion of the FB is unwitnessed and when the clinician does not think of FB ingestion as part of the differential diagnosis of chronic respiratory signs.ConclusionThis case highlights, the importance of recognizing, the rare and often forgotten respiratory symptoms of EFB body to avoid diagnostic delay especially in unwitnessed FB ingestion.     

Meckel’s diverticulum perforation by a fish bone: A case report

IntroductionMeckel’s diverticulum is the most common congenital abnormality of the gastrointestinal tract. The perforation of a Meckel’s diverticulum by a foreign body is a very rare complication.Case presentationA 61-year-old male presented to the Emergency Department with complaints with abdominal pain and fever, and abdominal rebound tenderness on physical examination. An intestinal perforation by a foreign body was diagnosed by CT scan. The patient was submitted to a diagnostic laparoscopy and a perforation of a Meckel’s diverticulum by a foreign body was identified. The foreign body was removed and a stapled diverticulectomy was performed.DiscussionMeckel’s diverticulum is asymptomatic in most of the affected individuals, with a 4.2–16.9% probability of symptomatic presentations. The clinical presentation ranges from intestinal obstruction, to bleeding, inflammation and perforation. While children with Meckel’s diverticulum present more often with gastrointestinal bleeding, intestinal obstruction is the most common presentation in adults. Foreign body perforation of a Meckel’s diverticulum is an extremely rare event. There is general agreement that a symptomatic Meckel’s diverticulum should be resected. Laparoscopy is a safe diagnostic and therapeutic tool that can decrease diagnostic time and theoretically avoids the morbidity and mortality of a delayed diagnosis.ConclusionThe perforation of a Meckel diverticulum by a foreign body is an extremely rare event and may have a bad prognosis in case of a delayed diagnosis.     

Codfish may cause acute abdomen

INTRODUCTIONForeign bodies ingestion is frequent and can cause several complications. Perforation is rare but can occur in any segment of the gastrointestinal tract. Fish bones are one of the most frequent objects responsible.PRESENTATION OF CASEA 77-year-old patient resorted to emergency room for severe abdominal pain with 5 days of evolution. A CT scan showed an undefined liquid collection involving a linear image with 25 mm, suggestive of a foreign body. On laparotomy an abscess was resected with a fish bone inside.DISCUSSIONBowel perforation by foreign bodies can mimic other abdominal emergency conditions. Since fish bone ingestion is usually not remembered, diagnosis can be late. Surgery is the treatment of choice and is most commonly performed by laparotomy.CONCLUSIONA low threshold of suspicion along with a good clinical history and radiological studies is extremely important in order to make a correct diagnosis.     

Open removal of pediatric airway foreign body: A case report and literature review

BackgroundForeign Body Aspiration is a common finding in children diagnosed based on clinical signs and radiological studies so that timely diagnosis and successful removal of the foreign body is essential to reduce complications and mortality.Case presentationIn this study, we described a case of a 7-year old boy with a foreign airway body whose bronchoscopy was not successful in removing the foreign body, and the removal required open surgery. We also review the literature on Pediatric airway foreign bodies.DiscussionThe patient was discharged in good condition after being monitored and receiving antibiotics in the pediatric ward for seven days.ConclusionRigid bronchoscopy involves fewer complications and is more successful in removing the foreign body in children. However, a small percentage of children require open surgery for removal, which can be attributed to the size of the FB, its shape, how long the FB stays in the airways, and the changes that follow are involved and sufficient expertise in rigid bronchoscopy.     

An unusual cause of chronic abdominal pain after laparoscopic Roux en Y gastric bypass: Case report of a penetrating fish bone causing adhesions at the biliary-digestive junction resulting in partial obstruction and chronic symptoms

BackgroundThe management of chronic abdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGP) is complex and challenging. Foreign body intestinal perforation including that caused by fish bones has previously been reported in the literature and if clinically unrecognized, can cause significant morbidity and mortality. Fish bone perforation as a cause of chronic abdominal pain after LRYGP has rarely been reported.SummaryThe unusual case of a 54 year old female presenting with recurrent episodes of postprandial pain 2 years after LRYGP is reported. Previous radiological and endoscopic investigations did not reveal any abnormality and after the most recent clinical presentation, a laparoscopic exploration was performed. A protruding fish bone at the biliary-digestive junction was discovered intra-operatively and successfully extracted. Dense adhesions between the involved intestinal loops were lysed in an attempt to improve intestinal transit and subsequently relieve post-prandial pain.ConclusionThis case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP.     

Rigid bronchoscopy and foreign body. Obsolute procedure?

Foreign body aspiration represents an emergency event that usually requires immediate medical intervention. In some cases this event may be misdiagnosed with few, or absence of, clinical symptoms, but it can result in serious consequences. The continuous technical improvements in minimally invasive procedures such as bronchoscopy have permitted success in foreign body removal. We present a case of aspiration of unusual foreign body (river stones) lodged in the left bronchial tree, in a patient with epilepsy, and that were removed by rigid bronchoscopy.     

Role of CT scan in diagnosis of renal lymphangiectasia: our single-center experience

Background: Renal lymphangiectasia is rarely reported benign renal disorder of lymphatic malformation. Though found incidentally; it presents with nonspecific symptoms and shows characteristic findings in radiological imaging studies.

Aim: Here, we report eight patients with symptoms, laboratory and imaging findings compatible with renal lymphangiectasia. This report describes clinical and laboratory characteristics, treatment, Imaging findings and outcome of a series of patients with renal lymphangiectasia and reviews the literature.

Methods and material: Eight patients (mean age 45?years, male:female ratio 3:1) from 1st January 2011 to 30th June 2016; showing renal lymphangiectasia as incidental finding on CT IVP were included in the series. Imaging and laboratory findings were reviewed. Two out of eight patients (25%) underwent aspiration of collection and laboratory findings confirmed the diagnosis of renal lymphangiectasia. Four out of eight patients (50%) did not undergo aspiration of fluid and were offered conservative treatment. Two out of eight patients (25%) were donors for renal transplantation who were managed conservatively.

Results: Renal lymphangiectasia was diagnosed on CT IVP. In each case, where aspiration of collection fluid was offered, the laboratory diagnosis of renal lymphangiectasia was confirmed and patients were managed conservatively. However, large collection in one patient was relieved by percutaneous aspiration.

Conclusions: Renal lymphangiectasia can be diagnosed with CT scan and confirmed by laboratory tests. As it may be confused with other cystic lesions of kidney; proper diagnosis and exclusion of other differentials can be effectively offered by CT scan IVP, which can avoid unnecessary invasive treatment options.     

Laryngeal foreign body aspiration misdiagnosed as asthma: two case reports and a review of the literature

Children who aspirate a foreign body initially present with choking and subsequently present with respiratory syndrome symptoms. However, foreign body aspiration can mimic other illnesses, causing some difficulties in diagnosis. Here we report two cases that were treated with glucocorticoids for several weeks after an initial diagnosis of asthma. When there was no response to treatment, further examination revealed laryngeal foreign body aspiration in both cases. Foreign body aspiration should be considered a differential diagnosis for asthma. The delay in diagnosis could have been avoided by paying more attention to the medical history and by performing a more through initial examination.     

Fine Needle Aspiration Cytology: A Useful Technique for Diagnosis of Invasive Fungal Rhinosinusitis

Mycotic infections are on the rise globally. Patients with invasive fungal infection of the paranasal sinuses often present with destructive mass lesions and mimic malignancy clinically and radiologically. To assess the utility of Fine needle aspiration cytology for early diagnosis of invasive fungal rhinosinusitis. Fine needle aspiration cytology was performed from the maxillary/ethmoid sinus in patients with a destructive mass lesion in the maxilla. Differential diagnoses were malignancy and fungal rhinosinusitis. In eight cases fungi were detected on initial examination whereas in a single case that was initially reported as giant cell lesion, hyphae could be identified within giant cells, on review. Smears showed inflammatory cells with variable numbers of eosinophils with neutrophils and histiocytes. Foreign body giant cells were seen in all cases. The fungi conformed to morphology of aspergillus in seven cases (77.78 %); in two cases (22.22 %), typing could not be done. Periodic acid Schiff and Grocott stains highlighted the fungi in all the cases. Fine needle aspiration is a simple technique that can be useful for diagnosis of fungal rhinosinusitis and to exclude malignancy. Search for fungus may be more aggressive in smears with many foreign body giant cells and inflammatory cells and in cases with a high clinical suspicion. Differentiation between aspergillus and mucor can be made with help of special stains. Aspergillus is the commonest agent isolated. Preoperative cytological diagnosis obviates the need for biopsy, saves time and helps to plan proper treatment.     

Extraluminal migration of ingested fish bone in the upper aerodigestive tract: A series of three cases with broad clinical spectrum of manifestations and outcomes

IntroductionIncidental fish bone ingestion may penetrate the upper aerodigestive tract and cause extraluminal migration due to late presentation or missed diagnosis. The migrated fish bone exhibits a wide spectrum of clinical manifestations, ranging from mild symptoms to potentially fatal complications.Presentation of caseWe report three cases of extraluminal fish bone migration with diverse clinical presentations and complications. The first patient had mild throat symptoms and a fish bone that travelled through the neck and migrated towards the subcutaneous tissue without causing complications. The second patient developed deep neck abscess and thoracic complications as a result of the migrated foreign body, but recovered after surgical exploration and foreign body removal. The third patient presented late in sepsis and upper airway obstruction, subsequently succumbed to multiorgan failure before any surgical intervention.DiscussionThorough physical and endoscopy examinations are essential in patients with fish bone ingestion. Normal endoscopic findings in a symptomatic patient should always raise the suspicion of a migrated fish bone. A radiographic imaging study is often helpful in locating the foreign body and potential complications. The migrated fish bone that acts as the source of infection in the neck should be traced and removed surgically. The resulting abscess, if present, must be drained. The management of a migrated fish bone can be challenging and often require multi-discipline collaboration.ConclusionThe migration of the ingested fish bone outside the upper aerodigestive tract can cause serious complications and death in some cases. Clinicians should always maintain a high level of suspicion towards extraluminal migration in a patient with a history of fish bone ingestions but normal endoscopic findings. We emphasize the importance of early recognition and prompt surgical intervention to remove the migrated fish bone to minimise the potential morbidity and mortality.     

Unusual esophageal foreign body in neonates: A case report

Introduction and importanceEsophageal foreign body mostly occurs in children aged 6 months to 5 years old. In neonates (babies less than 28 days old), such report is extremely rare. In this case, we report the first esophageal foreign body in neonates without any symptoms.Case presentationA 28-day-old baby boy, with normal body weight, from a low socio-economic status family, came to us with a history of ingested foreign body. No sign of unconsciousness, excessive saliva, dysphagia, and respiratory distress. The chest X-ray revealed a radiopaque foreign body in the upper third of the esophagus. The patient underwent extraction of the foreign body using a flexible endoscope under general anesthesia. We found a 1.9 cm in diameter pendant with no sign of bleeding nor inflammation in the esophageal lumen. After the foreign body removal, the patient is in good condition and recovered uneventfully.Clinical discussionForeign body in children under 6 months old is very rare. A high index of suspicion for foreign body ingestion must be considered in unattended children from lower socio-economic status, primarily if witness statements are present and confirmed with radiological examination. Most common impaction site is at the level of the cricopharyngeus muscle. Currently, flexible endoscopy is the standard for foreign body removal in children.ConclusionHigh index suspiciousness, witness statements and radiological examination are the important points in diagnosing ingested foreign body in neonates. Clinicians are required to provide education to parents to supervise their children when playing together.     

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.     

Alpha-Defensin Is Not Superior to Traditional Diagnostic Methods for Detection of Periprosthetic Joint Infection in Total Hip Arthroplasty and Total Knee Arthroplasty Patients

BackgroundSynovial fluid alpha-defensin (AD) may improve diagnostic accuracy of periprosthetic joint infection (PJI) following total knee (TKA) and hip (THA) arthroplasty but is only available as send-out test. This study evaluated laboratory result accuracy between send-out test vs hospital labs and if AD made a difference in treatment plan.MethodsA retrospective review was performed of 152 consecutive patients with a TKA or THA joint aspiration for painful or clinically concerning joint. Synovial fluid was sent to our institution (hospital-based labs, HBL) and send-out immunoassay laboratory (Synovasure). Patients were scored with specific criteria from validated scoring system for PJI using HBL and Synovasure results. The score with and without AD test was compared to determine if AD impacted patient management.ResultsOverall, there was strong agreement between institutions for PJI diagnosis (Cohen’s kappa score 0.96). Twenty-nine patients had PJI diagnosis (score ≥6), of which 28 (97%) had positive AD with 1 false-negative result. Sixty-three patients had inconclusive score (between 2 and 5) and 60 patients had negative PJI diagnosis (score ≤1). Of these patients, 5 underwent surgery for infection. Two patients had surgery for positive AD, 2 for positive culture, and 1 because of elevated HBL results. The AD test changed the PJI diagnosis and influenced decision for surgery in only 1.3% (2/152) of patients.ConclusionMinimal differences were found in laboratory values between institutions. The addition of AD may be useful in cases of equivocal laboratory results but does not appear to be necessary for routine diagnosis of PJI after TKA/THA.Level EvidenceLevel III.     

The case of the forgotten toothbrush

INTRODUCTIONAlthough foreign body ingestion is relatively common, toothbrush swallowing is rare. A diagnosis of small-bowel perforation, caused by a sharp or pointed foreign body, is rarely made preoperatively because the clinical symptoms are usually nonspecific and can mimic other surgical conditions, such as appendicitis and diverticulitis.PRESENTATION OF CASEWe report a case of a swallowed toothbrush which passed past the pylorus and perforated the terminal ileum. The patient however presented with a fluctuant mass in the left iliac fossa, pyrexia and generalised tenderness mimicking a diverticular abscess.DISCUSSIONIngestion of a foreign body is commonly encountered in the clinic among children, adults with intellectual impairment, psychiatric illness or alcoholism, and dental prosthetic-wearing elderly subjects. However, toothbrush swallowing is rare, with only approximately 40 reported cases.CONCLUSIONBowel perforation by foreign bodies can mimic acute appendicitis and should be considered in differential diagnoses. Clinically, patients often do not recall ingesting the foreign body, which makes the clinical diagnosis more challenging, and a correct diagnosis is frequently delayed. Several radiological investigations, such as small-bowel series, ultrasonography, and computed tomography scans, may lead to the correct diagnosis, but in most patients, the diagnosis is not confirmed until the surgical intervention has been performed.     

Perforation of the cecum from ingested foreign body in a 14 year old adolescent with autism spectrum disorder and epilepsy: A case report

Introduction and importanceAlthough foreign body ingestion is a common medical issue, intestinal perforations following foreign body ingestion are rare. Diagnosing foreign body ingestion is challenging especially in children with neurodevelopmental disorders such as Autism Spectrum Disorder (ASD). It is believed that approximately 80–90% of ingested foreign bodies pass through the gastrointestinal tract without causing any luminal damage, and only approximately 1% of foreign bodies are known to remain lodged within the bowel and cause luminal erosion and perforation.Case presentationA 14-year-old boy, diagnosed to have Autism Spectrum Disorder was brought in by his parents to our hospital with right lower quadrant (RLQ) abdominal pain and fever. On examination, he was tachycardic and there was direct tenderness over the RLQ of the abdomen. Acute appendicitis was entertained and the patient was examined with ultrasound. The ultrasound reported, “The tip of the appendix was dilated (0.62cm) and there is minimal RLQ intra-peritoneal fluid collection”. With the impression of acute appendicitis, the patient was explored and he was found to have a cecum perforation due to an ingested foreign body (twig). Initially we did tube cecostomy but later we did right hemicolectomy because the cecostomy tube had leaked.ConclusionForeign body ingestion should be taken into account during the evaluation of children and adolescents with neurodevelopmental disorders who presented with acute abdominal pain. Since diagnosis is difficult clinicians who are involved in acute care medicine should take a thorough history with a high index of suspicion for foreign body ingestion.     

Is There an Optimal Cutoff for Aspiration Fluid Volume in the Diagnosis of Periprosthetic Joint Infection?

BackgroundThe diagnosis of periprosthetic joint infection is often challenging in the setting of low aspiration volumes, or in the presence of infection with a slow-growing organism. We sought to determine if an optimal threshold of aspiration fluid volume exists when cultures from the preoperative aspiration are compared to intraoperative cultures.MethodsAll revision total hip and knee arthroplasty procedures over 5 years at our institution were reviewed. Cases were excluded if they underwent joint lavage during aspiration, had an antibiotic spacer in place, were suspected of adverse local tissue reaction to metal debris, did not have an accurate aspiration volume recorded, or if there were no aspiration or operative cultures available. Receiver operating characteristic curves were used to evaluate aspiration volume for identifying cases with identical aspiration and culture results.ResultsA total of 857 revision cases were reviewed, among which 294 met inclusion criteria. There were 45 cases (15.3%) with discordant aspiration and operative cultures. The mean aspiration volume for identical cases was significantly higher than for discordant cases (19.1 vs 10.2 mL, P = .02). The proportion of slow-growing organisms was significantly greater among discordant compared to identical operative cultures (52.4% for discordant cases vs 8.2% for identical cases, P < .001). The optimal cutoff value for predicting identical cultures was 3.5 mL for typical organisms and 12.5 mL for slow-growing organisms.ConclusionAspiration cultures are more likely to correlate with intraoperative cultures with higher aspiration volumes, and the optimal aspiration volume is higher for slow-growing organisms.     

Endoscopic ultrasound-guided fine-needle aspiration of the left adrenal mass accessed via the gastrostomy tract: A case report with video

Introduction and importanceAn adrenal metastasis is uncommon in esophageal cancer. Its diagnosis could be challenging if a percutaneous approach was inaccessible. Moreover, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), a useful adrenal sampling technique, is complicated by the luminal obstruction.Case presentationA patient with esophageal cancer accompanying by adrenal mass and established gastrostomy was described. The EUS-FNA of the adrenal lesion was successfully performed via the dilated gastrostomy tract. Adequate tissue for pathological examination was achieved, and the result indicated metastatic squamous cell carcinoma. Chemotherapy was started accordingly.Clinical discussionThis report described an uncommon event of adrenal metastasis of esophageal primary. Even though it is possible to perform EUS via the gastrostomy tract, performing EUS from an unusual direction might add some difficulty to an endoscopist, considering that EUS involves image pattern recognition in identifying structures. Thus, this technique should be operated by experienced EUS endoscopists.ConclusionGastrostomy can provide an enteral route for nutrition support in esophageal cancer patients. In addition, it could be an alternative EUS intervention portal when an esophageal stent is not accessible.     

Successful salvage of an infected breast prothesis by changing from continuous to intermittent suction under continuous irrigation

IntroductionImplant-based breast reconstruction is a widely performed procedure. However, prostheses are susceptible to infection and there are currently no established guidelines on treatment. In the present case, a prosthesis was salvaged by changing from continuous irrigation and suction to continuous irrigation and intermittent suction. This case report has been reported in line with the SCARE criteria [1].Presentation of caseA 50-year-old female patient underwent implant-based breast reconstruction following surgery for breast cancer. One month later, the left breast prosthesis was infected with abscesses. Surgical treatment and continuous irrigation were performed as postoperative therapy. However, recurrent infection was detected a few days after surgery. Continuous irrigation was changed to continuous irrigation with intermittent aspiration, which successfully controlled the infection.DiscussionFactors that limit the effectiveness of continuous irrigation and aspiration have not yet been identified. Inflow/discharge shunt routes may be established in continuous aspiration, and, thus, sufficient cleaning may not be possible. On the other hand, the storage of water throughout the wound in intermittent aspiration may facilitate cleaning.ConclusionIntermittent suction worked well in this patient and, thus, warrants further study.