Keratitis in patients with corneal foreign bodies: a cross-sectional study in Cali, Colombia / Ceratite em pacientes com corpos estranhos na córnea: um estudo transversal em Cali, Colômbia

ABSTRACT Purposes: To describe the clinical characteristics and factors associated with keratitis in patients with corneal foreign bodies in Colombia. Methods: This cross-sectional study was based on a clinical records review of patients who had corneal foreign bodies and were admitted to the emergency department between June 2018 and June 2019 in Cali, Colombia. The primary outcome was the presence of keratitis diagnosed based on clinical criteria. Univariate and multivariate logistic regression models were used to identify associated factors. Results: A total of 381 corneal foreign bodies in 372 patients were analyzed (median age, 40.0; interquartile range, 29.0-53.0 years; male, 94.7% (n=352). Ninety-five patients developed keratitis (24.9%, 95% confidence interval [CI] 20.8%-29.5%). In the multivariate analysis, age 30 years (odds ratio [OR] 2.15, 95% CI 1.06-4.36), finding of aqueous flare (OR 2.81, 95% CI 1.39-5.66]), and a foreign body in the peripheral cornea (OR 2.05, 95% CI 1.19-3.50] were associated with an increased risk for keratitis. Sex, time between injury and admission, and corneal edema were not related to keratitis (p>0.05). Conclusion: In Cali, Colombia, a high proportion of keratitis was reported in patients with corneal foreign body. Age, an aqueous flare, and a foreign body in the peripheral cornea were the factors associated with keratitis.

RESUMO Objetivo: Descrever as características clínicas e os fatores associados à presença de ceratite em pacientes com corpos estranhos na córnea em uma população colombiana. Métodos: Trata-se de um estudo transversal baseado na revisão dos registros clínicos de pacientes com corpos estranhos na córnea admitidos em um departamento de emergência em Cali, Colômbia, entre junho de 2018 e junho de 2019. O desfecho primário foi a presença de ceratite diagnosticada através de critérios clínicos. Foram utilizados modelos de regressão logística univariada e multivariada para identificar os fatores associados. Resultado: Neste estudo, foi analisado um total de 381 corpos estranhos na córnea em 372 pacientes (idade média: 40,0 anos, intervalo interquartil: 29,0-53,0; sexo masculino: 94,7% [352 casos]). Noventa e cinco casos desenvolveram ceratite (24,9%, intervalo de confiança de 95% — IC 95%: 20,8%-29,5%). Na análise multivariada, para idade ≤30 anos (razão de chances — RC: 2,15, IC 95%: 1,06-4,36), o achado de flare aquoso (RC: 2,81, IC 95%: 1,39-5,66]) e a presença de corpo estranho na periferia da córnea (RC: 2,05, IC 95%: 1,19-3,50) foram associados a um risco aumentado de ceratite. Sexo, tempo entre a lesão e a internação, e edema da córnea não foram relacionados à ceratite (p>0,05). Conclusão: Há uma proporção elevada de ceratite em casos de corpos estranhos na córnea em Cali, Colômbia. Os três fatores associados à ceratite foram a idade, o achado de flare aquoso e a presença de corpo estranho na periferia da córnea.

Alterações oculares decorrentes de picada de abelha na córnea / Ocular changes due to corneal bee sting

RESUMO O propósito deste estudo foi reportar as alterações oculares observadas após picada de abelha com ferrão retido na córnea. Destacamos o tratamento e o desfecho de uma lesão de córnea incomum e sua patogênese. Trata-se de relato de caso e revisão da literatura de lesões oculares por picada de abelha. Paciente do sexo feminino, 63 anos, procurou atendimento oftalmológico de urgência devido à picada de abelha na córnea do olho direito há 6 dias. Queixava-se de embaçamento visual, dor e hiperemia ocular. Apresentou acuidade visual de vultos no olho afetado. Ao exame, notaram-se hiperemia moderada de conjuntiva bulbar, edema corneano com dobras de Descemet e presença do ferrão alojado na região temporal, no estroma profundo da córnea. A paciente foi internada para ser abordada no centro cirúrgico sob anestesia geral. Durante a cirurgia, o ferrão teve que ser retirado via câmara anterior, mediante a realização de uma paracentese e uma lavagem da câmara anterior, com dupla via e solução salina balanceada. Ainda não existe na literatura um tratamento padrão na abordagem de pacientes com lesões oculares por picada de abelha, sendo importantes a identificação e o reconhecimento precoce de possíveis complicações que ameacem a visão.

ABSTRACT The purpose of this study was to report the ocular changes observed after a bee sting with a stinger retained in the cornea. We show the treatment and outcome of an unusual corneal injury and its pathogenesis. This is a case report and literature review of ocular injuries caused by bee stings. A 63-year-old female patient sought emergency ophthalmic care because of a bee sting on the cornea of her right eye six days before. She complained of blurred vision, pain, and ocular hyperemia. She had glare sensitivity on visual acuity in the affected eye. Examination revealed moderate hyperemia of the bulbar conjunctiva, corneal edema with Descemet's folds and a stinger lodged in the temporal region, in the deep stroma of the cornea. The patient was admitted to the operating room under general anesthesia. During surgery, the stinger had to be removed via the anterior chamber, by performing a paracentesis and washing the anterior chamber with a double flushing and balanced saline solution. There is still no standard treatment in the literature for patients with eye injuries caused by bee stings, and early identification and recognition of possible sight-threatening complications is important.

Gastrointestinal Foreign Bodies: 14 Years of Experience in a University Clinic

Introduction: Ingesting foreign bodies is a common medical problem, especially in the emergency department. Some small studies describe experiences in this regard. Materials and methods: A descriptive retrospective study included patients with suspected ingestion of foreign bodies admitted to the gastroenterology and GI endoscopy service of the Clínica Universitaria Colombia between January 2007 and August 2020. Results: The age of occurrence of the event was 18 to 95 years, and the average age was 45 years. The foreign bodies ingested and found were variable. The most frequent was fish bones, representing 64.11% of the cases, followed by chicken bones and dietary impaction. Thirty-eight percent of patients required foreign body removal; the most frequently used tool was the foreign body forceps. The primary location was the esophagus in 12.53% of cases, followed by the cricopharynx in 11.18% and the hypopharynx in 10%. Conclusions: The Clínica Universitaria Colombia is a referral site for many gastroenterology emergencies due to its high technological level and extensive human resources. This paper probably describes the largest number of patients with this reason for consultation, which is why this retrospective descriptive study was designed. It shows the demographic characteristics, foreign body types, radiological and endoscopic findings, and associated complications, which help to provide a more accurate knowledge of this pathology.

Introducción: La ingesta de cuerpos extraños es un problema médico frecuente, especialmente en el servicio de urgencias. Existen algunos estudios pequeños que describen las experiencias al respecto. Materiales y métodos: Estudio descriptivo, retrospectivo, en el cual se incluyó a pacientes con sospecha de ingesta de cuerpos extraños, ingresados al servicio de gastroenterología y endoscopia digestiva de La Clínica Universitaria Colombia, entre enero de 2007 y agosto de 2020. Resultados: La edad de ocurrencia del evento se presentó en pacientes desde los 18 hasta los 95 años, y la edad promedio fue de 45 años. Los cuerpos extraños ingeridos y encontrados fueron variables; los más frecuentes fueron la ingesta de espinas de pescado, que representó el 64,11% de los casos, seguido por la ingesta de huesos de pollo y la impactación alimentaria. Un 38% de los pacientes requirieron la extracción de cuerpo extraño y la herramienta usada con mayor frecuencia fue la pinza de cuerpo extraño. La localización principal fue el esófago, en el 12,53% de los casos, seguido por la cricofaringe, en el 11,18%, y la hipofaringe, en el 10%. Conclusiones: La Clínica Universitaria Colombia es un sitio de referencia de una gran cantidad de urgencias en gastroenterología debido a su alto nivel tecnológico y al gran recurso humano que requieren. Este trabajo representa probablemente la cantidad más grande de pacientes con este motivo de consulta, razón por la que se diseñó este estudio descriptivo retrospectivo, que muestra las características demográficas, los tipos de cuerpo extraño, los hallazgos radiológicos y endoscópicos y las complicaciones asociadas, que son de utilidad para tener un conocimiento más real de esta patología.

Cuerpos extraños en esófago: revisión de 84 casos

La presencia de cuerpo extraño esofágico (CEE) es una urgencia habitual en gastroenterología. El protocolo en el manejo y la intervención endoscópica puede ser variable entre las instituciones. Objetivo: Definir características clínicas del CEE en adultos, su diagnóstico radiológico y endoscópico, y complicaciones a partir de una muestra de pacientes en un centro de gastroenterología. Materiales y métodos: serie de casos de pacientes que ingresaron desde urgencias y fueron interconsultados al servicio de gastroenterología con diagnóstico presuntivo de CEE. Se recolectaron variables clínicas, así como características, comorbilidades, tiempo de evolución y oportunidad diagnóstica, estudios confirmatorios, y complicaciones. Resultados: 84 sujetos, 70% hombres, promedio de edad 45 (rango:17-87; SD 12,5) años. En 98,8% de los pacientes se realizó endoscopía digestiva alta de modo urgente, con estancia intrahospitalaria promedio de 2,5 días. 93% sin patología de base asociada, en 6/84 (7,14%) pacientes se documentó patología esofágica estructural o funcional. 59/84 70,2%) pacientes consultaron en las primeras 24 horas, en 57,6% se confirmó endoscópicamente presencia de cuerpo extraño. En 67/84 (79,76%) pacientes se realizó radiografía previa a endoscopia, de los cuales, 62/67 (92,5%) con resultado anormal. 70% de los CEE confirmados fueron espinas de pescado. El sitio más frecuente de localización fue en región cricofaringea en el 90% de los casos. En 66/84 (78,6%) sujetos hubo ausencia de complicaciones, seguido de laceración profunda en 10/84 (11,9%) casos. En 3/84 (3,6%) casos se identificaron complicaciones con requerimiento quirúrgico. Conclusiones: La intervención endoscópica en las primeras 24 horas es un momento oportuno para identificación de complicaciones y brindar el tratamiento indicado.

The presence of esophageal foreign body (EFB) is a common emergency in gastroenterology. The protocol for management and endoscopic intervention can be variable among institutions. Objective: to define the clinical characteristics of EFB in adults, its radiological and endoscopic diagnosis, and complications based on a sample of patients in a gastroenterology center. Materials and methods: case series of patients admitted from the emergency department and referred to the gastroenterology department with a presumptive diagnosis of EFB. Clinical variables were collected, as well as characteristics, comorbidities, time of evolution and diagnostic opportunity, confirmatory studies, and complications. Results: 84 subjects, 70% men, mean age 45 (range: 17-87; SD 12.5) years. Urgent upper endoscopy was performed in 98.8% of the patients, with an average in-hospital stay of 2.5 days. 93% had no associated underlying pathology, in 6/84 (7.14%) patients structural or functional esophageal pathology was documented. 59/84 (70.2%) patients consulted in the first 24 hours, in 57.6% the presence of foreign body was confirmed endoscopically. In 67/84 (79.76%) patients radiography was performed prior to endoscopy, of which 62/67 (92.5%) had an abnormal result. Seventy percent of confirmed EFB were fish bones. The most frequent site of localization was in the cricopharyngeal region in 90% of the cases. In 66/84 (78.6%) subjects there was absence of complications, followed by deep laceration in 10/84 (11.9%) cases. In 3/84 (3.6%) cases complications requiring surgery were identified. Conclusions: Endoscopic intervention in the first 24 hours is an opportune moment to identify complications and provide the indicated treatment.

Maternal temperament and anxiety sensitivity in children with foreign body aspiration

SUMMARY OBJECTIVE: Foreign body aspiration is one of the childhood emergencies that thoracic surgeons are interested in, and it can cause morbidity and mortality. Although the relationship between various behavioral problems related to children and foreign body aspiration has been investigated so far, there is no study investigating the relationship between maternal temperament and anxiety sensitivity. This study aimed to investigate the relationship between maternal emotional temperament, anxiety sensitivity, and foreign body aspiration. METHODS: Mothers of 18 children with foreign body aspiration have been evaluated by a thoracic surgeon, and 18 healthy controls have also been included in the study. Maternal emotional temperament has been measured with the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego - Auto questionnaire scale, and anxiety sensitivity has been measured with the Anxiety Sensitivity Index-3. RESULTS: There has been no statistically significant difference between groups in terms of maternal emotional temperament and anxiety sensitivity. In the logistic regression analysis conducted to determine the predictors of foreign body aspiration, it is determined that the mother's anxious temperament has predicted foreign body aspiration significantly. CONCLUSION: As a result of the study, it can be concluded that mothers' anxious temperament can be considered a risk factor for foreign body aspiration because it affects parenting skills and children's ability to manage behavioral problems. Consistent results could be able to be obtained with studies including larger samples on the subject.

POLYEMBOLOKOILAMANIA IN THE EMERGENCY DEPARTMENT.

Polyembolokoilamania is a rare but serious medical condition that involves the presence of multiple foreign bodies in the patient's body. This condition can be challenging to diagnose and manage in the emergency department. In this chapter, we will discuss the presentation, diagnosis, and management of polyembolokoilamania in the emergency department.

Foreign Body Accidents in a Pediatric Emergency Department

Abstract Introduction Foreign body accidents (FBAs) are frequent in children and can be severe, being a common cause of morbidity and mortality and a public health problem. As these accidents are multifactorial, their cause can only be determined by analyzing the clinical details and characteristics of the object. Knowing the associated mechanisms and factors is essential to determine a risk profile and have a preventive, therapeutic, and diagnostic purpose. Objective The present study aimed to describe the incidence of FBAs in otorhinolaryngology according to their anatomical location, focusing on the aerodigestive system. Methods This is a retrospective study performed by reviewing the medical records of 668 cases seen in the emergency department of a tertiary pediatric hospital in São Paulo, state of São Paulo, Brazil, between 2014 and 2017. Results Foreign bodies (FBs) were found in the digestive system (238/668), in the nasal cavities (206/668), in the ears (182/668), in the oropharynx (34/668), and in the respiratory system (8/668). A total of 91.77% of the patients were treated in the emergency room. The main age group affected was < 5 years old, with no difference between genders. The most frequent complications affected the digestive system and the most serious occurred in cases involving the respiratory system. Conclusion Multidisciplinary teams should be ready in the emergency room to provide adequate care in FBAs. Early diagnosis, FB removal in the emergency room or the surgical center and follow-up are essential. Developing prevention campaigns including a risk profile for certain products and/or materials, helping to ensure safety for consumers, is necessary. For this, a national database with compulsory notification containing relevant information on FBAs in the pediatric population should be created.

AURAL SYRINGING: A ONE SIZE FITS ALL SOLUTION FOR EAR FOREIGN BODIES?

Objectives: To ascertain if aural syringing is a one size ?ts all solution for aural foreign body removal in a rural setting A Record based descriptive study was looked at paediatric and adult patients Methods: with Aural FB (foreign bodies) who visited ER (Emergency) and ENT-OPD (Out Patient Department) of a single institution between January 2022 and December 2022.The Diagnosis of Aural foreign bodies was based on personal history and Otoscopic ?ndings. Patient characteristics, foreign body type, removal attempts and complications were evaluated with respect to clinical setting and patient outcome. The Data was obtained from the records. 86 patients were brought to Results: the emergency department and ENT-OPD over a 12-month period with foreign bodies of the EAC (External Auditory Canal). Otolaryngologists used otoscope and standard metallic aural syringe as their mainstay of management. Analysis of ER and OPD cases revealed Inorganic aural foreign bodies were 65.11% and 34.88% were Organic foreign bodies. Unilateral Purulent Aural Discharge was in 46.51% (40) patients, pain in 17.44% (15), Ear Bleeding in 8.13% (7), conductive hearing loss and tinnitus was 10.46% (9) and itching in 4.65% (4). Duration of Symptoms was <1 week in 65.11% (56) cases ,1-2 weeks in 22.09% (19) and 2-4 weeks in 12.79% (11) cases. Successful removal of foreign bodies from ear by only applying aural syringing was achieved in 91.86% of cases, and usage of other methods of aural foreign body removal Forceps, Hook and Suction in 5.8% and foreign body removal under GA was 2.32% were recorded Aural foreign bodies were commonly seen in paediatric Conclusion population. Patients commonly present to the ER and OPD for removal of EAC foreign bodies. The common inorganic aural foreign bodies were cotton tip, stone and eraser whereas ?y, lice and bee were the organic FB. The most common symptoms and complications of aural FBs, were unilateral purulent discharge followed by pain, ear Bleeding, Tympanic membrane perforation, external meatus laceration, chronic otitis media and facial Nerve paralysis. The most common procedures used were Syringing followed by Forceps, hook and suction. It is observed that aural syringing performed by the trained hands of an otolaryngologist is a very effective method and can almost be described as a one size ?ts all solution for managing foreign bodies in EAC with some notable exceptions.

Autoimmune/inflammatory syndrome induced by adjuvants (ASIA), medical treatment of severe systemic compromise: case report

Case description: A 42-year-old woman with severe pulmonary and mediastinal inflammatory involvement, secondary to infiltration of a silicone-related allogenic material with systemic migration. Clinical findings: The patient developed esophageal and bronchial stenosis, recurrent infections, malnutrition, and respiratory deterioration, making surgical removal of the allogenic material impossible. Treatment and outcome: Clinical and radiological improvement was achieved after treatment with multiple intravenous and oral immunomodulators. Clinical relevance: Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is a heterogeneous disease resulting from exposure to allogenic substances in a susceptible subject. These substances cause autoimmune or autoinflammatory phenomena. Since ASIA was described ten years ago, its diagnostic criteria are still under discussion, with an uncertain prognosis. The ideal therapy is based on eliminating the causative substance, but this is not always possible. Therefore, it is necessary to start an immunomodulatory treatment, using it in this patient, a scheme that had not been previously reported in the literature.

Descripción del caso: Mujer de 42 años con compromiso inflamatorio pulmonar y mediastinal severo, secundario a infiltración de un material alogénico relacionado con la silicona con migración sistémica. Hallazgos clínicos: La paciente desarrolló estenosis esofágica y bronquial, infecciones recurrentes, desnutrición y deterioro respiratorio, imposibilitando la extracción quirúrgica del material alogénico. Tratamiento y resultado: Mejoría clínica y radiológica lograda tras un tratamiento con múltiples inmunomoduladores intravenosos y orales. Relevancia clínica: El síndrome autoinmune / inflamatorio inducido por adyuvantes (ASIA) es una enfermedad heterogénea que resulta de la exposición a sustancias alógenas en un sujeto con susceptibilidad genética. Estas sustancias inducen fenómenos autoinmunitarios o autoinflamatorios. Desde que ASIA fue descrito hace 10 años, sus criterios diagnósticos continúan en discusión, con un pronóstico incierto. El tratamiento idóneo se basa en eliminar la sustancia causante, pero no siempre es posible, por lo cual se hace necesario iniciar un tratamiento inmunomodulador, empleándose en esta paciente un esquema que no había sido reportado previamente en la literatura.

Cases of Orbital Cellulitis Revealing Neglected Intraocular Foreign Bodies

Background: Orbital cellulitis is defined as acute inflammatory orbital swelling of infectious origin. Most often secondary to sinusitis. Intraocular foreign bodies neglected because of their small size, or sometimes radio-transparent nature, can be difficult to diagnose even with radiology and be responsible for orbital cellulitis. We demonstrate the diagnostic and therapeutic difficulties.Patients and Methods: This is a retrospective descriptive study of patients with unilateral orbital cellulitis revealing neglected intraocular foreign bodies, conducted in the Department of Adult Ophthalmology, Hospital August 20, 1953, involving 58 patients, from January 2015 until December 2020.Results: The average age of the patients was 38.5 years. The most affected age group was between 21 and 30 years with a clear male predominance. A decrease in visual acuity was found in all patients (unilateral blindness 43%) and a cellulitis complicated by a purulent melt (43%). All patients received medical treatment, including intravitreal injections of antibiotics in 71% of cases, and surgical treatment consisting of extraction of the foreign body and immediate evisceration of the eyeball in 25% of cases.Conclusion: Orbital cellulitis, although mostly secondary to sinusitis, can reveal various etiologies such as intra-orbital foreign bodies that can go unnoticed and be life-threatening and functionally damaging, especially when the diagnosis is made late and management is inappropriate. The presence of an intraocular foreign body must be suspected in all cases of orbital trauma associated with a palpebral wound, even if it is minimal, or in the presence of a clinical aggravation. Any delay in diagnosis and/or treatment can lead to serious complications that can affect the functional and even vital prognosis. The surgical treatment consists of the extraction of the foreign body. The recourse to evisceration in our context unfortunately continues to persist at high rates; because of the delay of consultation and thus of the management.

Research on effect of pulsatile external auditory canal irrigation on foreign bodies in children / 中国实用护理杂志

Objective:To explore the methods to improve the success rate of external canal foreign body washing and reduce the incidence of adverse reaction in children (≤14 years old).Methods:This study was a randomized controlled trial. A total of 60 pediatric patients with ear canal foreign bodies who were admitted to the otolaryngology-head and neck surgery clinic of Shengjing Hospital Affiliated to China Medical University from January 2021 to May 2022 were selected. The patients were divided into the experimental group and the control group by the random number table method, with 30 cases in each group. The experimental group were treated with pulsatile external auditory canal irrigation method, while the control group were treated with the conventional ear canal flushing method. The success rate of flushing, the flushing time, the incidence of adverse reactions and satisfaction of the patient's family were compared between the two groups.Results:The success rate of flushing was 80.0% (24/30) in the experimental group and 46.7% (14/30) in the control group, with statistically significant difference ( χ2= 7.18, P <0.05). The flushing time was (140.80 ± 44.48) s in the experimental group and (296.60 ± 82.79) s in the control group, with statistically significant difference ( t=9.08, P <0.05). The incidence of adverse reactions was 23.3% (7/30) in the experimental group and 63.3% (19/30) in the control group, with statistically significant difference ( χ2=9.77, P<0.05). The satisfaction of the patient's family was 93.9% (28/30) in the experimental group and 36.7% (11/30) in the control group, with statistically significant difference ( χ2=21.17, P<0.05). Conclusions:The pulsatile external auditory canal irrigation method can improve the success rate of ear canal foreign body flushing, shorten the flushing time and reduce the adverse reactions. The need for surgery and hospitalization due to ear canal foreign body, the suffering of patients and the corresponding cost can be decreased accordingly. The new treatment showed clear advantages clinically and should be widely applied.

Perforación gástrica y pancreática, con trombosis de vena porta por ingesta de cuerpo extraño

La ingesta accidental de cuerpos extraños en una entidad frecuente en la urgencia, presentándose en general como dolor abdominal inespecífico. Presentamos caso que ingirió un escarbadientes de madera cuyo manejo inicial fue conservador. Su evolución fue tórpida, requiriendo cirugía de urgencia por perforación del estómago y páncreas.

Accidental ingestion of foreign bodies is rather a frequent entity in the ER, presenting in general as non-specific abdominal pain. The study presents the case of a patient who ingested a wooden toothpick, the handling of which was conservative. Evolution was torpid, requiring emergency surgery given the perforation of the stomach and pancreas.

A ingestão acidental de corpos estranhos é uma entidade frequente no pronto-socorro, apresentando-se geralmente como dor abdominal inespecífica. Apresentamos um caso de ingestão de palito de madeira cujo manejo inicial foi conservador. Sua evolução foi complicada sendo necessário realizar uma cirurgia de emergência devido à perfuração do estômago e do pâncreas.

Anterior segment optical coherence tomography characteristics and management of a unique spectrum of foreign bodies in the cornea and anterior chamber

Purpose: To report anterior?segment optical coherence tomography (ASOCT) characteristics of different types of corneal and anterior chamber (AC) foreign bodies (FBs) and their usefulness in diagnosis and management. Methods: This is a retrospective descriptive clinical study involving 11 eyes of 11 patients who presented at the outpatient department of a tertiary ophthalmic care center from January 2017 to January 2022. All patients had a diagnosed or suspected corneal FB. All participants underwent a comprehensive ophthalmological examination, followed by slit?lamp photography and ASOCT. FB removal was done where required by an external, internal, or combined approach. Results: The mean age of patients was 28.2 (7–53) years. Ten were male, and one was female. Seven patients had a definitive positive history of injury; in one, there was a history suggestive of trauma, one had the post?operative complication of scleral buckling surgery, and two patients had a history of insect fall in the eyes. Three patients had acute, four had sub?acute, and four had chronic presentations. Descemet’s membrane (DM) breach was suspected in three cases of deep FB, which was later confirmed on ASOCT. In two cases, DM was presumed to be intact clinically, but ASOCT showed an AC penetration. The FB was removed in seven patients, one via slit?lamp, one via an external approach, two via an internal approach, and three via a combined approach. Conclusion: ASOCT facilitates non?invasive rapid imaging of ocular tissue at various depths, provides an accurate assessment of FB characteristics, and thereby serves as an additional tool in our armamentarium for diagnosis and management of deep corneal and AC Fbs

Asymptomatic foreign body spontaneously discharged from Wharton's duct: a case report

Some situations can lead to obstruction of Wharton's duct. Obstructions are usually due to endogenous causes, such as calculi, fibromucinous plugs, stenosis, and malformations of the duct system; however, in rare situations, obstructions can also have exogenous causes, such as foreign bodies. The tortuous anatomy of Wharton's duct hinders the retrograde migration of straight-shaped foreign bodies, as well as makes their spontaneous discharge virtually impossible. Here, we report the case of a 47-year-old woman with an asymptomatic foreign body in Wharton's duct that was spontaneously discharged.

Esofagotomía y cierre primario por cuerpo extraño en esófago superior / Esophagotomy and primary closure due to foreign body in the upper esophagus

RESUMEN Los cuerpos extraños en el esófago son un problema frecuente en urgencias, debido la mayoría de las veces a ingestión accidental. Presentamos el caso de una paciente femenina de 50 años, sin antecedentes patológicos, que consulta por presentar la ingesta de prótesis dental mientras almorzaba, con posterior disfagia, odinofagia y dolor cervical. Se le realizan radiografías y tomografía computarizada (TC) donde se evidencia imagen radiopaca en esófago cervical. Se interconsulta con el Servicio de Gastroenterología, dada la imposibilidad de extracción de la prótesis por vía endoscópica. Se realiza luego cervicotomía lateral izquierda de emergencia, con esofagotomía, extracción del cuerpo extraño y cierre primario del esófago. La obstrucción del esófago por cuerpos extraños puede ocasionar muchas complicaciones. La consecuente demora en el tratamiento puede llevar a un marcado aumento de la mortalidad. Por eso, en este caso, se prioriza la cirugía ante un riesgo elevado de perforación y hemorragia.

ABSTRACT Esophageal foreign bodies are a common problem in the emergency department, usually due to accidental ingestion. We report the case of a 50-year-old otherwise healthy female patient who sought medical care due to dysphagia, odynophagia and cervical pain after swallowing a partial denture while having lunch. The patient underwent X-rays and a computed tomography (CT) scan which showed a radiopaque image in the upper esophagus. After a failed attempt to remove the denture through endoscopy, surgery was decided via a left lateral emergency cervicotomy with esophagotomy, foreign body removal and primary closure of the esophagus. Esophageal obstruction due to foreign bodies may cause many complications. Treatment delays may result in increased mortality. Thus, in this case we prioritized surgery due to high risk of perforation and bleeding.

Cuerpos extraños intracorneales retenidos / Retained intracorneal foreign bodies

Los cuerpos extraños constituyen la segunda forma más común de traumatismos corneales. Pueden localizarse superficiales o intracorneales. Se realiza presentación de caso de paciente con cuerpos extraños intracorneales retenidos de 34 años de evolución secundario a trauma por onda expansiva, con el objetivo de mostrar los hallazgos clínicos y resultados por pruebas diagnósticas como la microscopía confocal corneal, frente de onda corneal por topografía y microscopía especular. La presencia de cuerpos extraños intracorneales en este paciente provocó respuestas en el tejido corneal en dependencia de su composición, nivel de profundidad; evidentes a pesar de tiempo de retención. La presencia de estos induce niveles altos de aberraciones corneales que dependen del grado de afectación(AU)

Foreign bodies are the second most common form of corneal trauma. They can be superficial or intracorneal. A case of a patient was presented, with retained intracorneal foreign bodies of 34 years of secondary evolution due to blast wave trauma. The objective is to show the clinical findings and results of diagnostic tests such as corneal confocal microscopy, corneal wavefront topography and specular microscopy. The presence of intracorneal foreign bodies in this patient provoked responses in the corneal tissue depending on its composition, depth level; evident in spite of retention time. The presence of intracorneal foreign bodies induces high levels of corneal aberrations depending on the degree of involvement(AU)

Importance of the use of pre- and intra-operative imaging as a tool for planning foreign body removal in the floor of the mouth: a case report / Importancia del uso de la imagenología pre e intraoperatoria como herramienta para la planificación de remoción de cuerpo extraño en piso de boca: presentación de un caso

Introduction: Body piercings consist of small holes made with a needle in different parts of the skin or body to introduce a jewel or decorative element. In the oral cavity, most piercings are placed in the tongue. However, some complications may occur, and surgical techniques must be used for their removal. These complications present a certain degree of difficulty due to their position and may challenge the ability of the clinician to access the specific anatomical location. The different imaging techniques, from simple radiography to intraoperative techniques such as image intensifiers, have become an extremely useful tool for locating an object in the three dimensions of space, allowing safe location and extraction. Objective: The aim of this study is to report the case of a complication of a body piercing in the oral cavity and how the use of imaging was decisive for surgical planning and for the quick and effective resolution of the case. Material and Methods: A 14-year-old female patient came looking for treatment. Her mother reported the onset of the condition after the insertion of a needle-like metallic object while performing an artistic perforation in the lingual region. Since the girl was unable to extract the object, she sought medical advice at the Carlos Arvelo Military Hospital in Caracas, Venezuela. Subsequently, an imaging study was performed by means of a Computed Tomography to locate the metallic object. It was observed that the foreign body had migrated to the floor of the mouth/sublingual region, requiring the area to be surgically approached. It was also decided to use an intraoperative image intensifier. The removal of the object was performed satisfactorily. Conclusion: The extraction of foreign bodies placed in the lingual and sublingual region represents a challenge for the clinician due to the number of important anatomical structures that pass through that area. This makes clinicians plan their surgical removal using pre- and intraoperative imaging, to find a less traumatic location, reduce surgical time as well as the risk of damaging adjacent anatomical structures.

Introducción: Los body piercings consisten en producir perforaciones con una aguja en diferentes localizaciones de la piel con el fin de introducir una joya o elemento decorativo a través del agujero producido previamente. En la cavidad oral, la lengua es el sitio de mayor elección; sin embargo, en ciertas ocasiones suelen presentarse ciertas complicaciones, por lo cual se debe recurrir a técnicas quirúrgicas para su remoción presentando cierto grado de dificultad para su localización y la capacidad del clínico para acceder al espacio anatómico. Las diferentes técnicas imagenológicas desde una radiografía simple hasta técnicas intraoperatorias como los intensificadores de imágenes se han convertido en una herramienta sumamente útil para la ubicación de un objeto en las tres dimensiones del espacio, permitiendo una localización y extracción segura para el clínico y el paciente. Objetivo: El propósito de este trabajo es reportar un caso de una complicación de esta práctica en la región bucal y cómo el uso de la imagenología fue determinante para la planificación quirúrgica y la resolución del caso de manera rápida y efectiva. Material y Métodos: Se presenta a consulta una paciente femenina de 14 años de edad, quien madre refiere inicio de enfermedad actual posterior a introducirse objeto metálico tipo aguja de compás con la finalidad de realizar perforación artística en región lingual, al no poder extraer dicho objeto, acude a evaluación en el Hospital Militar Carlos arvelo de Caracas; posterior se realiza estudio imagenológico tipo Tomografía Computarizada para la ubicación del objeto metálico donde se observa que el cuerpo extraño habría migrado hacia el piso de boca/región sublingual, teniendo la necesidad de abordar quirúrgicamente la zona y elegir el uso de intensificador de imagen transoperatorio para retiro del mismo el cual se dio de manera satisfactoria. Conclusión: Los cuerpos extraños desplazados a la región lingual y sublingual representan un desafío para el clínico al momento de extraerlos, esto se debe a la cantidad de estructuras anatómicas importantes que pasan por dicha zona, lo que hace que el clínico opte en su planificación quirúrgica por el uso de imagenología pre y transoperatoria obteniendo así una localización menos traumática, menor tiempo operatorio y menor riesgo de lesión de estructuras anatómicas adyacentes.

Cuerpos extraños en otorrinolaringología: Experiencia en Clínica Santa María / Foreign bodies in otolaryngology: Experience at Clínica Santa María

Resumen Introducción: Los cuerpos extraños (CE) en oído, nariz y vía aéreodigestiva superior son el 30% de las urgencia en otorrinolaringología (ORL). No existen datos epidemiológicos nacionales que describan la casuística de CE. Objetivo: Describir la epidemiología de pacientes con diagnóstico de CE evaluados, entre el 2013-2018 en Clínica Santa María de Santiago, Chile. Describir las características de los CE, ubicación, método de extracción y complicaciones. Material y Método: Estudio descriptivo y retrospectivo, basado en revisión de fichas clínicas de pacientes con diagnóstico de CE, analizando variables epidemiológicas y clínicas. Resultados: Se revisaron 1.847 casos con diagnóstico de CE, confirmando 1.494. La mayoría de sexo masculino (53,3%), con un promedio de edad de 16,5 años (rango de 0-95 años). Los CE más prevalentes fueron ótico (52,9%) y nasal (27,9%). El síntoma asociado más frecuente fue la sensación de CE (18,1%). El diagnóstico fue principalmente por examen físico (84%), requiriéndose exámenes complementarios en 18,2%. La extracción fue ambulatoria en su mayoría (84,6%), requiriendo extracción en pabellón el 12,5%. El 5,5% presentó complicaciones, y la tasa de letalidad fue de 0,07%. Conclusión: Esta casuística, única a nivel nacional, nos permite conocer la epidemiología de los CE. Un bajo porcentaje de pacientes fue de riesgo vital, pero el manejo oportuno permite una baja tasa de complicaciones y letalidad.

Abstract Introduction: Foreign bodies (FB) in the ear, nose and upper airway-digestive tract are 30% of the emergencies in otolaryngology (ORL). There is no national epidemiological data that describes the FB casuistry. Aim: To describe the epidemiology of patients who have a diagnosis of a FB evaluated, between 2013-2018, at Santa María Clinic in Santiago, Chile. To describe the characteristics of FB, location, method of removal, and complications. Material and Method: A descriptive and retrospective study, based on review of clinical records of patients with the diagnosis of FB, analyzing epidemiological and clinical variables. Results: 1847 cases with a diagnosis of FB were reviewed, of which 1494 were confirmed. Most were male (53.3%), with an average age of 16.5 years (range 0-95 years). The most prevalent FB locations were otic (52.9%) and nasal (27.9%). The most frequent associated symptom was sensation of a FB (18.1%). The diagnosis was fundamentally based on physical examination (84%), requiring complementary tools in 18.2%. The extraction was mostly ambulatory (84.6%), requiring extraction in the operation room in 12.5%. 5.5% presented complications, and the fatality rate was 0.07%. Conclusion: This casuistry is unique at the national level, and allows us to know the epidemiology of FB. A low percentage of patients correspond to life-threatening locations, but timely management allows a low rate of complications and fatality.

Successful endoscopic removal of a swallowed toothbrush, a therapeutic challenge. A case report / Extracción endoscópica exitosa de un cepillo de dientes, un reto terapéutico. Reporte de caso

Abstract Introduction: Toothbrush swallowing, whether voluntary or accidental, is a rare event and must be handled as an emergency, because these foreign bodies, due to their length and hardness, are not expected to pass completely through the digestive tract and may cause serious complications. Case presentation: A 22-year-old woman with an eating disorder (bulimia nervosa) involuntarily swallowed a toothbrush while inducing vomiting. Unfortunately, after the initial assessment in the emergency department, and due to the lack of symptoms, her psychiatric history, and the fact the toothbrush was not observed in imaging studies, she was discharged. Due to the patient's insistence that she was telling the truth, she was referred to a secondary healthcare institution by her treating physician, where the successful endoscopic extraction of the toothbrush was performed 36 hours after it was swallowed. The procedure was carried out with the patient under sedation and by experts in digestive extraction who used an overtube, foreign body forceps, and polypectomy loops. Conclusion: Cases of toothbrush swallowing are rarely reported and occur mainly in people with mental illnesses, such as eating disorders involving self-induced vomiting. Therefore, in these cases, physicians should always believe what these patients say, even in the absence of symptoms and imaging findings, as this enables their timely referral to a digestive service to confirm whether the toothbrush was swallowed or not and to perform the endoscopic extraction as soon as possible, since it can cause serious complications due to its characteristics.

Resumen Introducción. La ingesta de cepillos de dientes, voluntaria o accidental, es una situación poco frecuente que requiere ser tratada como una emergencia, pues por su longitud y dureza, no se espera que estos cuerpos extraños tengan un tránsito completo por el tracto digestivo, lo que puede causar graves complicaciones. Presentación del caso. Mujer de 22 años con trastorno alimentario (bulimia nerviosa) quien al inducirse vomito ingirió involuntariamente un cepillo de dientes. Lamentablemente, después de la valoración inicial en el servicio de urgencias, debido a que no presentaba síntomas, a su antecedente psiquiátrico y a la no identificación del cepillo en estudios de imagen, fue dada de alta. Ante la insistencia de la paciente de decir la verdad, fue remitida por su médico tratante a una institución de salud de segundo nivel, donde, a las 36 horas de la ingesta, se realizó la extracción endoscópica exitosa del cepillo. El procedimiento fue realizado bajo sedación por expertos en extracción digestiva usando un sobretubo, pinzas para cuerpos extraños y asas de polipectomía. Conclusión. Los casos de ingesta de cepillos de dientes son raramente reportados y ocurren principalmente en personas con trastornos psiquiátricos como desórdenes alimentarios que involucran la inducción de vómito. Por tanto, en estos casos siempre se debe creer la versión del paciente, incluso en ausencia de síntomas y hallazgos imagenológicos, pues esto posibilita una remisión oportuna al servicio digestivo para confirmar la ingesta y realizar la extracción endoscópica lo más pronto posible, ya que, por sus características, pueden causar graves complicaciones.