In emergency, the extraction of the foreignbody was made two hours after the acci- dent by endobuccal way under general anesthesia. Indeed, in its appropriate direction, the pencil was gently removed. It is then found that it is the rounded gumming end that penetrated the pillar. After extraction, we discovered a rounded wound of approx- imately two (02) centimeters in the right anterior pillar. This penetrating wound in the anterior pillar was not hemorrhagic during examination (Figure 3). It was sutured loosely by two points with absorbable 3/0 thread. The postoperative course was un- eventful.
It is about a patient of 42, a laboratory technician, who was admitted, 20 hours after he had voluntarily ingested a cola nut, in the frame of a ritual. According to the patient, the cola nut, after it had been ingested, should have come out intact through the anus and be used to make a love potion. He said he had felt, immediately after the ingestion, an odynophagia and a jamming of the cola nut in his cervical esophagus. A few hours later, he started feeling retro sternal pain, showing signs of hypersalivation and total intermittent dysphagia. The patient had no past history of esophageal-gastric or psychiatric pathology. Upon examination, the patient appeared anxious, in good condition, with a salivary stasis in the oropharynx. His front and profile chest X-ray performed with soft rays were normal. It was then decided on an observation in the hope of a spontaneous elimination of the cola nut. The absence of elimination motivated, on the 3rd day of hospitalization, the performance of an esophageal en- doscopy which found the cola nut (Figure 1(a)) jammed in the esophagus at about 23 cm from the dental arches. All the attempts at removing it by the mouth or pushing it into the stomach failed. The day following the endos- copy, a surgical extraction of the cola nut was performed through a gastrostomy (Figure 1(b)). It measured 3 cm in diameter (Figure 1(c)). While an assistant was pushing the cola nut by the upper route with a CH34 Savary candle, the surgeon, with a gastrostomy, extracted the cola nut by pushing his finger upward in the esophagus. At the end of the surgery, the palpation of the lower esophagus did not show any clinically detectable pathology that may have lead to the jamming of the cola nut. However, on the other hand, an iatrogenic perforation of the esophagus was suspected. His esophagus was filled with methylene blue by the upper route. This resulted into a bluish coloration of the peri-esophageal compress, thus confirming
hyperdense structure demonstrated on CT-Scan, use of MRI was waived in order to prevent subsequent complica- tions in case of metal object foreignbody. However, initial assessments of patient’s images amplified the suspicion of skull base fracture, regarding the foci of pneumocephalus, especially at the region of the right superior orbital wall. Based on these findings, the patient was admitted to the trauma section of the neurosurgery ward and received ini- tial necessary supportive care. Antibiotic therapy was commenced for surgery preparation and preventing prob- able meningitis, with Cefepime and Vancomycin. A con- sult with ophthalmologists was performed, and regarding their evaluation, both ophthalmologists and neurosurgeons were agreeing with choosing a craniot- omy approach. The procedure was performed by using the method of “ extra-dural orbitocranial approach to the anterior cranial fossa” craniotomy. After a right brow skin incision with a soft tissue dissection with
X-ray exam of the right orbit showed an almost imperceptible small radio-opaque foreignbody (Figure 1 A). Ultrasound examination (Figure 1 B) and CT scan (Figure 1C) confirmed the presence of a metallic IOFB. Treatment with intravenous vancomycin (10 mg/kg/day divided q6hours) and ceftazidime (25 mg/Kg/day divided q8hours) was begun. After informed consent the patient was operated on the same day as he presented. Following primary wound closure, phacoemulsification of the cataract, scleral buckling and 20-gauge pars planavitrectomy (PPV) with posterior vitreous detachment were performed. After the PPV and clearing of the vitreous cavity with a backflush needle, a 0.7-mm IOFB was visualized embedded in the inferotemporal retina. Argon laser photocoagulation at the site of impact of the foreignbody was applied (Figure 1 D). Using intraocular forceps, the object was removed from the eye through the sclerotomy. A fluid-gas exchange with 25% SF 6 gas
Flexible bronchoscopy is effective both in the diagnosis and removal of aspirated cayenne. In our study, most of the patients had been misdiagnosed with pneumonia for months until the aspiration of cayenne was confirmed through flexible bron- choscopy. First, although cayenne may be added to food vari- ously in its fresh form, dried and powdered, or as dried flakes, in our study, only cayenne in fresh form was observed. This is probably because the dried powder and flakes were not visible under bronchoscopy. Secondly, foreign bodies in the airway tend to localize in the right bronchial tree, as reported in the literature. 7 Cayenne is no exception. In our study, the cayenne
stent was replaced by an inflatable balloon). After 5 years, upon X-ray computed tomography (CT) examination in the urology clinic, however, a foreign structure of a length of ~ 10 cm was observed (his former stent from 2008) in the sig- moid colon, with double perforation and air in the peritoneal cavity as well as massive inflammation of the perivisceral structures. For stent extraction (Figure 3), a sigmoidoscopy was performed, followed by colostomy, sigmoidal anus praeter, and debridement of the scrotum and peritoneum (Figure 4); during surgery, the distal and sigmoid colon were rinsed with saline and no evidence of perforation was further noticed. Surgical necrosis removal and repeated debridement (Figure 5) under antimicrobiotic protection followed. Upon intervention, the patient was transferred from the intensive care unit to the urologic ward. Here, debridement, suprapubic catheter change, and subcutaneous testicle relocation towards the inguinal region continued (Figure 6). The patient was then released with no sign of local infection and recommendation for plastic surgery for visible defect removal was given.
The swallowing mechanism of children varies in several ways form that of adults. Because the hard palate is relatively closer to the base of the skull in children, angulation of the soft palate during nasopharyngeal closure is not a prominent feature. The adenoid pad also contributes to closure in children. In addition, the tonsils acts as directors of small quantities of food into the oropharynx and help to keep the airway open until the child is ready to swallow. Because the larynx is relatively higher in the neck in children, there is less upper and posterior movement of the hyoid and larynx. Finally, the swallowing frequency during sleep in the adult is one sixtieth that of the sleeping preterm infant (six swallows per minute).
laryngoscopy did not permit us to detect the beetle that probably already occluded air passage in the trachea. Bronchoscopy should be recommended in all cases where obstruction of the airways is present (Jones and Roudebush 1984; Nutt et al. 2014), but in our case this was not performed due to financial constraints. The cat was then euthanised to avoid prolonged suffering. Depending on the experi- ence of the operator the vast majority of foreign objects may be removed endoscopically without the need for surgery. However, removal of foreign bodies in the trachea may be challenging because such patients may have complications like hypoxia or hyperthermia and such procedures are further limited in most cats by the small diameter of the trachea (Jones and Roudebush 1984; Levitt et al. 1993; Nutt et al. 2014). In these cases, a small- diameter flexible fiberscope (3 mm or less) with a working channel of 1.2 mm may be used to ex- plore feline airways. One veterinary study reported a success rate of 40% when using bronchoscopy for foreignbody extraction in cats (Tenwolde et al. 2010). Using forceps with fluoroscopy to re- move tracheal foreign bodies may be faster than endoscopy and may thus decrease the duration of anaesthesia; however, grasping the end of a foreignbody may increase trauma to the adjacent tracheal wall (Nutt et al. 2014). Nevertheless, such exami- nation should be accompanied by bronchoalveolar lavage and cultivation, because foreign bodies often cause secondary bacterial infection of the respira- tory tract or migrate to other places in the body like the thoracic cavity, heart and abdomen, lead- ing to bronchopneumonia, pyothorax, abscesses or pneumothorax or haemoabdomen.
The past history revealed there was a similar incidence at the age of 6 years. The patient had introduced a for- eign body in his left ear for which he was hospitalized for foreignbody removal .The family history revealed that the parents were having literacy up to the primary school level with poor socioeconomic status. Routine blood investigations were within normal limits. The X-ray skull lateral view (Figure 2), X-ray water’s view, and CT paranasal sinuses (Figure 3) pointed out that it was a looped iron wire where the looped end had pierced the lower part of posterior end of the septum and protruded into the opposite choana.
Lipoma being the most common mesenchymal tumour of the body is rare in head and neck region. Fibrolipoma is a rare benign tumour of palatine tonsil which may present a pedunculated lesion in oropharynx and can cause dys- phagia, foreignbody sensation in throat, sleep disturbance and voice change. Our patient presented with foreignbody sensation in throat. Examination showed pedunculated polypoidal mass arising from right palatine tonsil, treated with tonsillectomy under general anaesthesia. Histopathological ex- amination confirmed as fibrolipoma of tonsil. Malignant transformation in fibrolipoma is very rare but some cases have been reported. Hence patient was followed up for two years and no recurrence noted.
Adapting the search strategy of PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines , a literature search of Medline (Pubmed), Science Direct and the Cochrane databases was done, for articles relating to body packing or body stuffing. (Fig. 1.) Additional abstracts and articles were reviewed based on references from the available full texts. There was no limit to the search. The following search terms were used either singly or in combination: body packing, body stuffers, body packers, cannabis, heroin, cocaine, foreignbody, nasal cavity and unusual sites. Date of last search was 4 th of October
Syringing test revealed immediate and watery regurgitation from left eye. CT PNS (plain and contrast) re- vealed mucosal thickening of left maxillary sinus and multiple irregular foreign bodies, most probably glass par- ticles, in left maxillary sinus, blocking the left ostium. There was no evidence of any fistula or sinuses (Figure 3 and Figure 4).
Introduction: Generally in adults, most foreignbody ingestion occurs accidentally, but may be as a result of contributory factors such as psychiatric disorders, mental retardation, alcohol consumption, and an edentulous state. The ingested foreign bodies usually pass uneventfully through the gastrointestinal tract within one week. Perforation occurs in less than 1% of all patients. Patients may present with vague abdominal pain with no known history of foreignbody ingestion. Case Series: Herein, we report two cases of bowel perforations by ingesting foreignbody who did not recall the ingestion that required surgical intervention. Conclusion: Clinicians should suspect such condition in the presence of some predisposing factors, and a surgical consultation is necessary. Keywords: Abdominal pain, Bowel perforation, Ingestion of foreignbody (IFB)
Often, the presence of a wooden foreignbody in the orbit is inferred secondary to a geometrical interface between the area of low attenuation and soft tissues (3–7). Measurement of absorp- tion coefficients was not thought to be helpful in distinguishing small pieces of wood from air because of volume averaging. Our experiment demonstrated that window width and level vari- ation are extremely useful in differentiating wood from gas, fat, and extracellular fluid.
air content. Computed tomography (CT) confirmed the position of MCB in the right lower lobe bronchus near its origin (Figure 3). Aspirated foreignbody was lodged in the right main stem bronchus, on 7.8cm distance from the tracheal bifurcation, 1.5cm distantly from middle lobe branches (on the transitional boundary between the right middle and right lower lobe). Before inserting flexible optical fiberscope (Olympus BF P-10, pulmonary inser- tion tube 5.0 mm, biopsy channel 2.0 mm, working length 55 cm) transorally, we administrate premedication of intramuscular atropine sulfate 1 mg, midazolam and pethidine and we gave topical anesthesia of the upper and lower airways consisted of 2% and 0.5% lidocaine, respectively. Foreignbody forceps was inserted and this MCB was grasped and withdrawn together with the bron- choscope. It was found to be inhaled MCB with 4-unit crown, presented in figure 4. The size of retrieved foreignbody was: 26.3 x 8.2 x 6.3 mm.
A similar hospital based study was done in Taiwan in 156 children. The study showed that the preponderance of injuries in boys over girls was 2.1:1. Their study showed that the most common place of pediatric eye injuries is home (15.4%) followed by street (9.0%), school (7.7%) and sports venues (5.8%). The objects responsible for ocular injury were: unspecified sharp object(16.7%), scissors(13.5%), pencils/pens(12.2%), broken spectacles (7.7%), knife(6.4%), animal claws(5.8%), metal nails(2.6%), fingernails(1.3%). Their study also showed that the predictors of worst outcome were open globe injuries with large wound size, posterior segment involvement and the presence of an intraocular foreignbody 1 .
Paraganglioma (PGL) is a rare tumour of the head and neck, which arises from the neural crest cells . Histo- pathologically similar to the adrenal gland neoplasm, it is usually benign and non-functional. In general, para- ganglioma expands metastasis slowly and rarely  . Because the paraganglionic cells contain very small amounts of catecholamines, significant catecholamine release is rarely seen. The medical therapy for a hormone producing paraganglioma should be addressed. For the treatment strategy of PGL, we started alpha blocker, and an additional fluid and a beta-blocker afterwards. We continue medication during surgery, and stop it after sur- gical intervention. Herein, we present our 2 cases with carotid body tumour which are diagnosed incidentally and surgical experiences.
Examine Cornea- for erosions, partial/full thickness tear, Bowman’s/ Descemet’s membrane tear and in case of penetrating injury wound of entry. Examine anterior chamber depth and for the presence of hyphema. In Iris, see for iris hole, foreignbody embedded in iris, sphincter tears. Pupils for size, iris peaking may provide information on occult scleral injury. Pupil reaction and for the presence of RAPD. Examine the lens for lens opacities. Detailed fundus examination after dilatation.