Ingestion of an unusually high number of foreign bodies in a mentally ill man.

The vast majority of ingested foreign bodies (FB) can pass through the digestive tract without major incidences. In some cases, they accumulate in large amounts in the stomach. They can also perforate the gastrointestinal wall and migrate to extraluminal sites, remaining quiescent for many years. We report a case of a psychiatric patient with more than 100 ingested FB in the stomach.

Penetrating hypopharyngeal foreign body impalement of the thyroid gland: A case report of rare complication of ingested fish bone.

INTRODUCTION AND IMPORTANCE: Foreign body ingestion complicated by hypopharyngeal perforation is an uncommon but potentially life-threatening condition. Early recognition and appropriate management are crucial to prevent serious complications. We present an extremely rare case highlighting the importance of this clinical entity. CASE PRESENTATION: A 60-year-old female presented with odynophagia 10 days after ingesting fish and chicken. Imaging revealed a linear foreign body penetrating through the left lateral hypopharyngeal wall into the left thyroid lobe, with surrounding inflammatory changes. The patient underwent neck exploration, which identified a sharp fishbone lodged in the postero-medial aspect of the left thyroid lobe, necessitating a left hemithyroidectomy for removal. CLINICAL DISCUSSION: To our knowledge, this is the first reported case of hypopharyngeal perforation by an ingested foreign body penetrating the thyroid gland itself. Despite its rarity, early recognition is crucial to prevent complications like abscess, mediastinitis, and mortality. A high index of suspicion is needed in patients with odynophagia or neck pain after ingesting fish. Advanced imaging and surgical intervention may be required for the management of larger perforations or those involving surrounding structures. CONCLUSION: This unique case highlights an extremely rare presentation of hypopharyngeal perforation with extension into the thyroid gland caused by an ingested fish bone. Prompt diagnosis through appropriate imaging and treatment with surgical exploration and foreign body removal was key to ensuring a positive outcome. Increased awareness of this potential complication is essential among clinicians.

Foreign Body Appendicitis Coexisting With Ascariasis in a Pediatric Patient: A Case Report.

In clinical practice, the typical approach to ingested foreign bodies in stable patients involves expectant management, as most materials pass through the gastrointestinal (GI) tract without adverse effects. However, foreign bodies that travel through the appendix's lumen can cause acute appendicitis due to their inability to exit the colon. Rarer causes of appendicitis include parasitic infiltration by Ascaris lumbricoides. The wandering behavior of Ascaris lumbricoides within the GI tract can lead to various surgical complications in the abdomen. Occasionally, these parasites can migrate to the vermiform appendix, where they may either induce pathological changes or remain asymptomatic. We report an unusual case of an eight-year-old Pakistani female patient who presented to the emergency room with pain in the right iliac fossa, associated with anorexia and nausea, for one day. On examination, the patient was found to be vitally stable, with right iliac fossa tenderness noted on palpation. Additionally, the patient exhibited positive pointing, rebound, Rovsing, and psoas signs. Her medical history revealed that she had ingested a metallic needle seven months ago. Blood tests were undertaken, and an abdominal X-ray confirmed the existence of a radiopaque metallic object in the right lower quadrant of the abdomen. The patient underwent an open appendicectomy for acute appendicitis and was discovered to have a metallic needle lodged in the vermiform appendix. Concurrently, she also had ascariasis, as she vomited a 23-cm-long Ascaris lumbricoides worm. It is important to consider both mechanical and parasitic etiologies in diagnosing acute appendicitis; detailed evaluation and management strategies are necessary to address these unique etiologies effectively.

Repeated intentional foreign body ingestion, what can be done?

Repeated intentional foreign body ingestion (RIFBI) in patients with Emotionally Unstable Personality Disorder (EUPD) is a common clinical presentation to the emergency department. The relationship between repeated foreign body ingestion and a co-existent personality disorder diagnosis is complex, making it challenging to manage. Our institution implemented a novel interdisciplinary model of care for RIFBI as a way of improving health outcomes in this cohort of patients. Our observations following the model of care are presented herein. We encourage other health networks to adopt this model of care for managing RIBFI in EUPD.

Foreign Body Ingestion in Children: An Experience of 99 Cases in a Tertiary Care Center in Delhi.

Background: Accidental ingestion of foreign bodies in children is critical, as the inability to effectively communicate can potentially lead to devastating consequences. We aimed to determine the epidemiology of foreign body ingestion and variability according to age, gender, type, and location of foreign body, and describe its management. Aim and Objective: The aim was to study the various types of foreign body ingestions in children admitted to pediatric surgery and their management. Materials and Methods: A retrospective study was conducted from January 2020 to June 2022 on children under the age of 12 years with a confirmed diagnosis of foreign body ingestion. Patients were clinically and radiologically assessed, after which standard protocols were followed wherein patients were followed by either observation or emergent management. Emergent management included removal of the foreign body by either endoscopy or surgery. Comparisons among multiple age groups, gender, type of foreign body, location of foreign body, and their management were analyzed. Results: Out of 99 subjects in our study, there were 76 boys and 23 girls. The median age of presentation was 5 years. Most children were asymptomatic at presentation. The most frequently ingested foreign body was a coin in all age groups. The majority of the foreign bodies were suspected to be in the small bowel. The foreign bodies that had crossed the duodenojejunal flexure (n = 74, 74.7%) were managed conservatively with the observation of a variable period of a minimum of 24 h and a maximum of 48 h. 21 cases were managed by endoscopic removal, while three cases required surgical intervention. Conclusions: Overall, the most common gastrointestinal foreign body was a coin in all age groups. Button battery is the most worrisome foreign body; however, depending on its position, it can be managed conservatively. Upper GI foreign bodies can be safely removed endoscopically. Parental counseling is very important for the prevention of ingestion of foreign bodies.

Esophageal Button Battery Retrieval: Time-In May Not Be Everything.

The management of ingested foreign bodies is a challenging task because each case is unique with multiple varying factors including a patient's age, anatomical considerations, clinical presentation, and the type and location of the foreign body ingested. Additionally, concern over complications associated with button battery ingestion typically drives management decisions. The common practice is the urgent retrieval of the foreign body within two to six hours of presentation. An unusual case is presented here that demonstrated significantly delayed endoscopic removal of an ingested button battery without complication, avoiding the many risks associated with any emergent endoscopic procedure. However, this practice is a case-by-case decision because there is a lack of literature to guide the current management.

A case of corrosive tracheoesophageal fistula: A complication of button battery ingestion.

Key Clinical Message: Button battery ingestion has been a common condition encountered by otorhinolaryngologists. Impaction in the esophagus can lead to serious and fatal complications such as tracheoesophageal fistula. Management involves a multidisciplinary team and varies from supportive therapy to surgical intervention. Abstract: Ingestion of button batteries has been seen with increasing frequency over the past decade. In several small numbers of reported cases, their impaction in the esophagus has led to severe, sometimes fatal, complications. The management of these cases has varied from expectant, supportive therapy to early surgical intervention. We report a case of button battery ingestion that was diagnosed late and resulted in a complication of tracheoesophageal fistula with migration to the thorax which was managed by open surgery.

"Necklace of magnets" in the abdomen: an unusual case with "multiple" bowel perforations.

Magnetic foreign body ingestion poses a threat especially if more than one is ingested. If consumed alone, small magnetic foreign bodies are likely to pass without significant event; however, when multiple magnets are ingested, they can be attracted to each other through the intestinal wall, which may lead to serious consequences and complications, including bowel perforation, obstruction, peritonitis, and death. We report a case of a 2-years male child patient presented with multiple small round magnetic beads ingestion from a magnetic pendant that appeared like a necklace pearl after conglomeration on abdominal radiograph. On exploration, we found multiple perforations involving ileum, cecum, and transverse colon, with multiple conglomerated beads extruding from the perforation sites.

Ingestion of fishing gear and Anisakis sp. infection in a beached Indo-Pacific finless porpoise (Neophocaena phocaenoides) in the Jeju Island, Republic of Korea: findings from post-mortem computed tomography and necropsy.

BACKGROUND: Human fishing activities have significantly affect environmental concern for marine ecosystems, conservation of marine mammals, and human health. Coastal cetaceans are highly vulnerable to ingestion of fishing gear, bycatching, or entanglement, all of which can be fatal for these animals. In particular, certain coastal dolphins and porpoises are heavily impacted by fishing gear such as angling gear or stownet, as their food often overlap with the target fish species of human fisheries. CASE PRESENTATION: This study presents a case of an Indo-Pacific finless porpoise (Neophocaena phocaenoides) beached on the coast of Jeju Island, Republic of Korea, with ingestion of fishing gear and severe Anisakis infection. Although this species inhabits waters ranging from the Persian Gulf to Taiwan, several stranded carcasses have been reported on Jeju Island in recent years. Post-mortem computed tomography revealed a bundle of four fishing hooks in the forestomach, along with nylon lines and steel lines with connectors, which were assumed to be angling gear for Jeju hairtail (Trichiurus lepturus). Further necroscopic investigation revealed that the forestomach contained a large number of Anisakis spp. (Nematoda: Anisakidae). Histological examination revealed a thickened forestomach wall with pinpoint and volcanic ulcerations, a thickened layer of stratified squamous epithelium, and infiltrated stroma in the squamous epithelium. CONCLUSIONS: This study emphasizes the urgent need to address the impact of fishing activities on marine mammals, marine litter pollution, and the bycatch problem in Korean seawater. In addition, the occurrence of N. phocaenoides in seawater around Jeju Island should be raised in future geographical ecology or veterinary pathology studies and when its distribution is updated.

Imaging approach to ingested foreign bodies in the neck.

Foreign body ingestion is a common clinical occurrence worldwide, with high morbidity in the pediatric population and in adult patients with intentional attempts. Coins and button battery ingestions are more common among children. Bone impaction and swallowed dentures are usually seen in older adults. While most ingested foreign bodies pass through the gastrointestinal tract spontaneously with no complications, some require endoscopic and/or surgical intervention. Complications such as pharyngoesophageal ulceration, perforation, stricture, and deep neck infection can develop without timely diagnosis and management. The purpose of this article is to familiarize radiologists with the imaging approach to assess for characteristics and impacted locations of ingested foreign bodies in the neck.

Endoscopic Removal and Conservative Treatment of a Small Bowel Perforation Caused by a Toothpick: A Case Report.

This case report describes a unique instance of small bowel perforation in a 49-year-old woman caused by an ingested toothpick. Initially suspected of colonic diverticulitis, a final diagnosis of small bowel perforation was made later, and the toothpick was successfully removed via endoscopy. This case emphasizes the need to consider foreign body ingestion in the differential diagnosis of abdominal pain and demonstrates the feasibility of conservative endoscopic approaches in similar cases.

Coconut leaf midrib skewer as a cause for small bowel obstruction and perforation: A case report.

Foreign body ingestion is an infrequent cause of small bowel obstruction and, rarely, perforation. It is a common occurrence among pediatric patients, mentally impaired and the edentulous elderly population majority of which will pass through the gastrointestinal tract uneventfully. The likelihood of complications such as perforation, bleeding or fistula formation increases markedly particularly for sharp, stiff, and elongated objects (i.e. toothpicks, meat bones, pins, and razor blades). Diagnosis can be difficult as frequently patients are incognizant of the nature and time of ingestion. Imaging is commonly non-specific as well. We present an unusual case of a 65-year-old male who had an ileal perforation secondary to a coconut leaf midrib skewer initially presenting as small bowel obstruction. Intraoperatively, adhesions were seen in the ileum with note of the foreign body perforating two bowel loops that was not identified in preoperative imaging. This case highlights the importance of considering atypical causes of small bowel obstruction even in the background of previous surgery. Finally, early recognition, accurate diagnosis, and timely intervention are essential to improve patient outcomes and decrease mortality in such cases.

Artificial intelligence in the detection of non-biological materials.

Artificial Intelligence (AI) has emerged as a transformative force within medical imaging, making significant strides within emergency radiology. Presently, there is a strong reliance on radiologists to accurately diagnose and characterize foreign bodies in a timely fashion, a task that can be readily augmented with AI tools. This article will first explore the most common clinical scenarios involving foreign bodies, such as retained surgical instruments, open and penetrating injuries, catheter and tube malposition, and foreign body ingestion and aspiration. By initially exploring the existing imaging techniques employed for diagnosing these conditions, the potential role of AI in detecting non-biological materials can be better elucidated. Yet, the heterogeneous nature of foreign bodies and limited data availability complicates the development of computer-aided detection models. Despite these challenges, integrating AI can potentially decrease radiologist workload, enhance diagnostic accuracy, and improve patient outcomes.

Ingestion of heated tobacco sticks containing a micro-blade by children: the importance of performing a radiograph.

INTRODUCTION: Some tobacco sticks, such as TEREA™ heat sticks for IQOS ILUMA™, contain a blade. Both the nicotine part of the device and the micro-blade can be ingested by children. CASE SUMMARIES: We report two children, an 18-month-old boy and a 10-month-old girl, who ingested a heat stick containing a micro-blade. IMAGES: Radiography revealed the micro-blade to be in the child's mouth in the first case and the stomach in the second. Endoscopy was performed on the second child, confirming the presence of the blade in the stomach. CONCLUSION: We recommend performing a radiograph on all children who ingest tobacco sticks containing a micro-blade. If a metallic object is present, we recommend endoscopic removal to avoid traumatic lesions from the sharp edges.

[Foreign body ingestion].

INTRODUCTION: Foreign body ingestion by young children has been increasing for years. Ingestions of batteries and magnets are particularly problematic.[1] Before and during diagnosis, there are some important steps that should be followed to allow for proper patient management.

Repeated foreign body ingestion as a dynamic game: A case report.

In this case report, we correct the analysis of mitigating intentional foreign body ingestion offered by Sarah J. Diamond and Amnon Sonnenberg. Patients who notoriously swallow foreign objects generate significant economic costs to hospitals. In previous publications, it has been argued that hospitals might reduce the need for endoscopy by offering such patients a paid position to discourage foreign body ingestions. However, the game-theoretical analysis offered in the literature was based on a static game which did not justify the relevant equilibrium. To obtain the actual goal of keeping the patient away from foreign body ingestion, we consider a repeated game with an infinite horizon. We show that there exists a combination of strategies applied by the hospital and the patient that leads to a steady state in which the patient will be discouraged from foreign body ingestion.

Incidental Finding of a Fish Bone Perforation in the Pylorus Mimicking Acute Cholecystitis.

We present a case of a 43-year-old man with Crohn's disease who presented with epigastric and right upper quadrant abdominal pain, initially suspected to be acute cholecystitis or a Crohn's flare-up. CT revealed a curvilinear, hyperdense foreign body adjacent to the duodenum, concerning micro-perforation. Endoscopic examination confirmed findings of a 3 cm fish bone lodged in the pylorus. Endoscopic extraction was successful without significant mucosal damage, and the patient recovered well postoperatively. This case highlights the rarity of pyloric perforation secondary to fish bone ingestion and highlights the importance of considering this diagnosis in patients presenting with unexplained acute abdominal pain, as prompt recognition and intervention are essential for favorable outcomes.

Safety beyond Sight: Handheld Metal Detectors as Diagnostic Allies in the Management of Children Suspected to have Ingested Foreign Bodies.

BACKGROUND: Foreign body (FB) ingestion remains a common cause of pediatric emergency department referrals, and the gold standard for detection is whole-digestive-tract radiographic examination. Our study explores whether handheld metal detectors (HHMD) can effectively identify the presence and location of ingested metal objects, potentially reducing the need for additional radiographic examination. METHODS: We collected medical data from children with suspected metal FB ingestion who were referred to our emergency department (October 2017-March 2023), focusing on object type and correlating metal detector findings with radiographic images. RESULTS: Data from 43 children (39.5% female; mean age: 4 y) referred to our emergency department were analyzed. Coins (32.6%), button batteries (18.6%), and hairpins (11.6%) were the most common ingested objects. Metal detectors detected the presence of FBs in 81.4% of cases (sensitivity: 89.7%; specificity: 100%). Radiographs, taken for 40 children, showed that the most common locations were the stomach (37%) and intestine (33%). The metal detector signals matched the radiography results in 69.8% of cases. According to HHMD, 34.9% of objects were accessible via endoscopy, contrasting with 51.2% via radiography (p < 0.05). CONCLUSION: While the findings obtained using handheld metal detectors often correlate well with radiograph findings in detecting metal FBs, for an important number of children, this confirmation is lacking, especially when determining the exact location of an object.

Successful Retrieval of 35 Razors From the Stomach via Upper Gastrointestinal (GI) Endoscopy: A Case Report.

Adult ingestion of foreign bodies in the digestive system is a common clinical challenge, often involving mentally impaired individuals, criminals, and drug dealers or occurring accidentally. Encounters with multiple sharp foreign bodies are infrequent and pose significant risks, including gastrointestinal (GI) bleeding, perforation, internal fistulas, and infection. The choice between endoscopy and emergency surgery for removal is contentious, with the less invasive endoscopy typically favored as the first line of management, depending on the foreign body's location and endoscopic accessibility. The current literature on the treatment of numerous sharp foreign bodies is sparse. This case report illustrates the successful endoscopic removal of a large quantity of sharp foreign bodies (35 half blades) from the upper GI tract, utilizing various extraction tools. It also aims to contribute to the existing literature regarding management strategies for ingested sharp foreign bodies. A comprehensive account is provided of the clinical presentation, imaging studies, consultations, and endoscopic procedures performed, culminating in the patient's safe discharge from our facility.

Occurrence of multiple fistulas decades after ingestion and neglect of numerous thermometers: a case report.

BACKGROUND: Ingestion of thermometers is a very rare occurrence and associated with penetrations of hollow organs. An event decades ago can lead to the development of fistulas. CASE PRESENTATION: We present a case of a 62-year-old male who swallowed multiple thermometers with a length of up to 22 cm over a period of 40 years. Diagnostic imaging presented a retroperitoneal abscess due to a duodenal perforation of the longest thermometer as well as multiple other thermometers stuck in the small intestine. After all thermometers were removed and the abscess drained, the patient showed a clinical deterioration. In further operations we found a duodeno-sigmoid fistula and a gastro-thoracal fistula, which were not visible in the initial operations and imaging. CONCLUSION: We recommend an active search for fistulas especially in the case of long-foregone ingestion.