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Swallow : foreign bodies, their ingestion, inspiration, and the curious doctor who extracted them
Discusses what it means to ingest things humans weren't meant to eat, and how the line between human bodies and foreign bodies can sometimes blur.
Book
Comparison of Cap-Assisted vs Conventional Endoscopic Technique for Management of Food Bolus Impaction in the Esophagus: Results of a Multicenter Randomized Controlled Trial
\"Push\" or \"pull\" techniques with the use of snares, forceps, baskets, and grasping devices are conventionally used to manage esophageal food bolus impaction (FBI). A novel cap-assisted technique has recently been advocated to reduce time taken for food bolus (FB) removal. This study aimed to compare the effectiveness of the cap-assisted technique against conventional methods of esophageal FB removal in a randomized controlled trial.
Consecutive patients with esophageal FBI requiring endoscopic removal, from 3 Australian tertiary hospitals between 2017 and 2019, were randomized to either the cap-assisted technique or the conventional technique. Primary outcomes were technical success and FB retrieval time. Secondary outcomes were technical success rate, en bloc removal rate, procedure-related complication, length of hospital stay, and cost of consumables.
Over 24 months, 342 patients with esophageal FBI were randomized to a cap-assisted (n = 171) or conventional (n = 171) technique. Compared with the conventional approach, the cap-assisted technique was associated with (i) shorter FB retrieval time (4.5 ± 0.5 minutes vs 21.7 ± 0.9 minutes, P < 0.001), (ii) shorter total procedure time (23.0 ± 0.6 minutes vs 47.0 ± 1.3 minutes, P < 0.0001), (iii) higher technical success rate (170/171 vs 160/171, P < 0.001), (iv) higher rate of en bloc removal (159/171 vs 48/171, P < 0.001), and (v) lower rate of procedure-related mucosal tear and bleeding (0/171 vs 13/171, P < 0.001). There were no major adverse events or deaths within 30 days in either group. The total cost of consumables was higher in the conventional group (A$19,644.90 vs A$6,239.90).
This multicenter randomized controlled trial confirmed that the cap-assisted technique is more effective and less costly than the conventional approach and should be first-line treatment for esophageal FBI.
Journal Article
Inhalation of multiple pen caps causing bronchial foreign bodies: a rare case in an older child
Background
Foreign body inhalation is rare in older children, often leading to underdiagnosis and delayed treatment. Most cases involve a single foreign body, but instances of multiple foreign bodies are exceedingly uncommon. This report presents a case of an elder child who inhaled two pen caps, emphasizing the need for clinical vigilance and thorough medical history collection.
Case presentation
A twelve-year-old boy was admitted with a persistent cough lasting over two months, accompanied by sputum with a peculiar odor. Previous treatments with oral Cefdinir (0.1 g, three times daily) and inhaled Budesonide Suspension had not improved his condition. Physical examination revealed decreased breath sounds on the right side without signs of respiratory distress or wheezing. Imaging studies, including chest X-ray and CT scan, along with bronchoscopy, confirmed the presence of two foreign bodies in the right bronchus. The patient was started on anti-infective therapy to address any underlying infection before proceeding with removal. A combination of flexible bronchoscopy and rigid bronchoscopy, supplemented by a cryotherapy instrument, successfully extracted the pen caps. Post-procedure assessments indicated that the patient’s body temperature returned to normal, cough symptoms resolved, and lung ventilation significantly improved.
Conclusion
This case highlights the critical need for clinicians to remain vigilant regarding bronchial foreign bodies in older children. The rare occurrence of multiple foreign bodies, particularly resulting from active inhalation, necessitates a comprehensive medical history during patient evaluation. Early recognition and intervention can lead to significant improvements in patient outcomes, underscoring the importance of thorough clinical assessment in similar cases.
Journal Article
Urethral self-insertion of foreign body; a peculiar doorway to a psychiatric diagnosis: a case report
Introduction
Self-insertion of foreign bodies into the genitourinary tract is a rare but critical emergency, often underreported due to patient embarrassment. Such presentations may mask underlying psychiatric disorders, including acute psychotic episodes. This case report highlights a unique instance of urethral self-insertion of a plastic and metallic cable, which ultimately led to the diagnosis of schizophrenia.
Case presentation
A 32-year-old man with no prior medical or psychiatric history presented with acute penile pain of three hours’ duration. On examination, the patient remained calm, and a plastic cable was visibly protruding from the urethral meatus. A plain pelvic X-ray revealed a 9-cm radio-opaque foreign body along the urethral tract. After administering tetanus prophylaxis, the foreign bodies were successfully extracted under local anesthesia. Postoperatively, the patient experienced only mild urethrorrhagia and resumed normal urination. Given the unusual nature of the self-injurious behavior, a psychiatric evaluation was performed, which revealed an acute psychotic episode leading to a diagnosis of schizophrenia.
Conclusion
This case underscores the necessity for prompt urological intervention to prevent complications such as infection and urethral strictures, as well as the importance of thorough psychiatric evaluation in patients presenting with self-insertion injuries. A multidisciplinary approach integrating both acute physical management and long-term psychiatric care is essential to optimize outcomes and prevent recurrence.
Journal Article
Sodium propionate decreases implant-induced foreign body response in mice
The short-chain fatty acid (SCFA) propionate, beyond its actions on the intestine, has been able to lower inflammation and modulate angiogenesis and fibrogenesis in pathological conditions in experimental animal models. Its effects on foreign body reaction (FBR), an abnormal healing process induced by implantation of medical devices, have not been investigated. We have evaluated the effects of sodium propionate (SP) on inflammation, neovascularization and remodeling on a murine model of implant-induced FBR. Polyether-polyurethane sponge discs implanted subcutaneously in C57BL/6 mice provided the scaffold for the formation of the fibrovascular tissue. Fifteen-day old implants of the treated group (SP, 100 mg/kg for 14 days) presented a decrease in the inflammatory response as evaluated by cellular influx (flow cytometry; Neutrophils 54%; Lymphocytes 25%, Macrophages 40%). Myeloperoxidase activity, TNF-α levels and mast cell number were also lower in the treated group relative to the control group. Angiogenesis was evaluated by blood vessel number and VEGF levels, which were downregulated by the treatment. Moreover, the number of foreign body giant cells HE (FBGC) and the thickness of the collagenous capsule were reduced by 58% and 34%, respectively. Collagen deposition inside the implant, TGF-β1 levels, α-SMA and TGF-β1 expression were also reduced. These effects may indicate that SP holds potential as a therapeutic agent for attenuating adverse remodeling processes associated with implantable devices, expanding its applications in biomedical contexts.
Journal Article
Increase in foreign body and harmful substance ingestion and associated complications in children: a retrospective study of 1199 cases from 2005 to 2017
Background
Children with a history of caustic or foreign body ingestion (FBI) seem to be presenting more frequently to emergency departments. This study aims to elucidate the clinical presentation, diagnostic procedures, and complications associated with the ingestion of different object categories over a 13-year time period.
Methods
A structured retrospective data analysis of patients who presented between January 2005 and December 2017 to the University Medical Centre Ulm was performed. Patients up to 17 years of age with food impaction or foreign body or harmful substance ingestion were included by selection of the corresponding International Statistical Classification of Diseases and Related Health Problems (ICD10-GM) codes. Descriptive statistics, parametric or non-parametric tests, and linear regression analysis were performed.
Result
In total, 1199 patients were analysed; the mean age was 3.3 years (SD 3.12; range 7 days to 16 years), the male to female ratio was 1.15:1, and 194 (16.2%) were hospitalized. The number of patients seen annually increased from 66 in 2005 to 119 in 2017, with a rise in percentage of all emergency patients from 0.82% in 2010 to 1.34% in 2017. The majority of patients (
n
= 619) had no symptoms, and 244 out of 580 symptomatic patients complained of retching or vomiting. Most frequently, ingested objects were coins (18.8%). Radiopaque objects accounted for 47.6%, and sharp objects accounted for 10.5% of the ingested foreign bodies, both of which were significantly more often ingested by girls (
p < 0.001
for both). Button battery ingestion was recorded for 63 patients with a significant annual increase (
R
2 = 0.57; β = 0.753;
p = 0.003
). The annual rate of complications also increased significantly (
R
2 = 0.42; β = 0.647;
p = 0.017
).
Conclusion
We found an alarming increase in the number of children who presented to our emergency department with FBI and associated complications. A standardized diagnostic and therapeutic approach may reduce and prevent serious complications. Further preventive measures within the home environment are needed to stop this trend.
Journal Article
Nailed It! A Case Report of Multiple Metallic Foreign Body Ingestion
Intentional foreign body ingestion is often seen in individuals with psychiatric disorders, particularly mood and personality disorders. This case illustrates the substantial healthcare resources involved in managing foreign body ingestion, which may require multiple endoscopic procedures and intensive care monitoring. Endoscopic removal, while minimally invasive, carries risks such as perforation and bleeding, particularly in the upper gastrointestinal tract. Surgical intervention in psychiatric patients can inadvertently reinforce maladaptive behaviors, complicating management strategies. Therefore, a collaborative approach between psychiatry and gastroenterology is essential to address both the medical and psychological aspects of care.
Journal Article
Characteristics and treatment of pediatric nasal foreign bodies with button batteries-A retrospective analysis of 176 cases
Button battery nasal impactions pose serious risks due to complications and the need for prompt removal, yet research on interventions remains limited due to its rare occurrence. To delineate the clinical manifestations of nasal foreign bodies associated with button batteries and to explore treatment approaches focused on minimizing the reliance on general anesthesia and surgical interventions.
This study focuses on 176 cases of children who received treatment for nasal cavity button battery impactions. It encompasses various factors including age, gender, battery location, impaction duration, methods of extraction, and associated complications.
The incidence of nasal button battery cases among nasal foreign body instances was 1.16%, with a majority being males (60.23%) aged 1-5 years (98.29%). Utilizing a specially designed nasal foreign body hook and following established treatment protocols enabled the successful outpatient management of the majority of cases. Only 12 cases (6.82%) necessitated removal under general anesthesia due to management challenges in an outpatient setting. Furthermore, our findings indicated no linear correlation between the duration of battery retention and the risk of nasal septal perforation, which was observed in 31 cases (17.61%).
Nasal foreign bodies caused by button batteries in children demand urgent attention due to their potentially grave outcomes. Our research is directed towards enhancing diagnostic and therapeutic strategies to bolster the success rates of outpatient removal, curtail the duration of foreign body retention, and diminish the reliance on general anesthesia.
Journal Article
Rectal foreign body removal: increasing incidence and cost to the NHS
Insertion of foreign objects into the rectum is a well-described phenomenon and not an uncommon referral to the general surgeon on call. Although usually not life-threatening, there can be consequences following migration of the object or perforation of the large bowel. This study looks at the incidence of removal of foreign objects from the rectum over the last decade and the financial burden it presents to the NHS.
Hospital Episode Statistics for 2010-2019 were used to calculate the number of rectal foreign bodies that required removal in hospital. Data for age groups and genders have been compared.
A total of 3,500 rectal foreign bodies were removed over the course of 9 years. Males accounted for 85.1% of rectal foreign bodies whilst 14.9% were females. This equates to 348 bed-days per annum. Admission peaks were observed in the second and fifth decades of life.
This study shows that the incidence of rectal foreign bodies is higher in men and has been increasing over the period studied. Most foreign bodies can be removed trans-anally with the use of anaesthesia, with only a small proportion of patients requiring hospital stay over 24 hours (mean length of stay = 24 hours). Nearly 400 rectal foreign body removals are performed each year with an annual cost of £338,819, illustrating the effect this has on NHS resources.
Journal Article
Retained crystal ball in pediatric gastrointestinal tract: a cautionary case report
Introduction
Decorative crystal balls, also known as superabsorbent polymer gel beads, pose a significant hazard when ingested due to their ability to expand upon exposure to water. Diagnosing crystal ball ingestion remains challenging because of their transparency to radiation, making them difficult to visualize using X-ray imaging. Small crystal balls may not be detected in their early stages, only becoming visible once they fully swell and cause intestinal obstruction. This often results in some crystal balls remaining in the distal intestine after primary surgery aimed at removing the proximal crystals.
Case presentation
A 2-year-old girl was referred to our hospital with persistent vomiting and fever. She was diagnosed with acute intestinal obstruction, and imaging revealed features of dynamic obstruction. Emergency laparotomy identified an obstruction in the mid-terminal ileum caused by a superabsorbent polymer gel bead (crystal ball). A jelly-like mass measuring 4x4.5 cm was removed and sent for histopathological examination. Intestinal anastomosis was performed during the initial surgery to restore bowel continuity. Postoperatively, complications arose, including infection in the abdominal cavity and breakdown of the anastomosed area. A previously missed gel bead, referred to as \"crystal baby,\" which had not been identified during the initial surgery, caused severe leakage and infection. Given the high risk of further anastomotic complications, a double-lumen ileostomy was performed. The child’s condition improved, and follow-up imaging one month after surgery revealed no further obstruction.
Conclusion
This case highlights the diagnostic and surgical challenges associated with crystal balls (superabsorbent polymer gel beads) and emphasizes the need for careful management to prevent severe complications. It also underscores the risks of intestinal anastomosis in such cases and the necessity of alternative approaches, such as ileostomy, to ensure better outcomes.
Journal Article