超声靶向钩针固定引导下四肢异物取出术的临床研究

目的探讨超声靶向钩针固定引导下四肢异物取出术的临床效果。方法对21例四肢异物患者,超声定位后通过钩针固定引导行异物取出术。结果 21例异物完整取出,伤口愈合良好。手术切口平均长约2.1(1.0~3.0)cm,出血量平均约13.6(5~20)ml,平均手术时间24.8(10~40)min。所有病例未发生血管、神经、肌腱损伤和术后肢体功能障碍等并发症。结论超声介导靶向钩针固定技术能避免手术者及患者接触X线的辐射,操作简便,手术时间短,出血量少,能最大限度地降低手术创伤,术后恢复快,缩短住院时间,减少医疗费用,值得推广应用。     

Ultrasound-guided Needle Localization to Aid Foreign Body Removal in Pediatric Patients

Patients with podiatric foreign body injury commonly present to the emergency department. Often, the foreign object cannot be easily located or removed, and radiographs are frequently obtained to aid in localization. In cases requiring tissue dissection to remove the foreign bodies, accurate localization is required for safe removal of small and difficult to visualize bodies. We present 2 pediatric cases in which an ultrasound-guided needle localization technique was used to facilitate successful removal of small, difficult to visualize foreign bodies from the plantar foot. Ultrasound-guided needle localization reduced the required incision length and depth and helped to minimize the risk of damage to surrounding tissue.     

Clinical value of ultrasonography in the detection and removal of radiolucent foreign bodies

A series of 39 consecutive patients with a suspected retained foreign body in the hand and in whom standard soft issue radiographs were negative were examined by real-time, high-resolution ultrasound scan. At operation 20 patients had radiolucent foreign bodies (18 wood, 2 thorns) removed. Ultrasound scan correctly localized 19 of the foreign bodies before surgery and failed to detect one. No foreign body was found in 19 patients. Ultrasound scan falsely predicted the presence of a foreign body in two of these cases. High-resolution ultrasound scanning is a sensitive, accurate technique for diagnosing foreign bodies which are otherwise difficult to demonstrate by conventional radiographic techniques, and provides accurate three-dimensional localization of the object which is of value to the surgeon at operation.     

Conventional radiographs: are they still the standard in localization of projectiles?

The penetration of air gun pellets in facial soft tissue can cause major problems during the removal of foreign bodies, although conventional radiography, computed tomography, image-guided surgical removal, and ultrasound have been applied to facilitate the procedure. It was the aim of the present case report to introduce a modified intraoperative method for the localization of air gun pellets, based on the use of radiopaque markers in conventional radiographs. A 66-year-old patient attempted to commit suicide by using an air gun. The pellet hit the right temporal region. A computed tomographic (CT) scan was acquired to localize the foreign body. The first attempt to remove the pellet through the penetrating wound failed. Because of a dislodgement of the pellet, the CT scan could no longer be used for the localization of the air gun pellet. As the air gun pellet was positioned under the zygomatic arch, ultrasound was unable to identify its position. Successful intraoperative localization of the projectile was performed after fixation of radiopaque markers to the skin in the region of the estimated localization, with conventional radiographs in 2 planes, acquired with a mobile dental x-ray device. Although the markers remained attached to the patient as reference makers, the air gun pellet was removed easily. The use of radiopaque markers in conventional radiographs in 2 planes allows fast, intraoperative localization of radiopaque foreign bodies within soft tissue. The procedure can be carried out with a conventional x-ray device that should be available in every oral and maxillofacial practice. The use of reference markers should be considered a standard procedure for the localization of radiopaque foreign bodies in the head and neck.     

The diagnostics and treatment of the foreign bodies of the gastrointestinal tract

We have analyzed the results of treatment of 542 patients with the foreign bodies of the gastrointestinal tract. 359 of patients were hospitalized. All patients were somatically healthy. The majority of the foreign bodies (502 (92.6%)) were radio-opaque. 423 (78%) patients had swallowed single foreign body, the rest demonstrated multiple substunses. In 285 (52.6%) cases the foreign bodies left the organism naturally within 7 days. 230 (24%) cases required the endoscopic removal. The surgical removal of the foreign body was performed in 25 (4.6%) cases.     

Laparoscopic Retrieval of Gossypibomas—Short Series and Review of Literature

Laparoscopic removal of retained abdominal foreign bodies represents an obscure domain of minimally invasive surgery. Although not an infrequent situation in general surgical practice, there are very few papers presenting laparoscopic approache in these circumstances. An iatrogenic foreign body following surgery, is a serious complication that may lead to medico-legal problem. We present our experience and a literature review.

Methods : In the last 20 years 48 patients with abdominal foreign bodies were referred to us. Out of these four gossypibomas were managed laparoscopically.

Results : Retained swabs represent the most common iatrogenic abdominal foreign bodies. Removal of gossypiboma present more problems in laparoscopic environment due to encapsulation and difficulties in localisation, as retained swabs unusually display radio-opaque markings. There was one conversion due to dense adhesion to the gastric wall. Postoperative recovery was uneventful in all cases.

Conclusions : Gossypibomas, among abdominal foreign bodies, represent a certain reality with significant legal implications. Prevention should prevail and all efforts should be made in such respect. Laparoscopic approach is possible in selected cases (small swabs, encapsulated, no complications).     

The advantage of computed tomography in locating a foreign body in the foot

A case report of a metallic foreign body in the foot which was not found in surgery following X-ray localization and fluoroscopy is described. CT detected the precise localization of a radio-opaque foreign body in a second exploration, after a negative exploration based on standard X-rays.     

Radio-opaque marker of a surgical sponge appearing as an intra-articular foreign body after total hip arthroplasty

We report a 73-year-old female patient who underwent total hip arthroplasty for osteoarthritis of the right hip. An anteroposterior radiograph obtained 1 week after surgery showed an intra-articular striated foreign body. This was subsequently removed and found to be a radio-opaque marker of a surgical sponge that had been used during the operation. The patient made an uneventful recovery. In recent years, cases of retained surgical sponge after surgery have been reported occasionally. Counting surgical sponges and using sponges with radio-opaque markers are methods for preventing them from being accidentally left in situ. However, to our knowledge, there has been no report of retention of a surgical sponge radio-opaque marker at the operation site, appearing as a foreign body on an X-ray film.     

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     

Intra-operative echocardiography: a useful tool in the localization of small intracardiac foreign bodies

Small intracardiac foreign bodies may be difficult to palpate and localize at surgery using conventional diagnostic procedures. The use of intra-operative echocardiography greatly facilitates the localization of intramyocardial foreign bodies, and minimizes operative time and iatrogenic myocardial damage. A case is presented in which this diagnostic modality was used.     

Retrieval of foreign bodies adjacent to the nervous system: aspects of intra-operative use of ultrasound

Summary The retention of a foreign body during a surgical procedure or the inadvertent migration of an implant are rare but potentially harmful complications. Especially in the case of the former, the legal situation is unequivocal. Nevertheless, the uncomplicated removal and limitation of the operative trauma may be in the interest of the surgeon. We report and illustrate 2 patients in whom the use of intra-operative ultrasound resulted in the safe and elective removal of an intracranial drill tip in one patient and a contraceptive implant located in the ulnar nerve sheath in the other. The characteristic acoustic shadowing artefact could be demonstrated in both examples. In the first patient, intra-operative magnetic resonance tomography could not be used because of the magnetic artefact, and in the second patient, ultrasound was preferred for reasons of simplicity. Intra-operative ultrasound is an appropriate and easily available tool for detection of small foreign bodies beneath the nervous system. The neurosurgeon should be familiar with the typical characteristics of foreign bodies, which is different from other structures. Correspondence: Priv.-Doz. Dr. med. Kay Mursch, Neurochirurgische Klinik, Zentralklinik, Robert-Koch-Allee 9, 99438 Bad Berka, Germany.     

Present-day fiber endoscopy in the diagnosis and therapeutic tactics in foreign bodies of the upper digestive tract

Characterization of foreign bodies and their localization in the digestive tract in 404 patients is given. Surgical methods of treatment of such patients are described. Endoscopy was used for examination and treatment. The adequate anesthesia is thought by the authors to be necessary for a successful endoscopic removal of the foreign bodies. The indications for general anesthesia are enumerated. The endoscopic removal of the foreign bodies during surgical interventions are indicated in patients with the perforation of the esophagus by a foreign body.     

Localization, detection and guided removal of soft tissue in the hands using sonography

Penetrating wounds and lacerations are frequent pathologies treated in the emergency room. The management of hand trauma represents a large part of the work in any surgical practice. Although X-rays are routinely taken, numerous foreign bodies remain undetected, and the wounds are just locally debrided and the lacerations sutured. Unfortunately, as not all foreign bodies are radio-opaque, the radiography results may appear normal, but the patient fails to recover. Patients complaining of persistent wound tenderness were sent for ultrasound investigations, and foreign bodies were detected. Had ultrasonography been carried out initially in the emergency room, the correct diagnosis would have been made, and the sonographic equipment could have helped to guide the physician in his attempt to remove the foreign body. Usually, in response to continued pain, an ultrasound investigation is ordered, and the pathology becomes apparent. A number of examples are briefly described in order to highlight the present inadequacies. It is suggested that hospital administrators consider the need to provide ultrasonographic services as an integral facility of the emergency room. Received: 20 December 1999     

Use of Holmium:YAG laser to facilitate removal of intravesical foreign bodies

BACKGROUND AND PURPOSE: Foreign bodies in the bladder present a challenge to the urologist. Previously, endoscopic extraction, with or without perineal urethrotomy, or open cystotomy were the only treatment choices. We describe a novel use of the Ho:YAG laser for the removal of intravesical foreign bodies. We further tested the laser on objects that have been reported in the literature to necessitate open cystotomy to determine their suitability for endoscopic removal. MATERIALS AND METHODS: The Ho:YAG laser is introduced through the cystoscope and used to cut large foreign bodies into a size that can be extracted through the urethra. We tested the Ho:YAG laser ex vivo on other objects that have been reported as intravesical foreign bodies. RESULTS: We removed a large complex foreign body with the laser that would otherwise have necessitated open cystotomy. No injury or sequela was observed. Many commonly reported intravesical foreign objects seem amenable to similar treatment. CONCLUSION: The Ho:YAG laser should be considered for use to facilitate removal of foreign bodies from the bladder.     

Nail Puncture Wound Through a Rubber-Soled Shoe: Should We Take Every Patient to the Operating Room?

Nail puncture wounds through rubber-soled shoes, when presenting acutely, have a deceivingly benign appearance. High index of suspicion for a retained rubber piece should be maintained by the physician. This study investigates whether preoperative ultrasound examination can rule out a foreign body and reduce the need for surgery. It is a retrospective cohort of 125 patients with deep nail puncture wounds through a rubber-soled shoe, who underwent surgical exploration between 2008 and 2018. All patients had a preoperative ultrasound examination for detection of a rubber foreign body. The patients’ median age was 29, and 112 (89.6%) were males. Median time of presentation was 1 day, but there were patients who presented up to 90 days after injury (mean 5.1 ± 15.6 days). Foreign bodies, ranging 1 to 4 mm in diameter, were surgically removed in 37 (29.6%) patients. Only 16 of these patients had a positive preoperative ultrasound examination, corresponding to sensitivity of 43.2%. Specificity of the ultrasound examination was 95%. Ultrasound examination has low sensitivity for detection of foreign bodies following a puncture wound of the foot. This is attributable to the small size of the foreign bodies in this scenario and to the complexity of sonography in this location. We conclude that ultrasound cannot be used to rule out foreign body in the foot, and should not be relied on when deciding to avoid surgery. Nevertheless, it can be a helpful adjunct preoperatively, as an assessment of the foreign body size and location.     

Laparoscopic extraction of an intrahepatic foreign body after transduodenal migration in a child

We report on a 3-year-old boy who, after ingestion of turpentine, had an x-ray and was incidentally diagnosed with an intrahepatic needle. He was asymptomatic with no history of needle ingestion. Imaging (ultrasound and computed tomographic scans) showed a needle in segment 1, close to the inferior vena cava, with a proximal end in contact with the superior angle of the duodenum. Because of the localization of the needle and subsequent risks of complications, removal was proposed. Laparoscopy showed dense adhesions between liver and duodenum, confirming the migration route. Laparoscopic extraction of an entire sewing needle was performed. Postoperative course was uneventful; the child was discharged home after 2 days and is alive and well 19 months after surgery.Laparoscopy may be useful in children for extraction of intrahepatic foreign bodies, after transduodenal migration.     

Clinical diagnosis and treatment of intraorbital wooden foreign bodies

Purpose: The intraorbital wooden foreign body is often misdiagnosed or missed on computed tomography (CT) scan, due to the invisible or unclear images. The residual foreign bodies often occur during surgical removal. The clinical manifestations, imaging features and treatment of intraorbital wooden foreign bodies were discussed in this study. Method: We retrospectively analyzed 14 cases of intraorbital wooden foreign bodies managed at our hospital between January 2007 and May 2015. All patients underwent orbital CT examination before surgery, and surgery was performed under general anesthesia with orbital wound debridement and suture, as well as exploration and removal of wooden foreign bodies. Results: At first, 11 cases underwent removal of foreign bodies, including 1 case with incomplete removal and then receiving a secondary surgery. Foreign bodies were not found in three cases with preoperative misdiagnosis and orbital MRI found residual foreign bodies in the orbit. Operations were performed via primary wound approach in eight cases, conjunctival approach in two cases, and anterior orbitotomy in four cases. Postoperatively, one case was complicated with eye injuries, three cases with ocular muscle injuries, eight cases with visual loss, and eight cases with orbital abscess. The length of foreign bodies ranged from 1.8 cm to 11.0 cm. The maximum of four foreign bodies were removed at the same time. Conclusion: Because the imaging of orbital wooden foreign bodies is complex and varied, MRI should be combined when they are invisible on CT scan. At the same time injuries trajectory and clinical manifestations of patients should be taken into account. Surgical exploration should be extensive and thorough, and foreign bodies and orbital abscess must be cleared.     

Video-mediastinoscope: for extracting upper esophageal foreign bodies

Patients with esophageal foreign bodies require prompt diagnosis and therapy. The proximal dilatation method using a video-mediastinoscope is safe and effective in removing sharp foreign bodies from the upper esophagus, avoiding surgery and possible perforation. The technique using a video-mediastinoscope proved to be effective and safe; this may be the first use of this procedure in the literature. We recommend using video-mediastinoscope for extracting foreign bodies involving the upper esophagus narrowing.     

Endoscopic removal of intrarenal foreign body using dormia stone basket

The literature is replete with reports of foreign bodies found in the upper urinary tract. However, most have necessitated removal by open surgery or percutaneous nephrostomy. We describe a nonoperative removal of a foreign body from a kidney.