Duodenal ileus caused by a cage magnet in a Fleckvieh cow.

The present report aims to describe the case of a duodenal obstruction ileus in a dairy cow that was caused by a cage magnet. The 4.7-year-old German Fleckvieh cow was hospitalized because of symptoms of intestinal obstruction such as anorexia, noticeable drop in milk yield, reduced defecation, dehydration and positive percussion and swinging auscultation in a circumscribed area cranial of the right flank over the last 2 ribs. Six months as well as 3 days prior to hospitalization the cow had already been treated for signs of hardware disease, which included administration of a cage magnet.After the initial clinical diagnostic procedure on hospital admission, a diagnostic laparotomy in the right paralumbar fossa was performed to identify the cause of the ileus. The cranial part of the duodenum was markedly dilated, and a solid foreign body was found obstructing the intestine immediately aboral to the duodenal sigmoid flexure. This was identified as a cage magnet, which was massaged in retrograde direction into the pyloric antrum and removed via abomasotomy. The cow recovered from surgical intervention and was discharged from the hospital 6 days later.The present report describes an unusual complication of cage magnet administration, which is a standard veterinary procedure and generally considered a safe treatment option in cows with clinical signs of acute traumatic reticuloperitonitis.

Intravaginal Foreign Body: A Rare Cause of Persistent Vaginal Discharge in a Child.

ABSTRACT: Vaginal discharge is a common gynaecologic complaint in pre-menarchal girls. However, an intravaginal foreign body (FB) must be suspected when it is persistent. We report the case of a referred 4-year-old girl with a 5-month history of persistent foul-smelling vaginal discharge. Clinical examination confirmed purulent vaginal discharge, along with a vaginal granuloma. A hard, intravaginal object was felt through the anterior rectal wall on digital rectal examination. A plain pelvic X-ray revealed a radiopaque object whose intravaginal position was confirmed by ultrasonography. The patient underwent granuloma excision plus FB removal and antibiotic treatment. The 12-month follow-up was unremarkable.

Otology: Cerumen Impaction and Aural Foreign Bodies.

Cerumen lubricates and protects the external auditory canal, but excess accumulation can lead to ear fullness, itching, otalgia, discharge, hearing loss, and tinnitus. Cerumen should be treated whenever symptoms are present or if it limits diagnosis by preventing a needed otoscopic examination. Clinicians should evaluate for cerumen impaction in those using hearing aids and patients with intellectual disability. Cerumen impaction can be treated with cerumenolytics, ear irrigation, and manual removal with instrumentation. Aural foreign bodies can cause ear fullness, otalgia, discharge, and hearing loss. They are more common in children than adults. The most common type of aural foreign bodies in children is jewelry, followed by paper products, parts of pens or pencils, desk supplies (eg, erasers), BBs or pellets, and earplugs or earphones. In adults, the most common aural foreign bodies are cotton swabs or cotton, followed by hearing aid parts and jewelry or ear accessories. Patients should avoid using cotton tip applicators in the external auditory canal. Alligator forceps, small right angle hooks, and ear irrigation commonly are used to remove aural foreign bodies in an outpatient clinic setting, but the choice depends on the type of foreign body. Soft and irregularly shaped objects can be removed without referral to an otolaryngologist. Patients with hard, spherical, or cylindrical objects should be referred to an otolaryngologist if previous removal attempts have failed or if there is ear trauma to avoid worsening its position in the ear canal.

Cardiac biomarkers as tools in the prediction and diagnosis of traumatic pericarditis and traumatic reticuloperitonitis in cattle and buffaloes.

BACKGROUND: In the livestock industry, Foreign Body Syndrome is a devastating disease condition. Feeding management, lacking of food discrimination, and eating chopped food increase the risk of swallowing sharp foreign bodies in bovine species. In addition to the honeycomb cells shape of the reticulum, the contractions of the reticular wall, gravid uterine pressure, and parturition efforts, foreign bodies can penetrate the reticular wall, causing cascade of problems including traumatic reticulitis, traumatic reticuloperitonitis, and traumatic pericarditis. The present study was carried out to evaluate the diagnostic significance of cardiac troponin I rapid test cassette and other cardiac biomarkers including serum cardiac troponin I (cTn I), creatine kinase-myocardial band (CK-MB), lactate dehydrogenase (LDH), and aspartate aminotransferase enzyme (AST), in confirmed cases of traumatic pericarditis (TP) and/or traumatic reticuleoperitonitis (TRP) in cattle and buffaloes. METHODS: A total number of 30 animals (22 cattle and 8 buffaloes) with different signs such as anorexia, jugular distension, brisket edema, and signs of pain (reluctance to move, arching back, and abduction of the forelimbs) were included in the present study. Based on case history, clinical signs, ferroscopic, pericardiocentesis, radiographic and ultrasonographic examinations, TP were confirmed in cattle (n = 10) and buffaloes (n = 8) while TRP were confirmed only in cattle (n = 12). Additionally, 20 clinically healthy animals (n = 10 cattle and 10 buffaloes) were used as a control group. Blood samples were collected for determination of blood level of Tn-I, and activity of CK-MB, LDH, and AST. RESULTS: The obtained results revealed a highly significant increase in serum cTn I in diseased cattle with TP and TRP (P = 0.00), while buffaloes with TP showed no significant changes in serum cTn I (P = 0.111). Both diseased cattle and buffaloes showed increased serum activities of CK-MB, AST, and LDH enzyme. On the other hand, cardiac troponin I rapid test cassette failed to detect cTn I in diseased animals. CONCLUSION: The study concluded that the cardiac troponin I rapid test cassette did not have a diagnostic significance and could not be used as a point-of-care under field condition for diagnosis of TP and TRP in large ruminants. However, the serum troponin I level is helpful in diagnosis of TP and TRP in cattle. Although cardiac biomarkers have some diagnostic values in TP and TRP, the traditional diagnostic methods (clinical, radiography and ultrasonography examinations) are crucial for thorough evaluation of TP/TRP cases in bovine.

Tracheobronchial Foreign Body in Children with an Insidious Medical History.

This study explored the clinical features of tracheobronchial foreign bodies (TFB) in children lacking both a foreign body aspiration history and bronchial cut-off signs on imaging. This study was conducted between 2011 and 2021, including 45 children without a choking history or tracheal interruption on CT scans. Common symptoms were cough and wheezing (91.1%, 41 cases), followed by decreased breath sounds (55.6%, 25 cases), rales (48.9%, 22 cases), and wheezing (42.2%, 19 cases). Prior to TFB confirmation, bronchopneumonia was the prevalent diagnosis (88.9%, 40 cases). Vegetable matter was the most frequent foreign body type (75.6%, 34 cases), primarily located in the right main bronchus (31.1%) and left lower lobe bronchus (22.2%). TFB in children with obscure medical histories presents non-specifically, highlighting bronchoscopy's pivotal role in diagnosis and treatment. Key Words: Bronchoscope, Paediatrics, Tracheobronchial foreign body, Diagnosis.

Clinical characteristics and removal approaches of tracheal and bronchial foreign bodies in elders.

The symptoms of tracheobronchial foreign body in the elderly are not typical, so they are often missed or misdiagnosed. This study aims to depict the clinical characteristics of tracheobronchial foreign body inhalation in the elderly. We retrospectively analysed the clinical data of elder patients (age ≥ 65 years) diagnosed with tracheal and bronchial foreign bodies. The data included age, sex, clinical symptoms, type and location of foreign bodies, prehospital duration, Chest CT, bronchoscopic findings, and frequencies and tools for removing these elderly patients' tracheal and bronchial foreign bodies. All patients were followed up for a half year. Fifty-nine cases were included, of which only 32.2% had a definite aspiration history. Disease duration > 30 days accounted for 27.1% of the patients. 27.1% of the patients had a history of stroke, and 23.8% had Alzheimer's Disease. Regarding clinical symptoms, patients mainly experience cough and expectoration. The most common CT findings were abnormal density shadow (37.3%) and pulmonary infiltration (22.0%). Under bronchoscopy, purulent secretions were observed in 52.5% of patients, and granulation tissue hyperplasia was observed in 45.8%. Food (55.9%) was the most common foreign object, including seafood shells (5.1%), bones (20.3%), dentures (18.6%), and tablets (20.3%). The success rate of foreign body removal under a bronchoscope was 96.7%, 28.8% of the foreign bodies were on the left and 69.5% on the right. 5.1% of the elderly patients required rigid bronchoscopy, and 6.8% required two bronchoscopies. In elderly cohorts, tracheal foreign bodies are obscured by nonspecific clinical presentations and a paucity of aspiration history, challenging timely diagnosis. Predominantly constituted by food particles, with a notable predilection for the left bronchial tree, these cases demand skilled bronchoscopic management, occasionally requiring sophisticated approaches for successful extraction.

Removal of airway foreign body using flexible bronchoscopy in children.

BACKGROUND: Flexible bronchoscopy is mainly used to diagnose airway foreign bodies (AFBs). Due to advances in pediatric anesthesia, many teams have considered the extraction of AFBs by flexible bronchoscopy. We aimed to assess the success of flexible bronchoscopy in AFB removal in children. PATIENTS AND METHODS: We analyzed retrospectively the data of children admitted for AFB aspiration in the Pediatric Respiratory Diseases Department B of Abderrahmane Mami Hospital in Tunisia between January 2012 and December 2022. AFB removal was performed by flexible bronchoscopy through the use of a laryngeal mask airway (LMA) or intubation. RESULTS: Of the 105 children included, AFB was removed by flexible bronchoscopy in 99 children (94.3 %). The mean age of the children was 32 months (9-150 months) with a sex ratio of 2:3. The foreign body was organic in 67 % of cases. Overall, 37 children underwent rigid bronchoscopy first (35.2 %). Flexible bronchoscopy was performed through the LMA in 77 cases (73 %) and after intubation in the other cases. Thoracic surgery was needed in two cases (1.9 %). Four infants expectorated the AFB after the procedure (3.8 %). Only two children developed laryngeal edema with transient oxygen desaturation. CONCLUSION: AFB removal using a flexible bronchoscope is an efficient and safe procedure when performed by an experienced team. The recent use of LMA has facilitated the use of a larger bronchofiberscope and the insertion of multiple tools that can reach distal airways.

How should one intervene when a foreign body is blocking a child's oral cavity?

BACKGROUND: Foreign bodies lodged in the oral cavity can be life-threatening. Their removal should be determined on the basis of the patient's condition, the type of object, the removal techniques available, the appropriate medication available and the potential complications. CASE REPORT: A 9-month-old girl was brought to the emergency room by ambulance after a part of a toy became stuck in her oral cavity. Her father had unsuccessfully attempted to remove it at home. A blue cylindrical, rigid plastic toy part was seen during examination of her oral cavity and her tongue was trapped inside it. On initial assessment, her vital signs were within the normal range. She was agitated, a small amount of saliva mixed with blood was coming out of her mouth and she could not swallow her spittle. She was treated in the resuscitation room by an otorhinolaryngologist and a paediatric emergency team, and the foreign body was removed using bayonet forceps inside the mouth. The child was monitored in the paediatric emergency observation unit for 6 hours for signs of asphyxia and aspiration, and she was discharged without complications. CONCLUSION: Foreign bodies in the oral cavity can cause serious complications, including injury, bleeding and sudden airway obstruction. Experienced healthcare professionals, especially those skilled in airway management, should handle these cases using a multidisciplinary approach to ensure respiratory safety.Abbreviations: LMA: laryngeal mask airway; PED: paediatric emergency department.

[Clinical application of Visual throat forceps in the removal of hypopharyngeal foreign body].

Objective:To explore the feasibility of using self-made visual throat forceps to remove hypopharyngeal foreign bodies. Methods:The throat forceps were combined with the endoscope and connected to a monitor via a data cable resulting in a visual throat forceps apparatus. This device was utilized to examine and treat the hypopharyngeal foreign bodies. Results:Among 53 patients, foreign bodies were detected in 51,with 48 cases involving hypopharyngeal foreign bodies. All were successfully extracted using the visual throat forceps. Three cases, diagnosed as esophageal foreign bodies by electronic gastroscopy, were treated using the same method. Conclusion:Visual throat forceps can be used to examine the hypopharynx and remove foreign bodies. It has the advantages of simple operation, rapid operation, and high success rate of foreign body removal from the hypopharynx. It is worthy of clinical application.

[Analysis of the diagnosis and treatment of 10 cases of complex respiratory foreign bodies in children].

Objective:To explore the diagnosis and treatment experience of complex respiratory foreign bodies in children. Methods:The clinical data of 1 243 cases of respiratory foreign bodies in children were retrospectively analyzed, among which 10 cases（0.8%） were complicated respiratory foreign bodies. Results:Among the 10 cases of complex respiratory foreign bodies, 2 cases were removed by open thoracotomy, 1 case was removed by tracheotomy, 1 case was removed by lobectomy, 1 case was removed by fiberoptic bronchoscopy because of difficult airway caused by the accompanying congenital pulmonary artery sling, and the pulmonary artery sling correction was synchronized with the fiberoptic bronchoscopic removal, 3 cases were removed by fiberoptic bronchoscopic holmium laser and/or freezing method to make the foreign body deformed and fragmented and then taken out by the sound gate, and 2 cases were removed because of the In 3 cases, the foreign bodies were deformed and fragmented by fiberoptic bronchoscopy, and in 2 cases, the foreign bodies were removed through the vocal folds because of their special characteristics. Two cases were intubated and sent to ICU after surgery because of obvious vocal edema and difficulty in deoxygenation, two cases were transferred to ICU after cardiac or thoracic surgery, and the rest of them returned to ordinary wards after surgery, and all 10 cases recovered well after surgery. Conclusion:Respiratory foreign body combined with airway stenosis, when the foreign body type, shape, embedded location of special foreign body, foreign body is too large, need to rationally choose the method of foreign body removal. If necessary, a combination of methods can be used to ensure that the airway obstruction is quickly relieved with the best program.

Diagnosis and treatment strategies for pediatric urogenital tract foreign bodies: A retrospective study.

BACKGROUND: Foreign bodies in the pediatric urogenital tract are rare but urgent clinical conditions that can cause severe symptoms and complications. The current management remains challenging. OBJECTIVE: This study aims to provide an in-depth understanding of the clinical characteristics, diagnostic challenges, and treatment strategies for pediatric urogenital tract foreign bodies. Through a retrospective analysis of patient data, valuable insights into the management of this condition are offered to facilitate the development of more effective management strategies. METHODS: A single-center retrospective study design was employed, reviewing clinical data of 30 pediatric patients with urogenital tract foreign bodies admitted to Anhui Children's Hospital from October 2016 to May 2023. This included 16 cases of urethral and bladder foreign bodies and 14 cases of vaginal foreign bodies. Among them, there were 14 males and 16 females, with a median age of 6.3 years. Treatment methods included transvaginal endoscopic removal, cystoscopic removal, pneumovesicum laparoscopy removal, and perineal incisional foreign body removal. Surgical time, blood loss, hospitalization days, and postoperative follow-up results were recorded. RESULTS: Key clinical presentations included vaginal bleeding, abnormal vaginal discharge, hematuria, dysuria, urinary retention, and perineal pain. Preoperative routine examinations included ultrasound, abdominal radiography, and, in some cases, CT scans. All 30 patients underwent successful surgery, with a median surgical time of 30.5 min (IQR 16.8-50.8), minimal intraoperative bleeding, and a median postoperative hospital stay of 2 days (IQR 2-3). Follow-up from 3 months to 1 year revealed no abnormalities in the urogenital system, no residual foreign bodies, and no occurrence of severe complications. No cases of recurrent foreign body insertion were observed. CONCLUSION: Early diagnosis and treatment of pediatric urogenital tract foreign bodies are crucial to reduce patient suffering and the risk of complications. The choice of surgical method depends on the type, size, and location of the foreign body, with endoscopy being the preferred option. Laparoscopic cystoscopy and open surgery are also effective treatment modalities.

[Recurrent bacterial abscess of the left liver lobe caused by a foreign body (fish bone)]. / Retsidivnyi bakterial'nyi abstsess levoi poloviny pecheni, obuslovlennyi inorodnym telom (ryb'ya kost') ­ taktika rentgenokhirurgicheskogo lecheniya.

The authors present minimally invasive surgical treatment of recurrent liver abscess caused by migration of fish bone from the upper gastrointestinal tract. Two-stage treatment implied small-caliber transparietal drainage of abscess with evacuation of purulent detritus at the first stage. At the second stage, primary percutaneous approach was transformed into access of sufficient diameter for flexible or rigid optics for visually controlled bone extraction. Foreign body removal through the drainage tube with endoscopic capture under visual control is preferable regarding safety compared to removal under ultrasound and/or X-ray control. Indeed, endoscopic approach is valuable for optimal positioning of the object and prevention of damage to liver parenchyma during extraction.

Liquid concrete as a gastrointestinal tract foreign body.

Gastrointestinal foreign bodies present a common clinical challenge. We present an unusual case of a 58-year-old construction worker who ingested liquid concrete that risked solidifying in his stomach. Gastroscopy revealed only partial solidification and pyloric obstruction, which were successfully resolved through endoscopic fragmentation and mechanical removal. To protect the gastric mucosa during elimination, liquid paraffin and a cellulose-based formula were administered. Complete gastrointestinal evacuation was achieved within 3 days, with no complications observed. This case emphasises the urgency of the early removal of concrete.

Mysterious Case of Drooling Infant - Hidden Foreign Body over Hard Palate.

Foreign body over the hard palate is a rare clinical entity that happen almost exclusively in young pediatric age group with only about 40 odd cases ever reported. Most cases in the literature are described as incidental findings of hard palate mass causing heightened anxiety to parents and clinicians alike during routine oral cavity examination. Owing to its rarity and lackluster presenting symptoms, this simple condition are often overlooked but has high propensity to develop into life threatening condition if dislodged into the airway.

Management of an Ingested Foreign Body in a COVID-Positive Patient.

This case report describes a 51-year-old man who swallowed an amalgam fragment dislodged during dental treatment performed without a throat screen. The patient was transferred to the emergency department, where the foreign body was confirmed to be in the esophagus following radiographic imaging. Foreign body removal from the esophagus is routinely achieved via esophagogastroduodenoscopy (EGD). However, this incident occurred in September 2020, at the height of the COVID-19 pandemic. Because of the patient's preoperative positive COVID-19 test, the option for EGD retrieval was eliminated per hospital protocol. Instead, a noninvasive approach with serial radiographic monitoring was deemed mandatory to observe the fragment as it passed through the gastrointestinal tract, warranted by the small size of the foreign body and the patient's lack of signs and symptoms of respiratory distress. This case report reinforces the importance of using airway protection during every dental procedure. Furthermore, reevaluation of EGD as the gold standard for treatment of ingested small materials may be warranted.

Association between pre-bronchoscopy time of illness and post-bronchoscopy discharge time in pediatric patients with foreign body aspiration: retrospective cohort study in a Peruvian referral center, 2014-2019. / Asociación entre el tiempo de enfermedad previo a broncoscopia y tiempo de alta posbroncoscopia en pacientes pediátricos con aspiración de cuerpo extraño: estudio de cohorte retrospectivo en un centro de referencia peruano, 2014-2019.

OBJECTIVE.: To determine the association between pre-bronchoscopy time of illness and post-bronchoscopy discharge time in pediatric patients with foreign body aspiration. MATERIALS AND METHODS.: Retrospective cohort study. Medical records were studied and reviewed at the Pediatric Emergency Hospital of Lima, Peru. We reviewed 324 medical records, and selected 183 because they had the diagnosis of foreign body aspiration and complete data. Fisher's exact test and Mann Whitney U test were used for the bivariate analysis, while Poisson regression was used to calculate the Relative Risk (RR) and its 95% confidence interval (CI). RESULTS.: We included 183 patients, of whom 65.6% were men with a mean age of 2.4 years. The most frequent location of the foreign body was the right bronchial tree and most of them were made of organic material. The majority (72.7%) of patients were discharged before 24 hours. We found an association between the time of illness prior to bronchoscopy and post-bronchoscopy discharge time (RR: 2.94, 95%CI: 1.72 - 5.01). CONCLUSIONS.: The time of illness prior to bronchoscopy and the length of hospital stay after removal of the foreign body were significantly associated when adjusted for age, sex, type of foreign body and mouth sweep maneuver as a rescue measure. Our findings are relevant because they highlight the importance of early care, timely diagnosis and early management of pediatric patients.

OBJETIVOS.: Determinar la asociación entre el tiempo de enfermedad previo a broncoscopia y el tiempo de alta posbroncoscopia en pacientes pediátricos con aspiración de cuerpo extraño. MATERIALES Y MÉTODOS.: Estudio de cohorte retrospectivo. El estudio y la revisión de historias clínicas se realizó en el Hospital de Emergencias Pediátricas de Lima, Perú. Se revisaron 324 historias clínicas, de las cuales, 183 historias fueron seleccionadas por contar con diagnóstico de cuerpo extraño en vías aéreas y estar adecuadamente llenadas. Para el análisis bivariado se utilizó la prueba exacta de Fisher y U de Mann Whitney, mientras que para el cálculo del riesgo relativo (RR) y su respectivo intervalo de confianza (IC) al 95% se utilizó regresión de Poisson. RESULTADOS.: Se incluyeron 183 pacientes, de los cuales, el 65,6% fueron hombres con una media de 2,4 años. La localización más frecuente fue el árbol bronquial derecho y cuerpo extraño de material orgánico. La mayoría (72,7%) de pacientes tuvieron un alta temprana antes de las 24 horas. Se encontró una asociación entre el tiempo de enfermedad previo a la broncoscopia y el tiempo alta posbroncoscopia (RR: 2,94, IC 95%: 1,72-5,01). CONCLUSIONES.: Existe una asociación estadísticamente significativa entre el tiempo de enfermedad previo a la broncoscopia y el tiempo de estancia hospitalaria posextracción del cuerpo extraño al ajustar por edad, sexo tipo de cuerpo extraño y maniobra de boca como medida de rescate. Este hallazgo es relevante debido a que pone en evidencia la importancia de una atención temprana, diagnóstico oportuno y manejo precoz en el paciente pediátrico.