[Treatment of foreign bodies in the upper third of the esophagus without endoscopy: is it a challenge for practitioners working in isolation?] / Prise en charge des corps étrangers du tiers supérieur de l'œsophage sans endoscope: un défi pour le médecin en situation isolée?

The treatment of foreign bodies in the upper third of the esophagus is well codified and it is more often based on endoscopic treatment. This specific instrument as well as gastroenterologists trained in its use are sometimes missing in African countries. Physicians have to use alternative approaches to treat this disease. This study aimed to evaluate the procedure for the removal of foreign bodies in the upper third of the esophagus carried out by anaesthetists-resuscitators in a medical and surgical center in Chad. Thirty seven cases of foreign body removal in children aged 0-15 years were analyzed. Coins and lithium batteries were removed in 92% and 8% of cases respectively. Foley balloon catheter was used in 43.2% of cases and laryngoscopy forceps in 56.8% of cases. One case of therapeutic failure requiring cervicotomy was recorded in each group. Four minor complications were reported in the "laryngoscopy forceps group", no complication in the "Foley" group. Physicians must have adequate preparation for the removal of a foreign body in the upper third of the esophagus. In case of unavailability of endoscope, other alternative techniques can be used with a satisfying success rate. In case of failure, surgery may be necessary.

Transaortic migration of a Steinman wire from the shoulder.

Orthopedic pins and wires are regularly used for the treatment of bone fractures and dislocations. Migration of these devices from the shoulder into the thoracic cavity is an uncommon but well-known complication. However, great vessels' injuries by a migrated wire are extremely rare. We report the case of a 78-year-old woman with a penetrating injury of the ascending thoracic aorta and the superior vena cava caused by migration of a Steinman wire that was used for percutaneous fixation of a left-shoulder dislocation 5 years earlier. There was no hemothorax, hemomediastinum, or hemopericardia, but hemoptysis was present. Such a case has not been previously described. The patient was treated by an emergency median sternotomy with a favorable outcome.

Right postoperative pleural effusion following laparoscopic appendicectomies: a case series.

Pleural effusion is not a commonly reported complication of appendicectomy. In our experience, we have performed all forms of appendicitis by laparoscopy (n = 217) since August 2006. We report three consecutive cases of right postoperative pleural effusion, all of which occurred during the immediate postoperative course of a laparoscopic appendicectomy. All three patients presented a perforated appendicitis. The right postoperative pleural effusions seem to be linked to the laparoscopic approach, and can be explained by the cumulative effects of peritoneal lavage, pneumoperitoneum and Trendelenburg position. The first two cases were managed medically by intravenous antibiotic therapy. The third patient required a pleural drainage by thoracoscopy. Surgeons should be aware of this complication when operating perforated appendicitis by the laparoscopic method.