Esophageal foreign bodies

An impacted esophageal foreign body is most often an urgent, rather than a life-threatening, medical situation. Pharmacologic or mechanical methods can be used to relieve the impaction, depending on the patient, as well as the location and physical properties of the foreign body. Flexible fiberoptic esophagoscopy is the accepted standard of care for removal of an object that is not smooth, radiopaque, inert or recently impacted. Although controversial, balloon catheter extraction may be an acceptable alternative in selected cases of esophageal impaction. Intravenous glucagon is useful in relieving distal impaction.     

Management of corneal foreign bodies

Optimal management of corneal foreign-body injuries includes an accurate history, thorough examination of both eyes, atraumatic removal of the foreign body, elimination of the rust ring, appropriate antibiotic prophylaxis and protective patching. Pitfalls to be avoided include using topical steroids, which may promote ulceration from fungal contaminants, and prescribing topical anesthetics, which can mask the pain of a retained tarsal foreign body or a developing corneal ulcer. Careful records of care and follow-up are essential.     

Management of gastrointestinal foreign bodies

Sharp, irregular objects or long, thin objects pose the most danger and need immediate attention. Otherwise, objects impacted in the esophagus should be removed within 12 hours. Objects that have advanced into the stomach usually pass without problems and should be observed for up to two weeks. Symptoms of bowel perforation, bleeding or obstruction call for immediate surgery.     

Simultaneous bilateral aspiration of foreign bodies

Aspiration of foreign bodies into the bronchial lumen continues to be a potential hazard especially in children. Bronchiectasis, lung abscesses, emphysema, or pleuropulmonary fistula may develop if untreated. The treatment of choice is extraction by bronchoscopy under general anesthesia. Our patient simultaneously aspirated two squirrel vertebrae, neither of which produced obstruction. The patient's symptoms were due mainly to the partial obstruction secondary to the formation of granulation tissue. One aspirated vertebra was extracted during the diagnostic fiberoptic bronchoscopy, but a rigid Jackson bronchoscope was necessary to remove the other foreign body. The patient has since been asymptomatic.     

Aspirated foreign bodies in children.

Children six months to four years of age are at greatest risk for aspiration of foreign bodies. A history of coughing after contact with small objects is the most important clue. The clinical presentation varies from paroxysms of choking and coughing to chronic cough or wheezing. Chest radiographs are normal in up to one-half of the children. The location and size of the foreign body determine the urgency and selection of therapy. Prevention and a high index of suspicion will decrease morbidity.     

Removal of minute foreign bodies.

The precise localization and surgical removal of the broken tip of an acupuncture needle is reported. The needle was suspected of causing chronic suppuration and sinus formation in the patient's leg. A localizing guide-wire was inserted pre-operatively under fluoroscopic control. Subsequent surgical removal of the foreign body was carried out swiftly and simply with the aid of an image intensifier.     

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.     

Uncommon, undeclared oesophageal foreign bodies

We report two cases of unusual and undeclared oesophageal foreign bodies. A small double-rounded calabash or bottle gourd Lagenaria siceraria, stuffed with traditional medicine designed to acquire spiritual power. A whole tricotyledonous kola nut Cola nitida also designed to make medicine to gain love from a woman after passing it out in stool. Each case presented with a sudden onset of total dysphagia and history of ingestion of foreign bodies was not volunteered by any despite direct questioning. Plain radiograph of the neck and chest in either case did not reveal presence of foreign body. Both were successfully removed through rigid oesophagoscopy.     

Radiologic evaluation of foreign bodies.

The correct selection of a radiologic imaging modality along with knowledge of indirect radiologic findings can help determine the presence and location of a foreign body. Plain radiographs should be the initial screening modality for a suspected foreign body. Whereas most metal and glass foreign bodies are detectable on radiographs, many foreign bodies, including wood, are not. We do not advocate using xeroradiography for the detection of foreign bodies. When a suspected superficial foreign body is not delineated on radiographs, ultrasonography should be the next modality of choice. CT should be reserved for deep foreign bodies or when foreign bodies are not seen on radiographs or ultrasonography but are suspected.