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.

Clinical features and outcomes of dogs with attempted medical management for discrete gastrointestinal foreign material: 68 cases (2018-2023).

OBJECTIVE: To retrospectively describe clinical characteristics of canine gastrointestinal foreign bodies (GIFB) that were successfully and unsuccessfully managed conservatively. ANIMALS: 68 client-owned dogs presented to the Texas A&M Small Animal Teaching Hospital between January 1, 2018, and October 1, 2023, for GIFB where medical management was attempted. CLINICAL PRESENTATION: Medical records were reviewed for signalment, history, physical examination, bloodwork, diagnostic imaging, foreign body type, location, treatments, and outcome. Success was defined as the passage of the foreign body through the colon, while failure was defined as requiring surgery, endoscopy, or euthanasia. RESULTS: Medical management was successful in 32 cases (47%; 95% CI, 0.32 to 0.66). Gastric dilation resolved in all success cases (n = 5 [100%]; 95% CI, 0.32 to 2.3) but did not resolve in any failure cases (13 [0%]). Small intestinal dilation resolved in all success cases (n = 13 [100%]; 95% CI, 0.53 to 1.7) but progressed in most failure cases (9 [75%]; 95% CI, 0.34 to 1.4). In the success group, 31 GIFB were nonlinear (96.9%; 95% CI, 0.66 to 1.4), while 1 was linear (3.1%; 95% CI, 0.001 to 0.17). In the failure group, 29 GIFB were nonlinear (80.6%; 95% CI, 0.54 to 1.16), while 7 were linear (19.4%; 95% CI, 0.08 to 0.4). Of the cases that elected surgery (n = 29 [42.7%]; 95% CI, 0.29 to 0.61), resection and anastomosis was performed in 3 cases (10.3%; 95% CI, 0.02 to 0.3). All cases that required resection and anastomosis were nonlinear GIFB. CLINICAL RELEVANCE: Conservative management of GIFB provides a feasible treatment option and may be considered based on presentation, foreign body location, hemodynamic stability of the patient, diagnostic imaging, and type of foreign body.

Evaluation of basic life support interventions for foreign body airway obstructions: A population-based cohort study.

AIM: To quantify the associations of foreign body airway obstruction (FBAO) basic life support (BLS) interventions with FBAO relief and survival to discharge. METHODS: We identified prehospital FBAO patient encounters in Alberta, Canada between Jan 1, 2018 and Dec 31,2021 using the provincial emergency medical services' medical records, deterministically linked to hospital data. Two physicians reviewed encounters to determine cases and extract data. Multivariable logistic regression determined the adjusted odds ratio of FBAO relief (primary outcome) and survival to discharge for the exposure of BLS interventions (abdominal thrusts [AT], chest compressions/thrusts [CC], or combinations) relative to back blows [BB]. Intervention-associated injuries were identified using International Classification of Diseases codes, followed by health records review. RESULTS: We identified 3,677 patient encounters, including 709 FBAOs requiring intervention. Bystanders performed the initial BLS intervention in 488 cases (77.4%). Bystanders and paramedics did not relieve the FBAO in 151 (23.5%) and 11 (16.7%) cases, respectively. FBAOs not relieved before paramedic arrival had a higher proportion of deaths (n = 4[0.4%] versus n = 92[42.4%], p < 0.001). AT and CC were associated with decreased odds of FBAO relief relative to BB (adjusted odds ratio [aOR] 0.49 [95%CI 0.30-0.80] and 0.14 [95%CI 0.07-0.28], respectively). CC were associated with decreased odds of survival to discharge (aOR 0.04 [95%CI 0.01-0.32]). AT, CC, and BB were implicated in intervention-associated injuries in four, nine, and zero cases, respectively. CONCLUSIONS: Back blows are associated with improved outcomes compared to abdominal thrusts and chest compressions. These data can inform prospective studies aimed at improving response to choking emergencies.

Etiology, pathogenesis, and management of angiosarcoma associated with implants and foreign body: Clinical cases and research updates.

Angiosarcomas are rare and highly malignant soft tissue sarcomas originating from endothelial cells lining the lymphatic or vascular system. While they predominantly emerge from (sub)cutaneous regions, occurrences have been reported throughout the body. The etiology of angiosarcoma remains elusive in most clinical cases. Nevertheless, several prognosis risk factors play a pivotal role, including chronic lymphedema, therapeutic irradiation, environmental carcinogens, familial syndromes, and the presence of foreign materials like metallic objects and biomedical implants. Despite evidence implicating retained foreign material in angiosarcoma development, understanding its prognosis and pathogenesis remains limited. The pathogenesis of angiosarcoma appears to involve a complex interplay of chronic inflammation, tissue remodeling, and genetic factors that create a conducive microenvironment for malignant transformation. Management of these sarcomas remains challenging due to their infiltrative nature owing to the high chance of metastasis and local recurrence. The primary treatment modalities currently include surgery, radiotherapy, and chemotherapy, but recent advances in targeted immunotherapy and gene therapy hold promise for more effective approaches. This comprehensive review delves into the potential etiological and pathogenic roles of foreign materials, such as metallic objects, biomedical implants, and biomaterials, in the development of angiosarcoma. Further research into the underlying molecular mechanisms could provide valuable insights for tailored management and developing novel targeted therapeutic strategies.

Fragmented acupuncture needle as a linear metallic foreign body near the proximal interphalangeal joint of a horse.

OBJECTIVE: To describe the clinical presentation, diagnosis, and treatment of a fragmented, migrating acupuncture needle near the palmar proximal interphalangeal joint (PIPJ) of a horse. ANIMAL: A 9-year-old Warmblood cross mare. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: The mare presented for evaluation of a linear metallic foreign body on the palmar lateral aspect of the PIPJ following acupuncture treatment. The mare had a pinpoint puncture wound and sensitivity to palpation over the lateral aspect of the PIPJ region. The referring veterinarian performed radiographs and found a linear metallic foreign body near the lateral palmar PIPJ. Ultrasonographic examination demonstrated a hyperechoic lesion consistent with a metallic object in the soft tissues of the palmar lateral aspect of the PIPJ. TREATMENT AND OUTCOME: The horse was anesthetized, and the linear metallic foreign body was removed. The use of intraoperative ultrasound and digital radiographs assisted in determining the location of and surgical approach to remove the foreign body. The linear metallic foreign body was the fragmented segment (body) of an acupuncture needle. The mare recovered from surgery uneventfully and returned to the previous level of activity. CLINICAL RELEVANCE: This report demonstrates the potential risks of prolonged retention and or delayed removal of acupuncture needles in the form of needle fragmentation and migration. It also demonstrates the use of imaging in determining the location and position of small, thin metallic foreign bodies to aid in surgical approach and removal.

Oral Ingestion of an Iron-Containing Hand Warmer in a Pediatric Patient.

Hand warmer packets are common products used to provide a portable, nonflammable heat source via the exothermic oxidation of iron. We present the first reported case of pediatric hand warmer packet ingestion in a three-year-old male who developed an elevated serum iron concentration (peak 335 ug/dL) and gastrointestinal injury after ingesting the contents of a HOTHANDS hand warmer packet. He was treated with endoscopic gastric foreign body removal and lavage, as well as proton-pump inhibitors and whole bowel irrigation. Hand warmer packs contain reduced elemental iron powder, which has been shown to have a more favorable safety profile when compared to iron salts. The mechanism of toxicity for reduced iron is unknown, though it is thought to be due to conversion to more toxic iron ions in an acidic environment. While the current adult literature suggests that ingestion of a single hand warmer packet is without significant risk, our case demonstrates that even a partial ingestion carries a significant risk of both iron toxicity and direct gastrointestinal caustic injury in a young child. This case demonstrates the need for multidisciplinary care and consideration of urgent endoscopic foreign body removal and gastric lavage followed by whole bowel irrigation to mitigate the potential of severe iron toxicity.

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.

Managing magnets: An audit of introduction of the Royal College of Emergency Medicine Best Practice Guideline.

AIM: To evaluate management of children and young people presenting to the Emergency Department (ED) with magnet ingestion before and after new guidance. METHODS: In May 2021, a National Patient Safety Agency and Royal College of Emergency Medicine (RCEM) Best Practice Guideline about management of ingested magnets was published. This was implemented in our department. Children and young people presenting after magnet ingestion were identified from SNOMED (coded routinely collected data) and X-ray requests between January 2016 and March 2022. Management was compared to national guidance. RESULTS: There were 138 patient episodes of magnet ingestion, with a rising incidence over the 5-year period. Following introduction of the guideline, there was a higher incidence of admission (36% vs. 20%) and operative intervention (15.7% vs. 8%). Use of follow-up X-ray increased from 56% to 90%. There was substantial variation in the management prior to guidance which reduced after introduction of the RCEM guidance. CONCLUSION: Management of magnet ingestion has become more standardised since introduction of the National RCEM Best Practice Guideline, but there is still room for improvement.

Characteristics And Outcomes Of Aerodigestive Foreign Bodies In Children.

Background: Aerodigestive foreign bodies are common in children of pre-school-going age. It is one of the leading cause of morbidity and mortality in the paediatric population and a global health burden. Methods: We present here data of 108 patients who presented to Children hospital's Emergency with a suspicion of foreign body ingestion/aspiration over 2 years from July 1st 2021 to 30th June 2023. Their descriptive analysis including, socio-demographics, type of foreign body, age of presentation, and mode of presentation were calculated and correlation was done using the Pearson Chi square test. Results: We observed different types & characteristics of foreign bodies, patients were predominantly male with 62.26%. The mean age of presentation was 40.97 months. The majority of patients were of pre-school age, younger than 4 years (44.44%) followed by the infant population (19.44%) p=0.002. Foreign bodies were mainly located in the upper oesophagus for ingested FBs (60.8%). Most of the population presented within the first 5 hours (52.88%) followed by the first 12 hours (11.11%). Coin ingestion was by far the most common (54%) followed by button battery (19%) and the whistle was the most common aspirated object (33%). Conclusion: All patients with a suspicion of foreign body ingestion/inhalation should be evaluated. Early recognition and treatment are imperative because the complications are serious and can be life-threatening and once confirmed should undergo endoscopic removal.

FOREIGN BODY ASPIRATION AND INGESTION IN CHILDREN.

Aspiration and ingestion of a foreign body is most frequently seen in children younger than 3 years. Foreign body aspiration is always a life-threatening, urgent state demanding quick recognition and treatment to avoid potentially lethal complications. Most foreign bodies that are ingested pass spontaneously through the gastrointestinal tract without complications, however, some could lead to problems if they become lodged. A literature review was performed via MEDLINE database using key terms. Primary care providers should be trained to give proper initial care. Aspirated/ingested foreign bodies in children removed by rigid or flexible bronchoscopy/gastroscopy always are challenging procedures that require well-planned anesthesia management and excellent intercommunication between anesthesiologists and surgeons. Extracorporeal membrane oxygenation can be used as a rescue mode of support in children with life-threatening foreign body aspiration for stabilization before, during and after removal of the aspirated foreign body. It is of utmost importance that all foreign body extractions, if possible, be done in centers supplied with all the necessary equipment and trained personnel. However, prevention of foreign body aspiration and ingestion is still the best therapy.

A Mislocation of Double-lumen Catheter Guidewire in Right Atrium Successfully Retrieved with Loop-wire Snaring: A Case Report.

The increasing rate of central vascular access use especially for hemodialysis access in Indonesia carries risk of retention of the guidewire to the heart resulting in a condition known as heart foreign bodies. We described a case of mislocation of double-lumen catheter guidewire to the right atrium in a patient planned to perform hemodialysis. The patient complained of dyspnea and swelling of extremities but the symptoms had already appeared before the insertion of the catheter due to the patient's underlying kidney disease arising conclusion that the foreign bodies itself are asymptomatic. The wire was found on chest x-ray and then confirmed on fluoroscopy during the retrieval procedure. Loop-wire was used to snare the guidewire. The wire was successfully evacuated and the patient was stable. The rare nature of the condition could become a challenge in recognizing the condition. Percutaneous retrieval is the preferred management of the condition.

[Esophageal foreign bodies: review of 84 cases]. / Cuerpos extraños en esófago: revisión de 84 casos.

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.

Guía de Práctica Clínica de cuerpo extraño gastrointestinal en niños / Clinical practice guideline of gastrointestinal foreign bodies in children

La ingestión de un cuerpo extraño es un tipo de lesión no intencionada muy frecuente en la infancia, particularmente en lactantes mayores de 6 meses y preescolares. El propósito deseado con la publicación de esta guía es contar con herramientas actualizadas en el diagnóstico y tratamiento de esta afección que permitan sistematizar la conducta y mejorar la calidad de la asistencia médica. Dentro de los cuerpos extraños más frecuentes tenemos: monedas, imanes, baterías, juguetes pequeños, plásticos, joyas, botones, huesos e impactaciones alimentarias en los niños mayores. La sintomatología varía según la naturaleza del cuerpo extraño, el lugar donde se impacte, que casi siempre es en las estrecheces anatómicas o adquiridas del tubo digestivo o por la presencia de complicaciones. Para confirmar el diagnóstico son necesarios diferentes estudios imagenológicos y endoscópicos, estos últimos con un valor terapéutico. El tratamiento depende de factores como la edad, el tiempo de ingerido, la localización, la presencia de complicaciones, la naturaleza del cuerpo extraño, su número y el potencial lacerante, tóxico o corrosivo. En la mayoría de los casos los cuerpos extraños son expulsados de forma espontánea y tienen un pronóstico favorable, pero queda un grupo de pacientes donde es necesario un tratamiento quirúrgico. Después de realizar una búsqueda de revisiones sistemáticas de calidad y tomando en cuenta la experiencia del Servicio de Cirugía Pediátrica de Matanzas en el tratamiento de estos pacientes se elaboró esta guía que fue discutida y aprobada en el IV Simposio Nacional de Cirugía Pediátrica. La publicación de esta guía permitiría a los servicios de Cirugía Pediátrica emplearla como referencia y aplicarla en sus propias instituciones con el consecuente beneficio para los pacientes(AU)

Ingestion of a foreign body is a very common type of unintentional injury in childhood, particularly in infants older than 6 months and preschoolers. The desired purpose with the publication of this guideline is to have up-to-date tools in the diagnosis and treatment of this condition that allow to systematize the behavior and improve the quality of medical care. Within the most frequent foreign bodies we have: coins, magnets, batteries, small toys, plastics, jewelry, buttons, bones and food impactations in older children. Symptomatology varies depending on the nature of the foreign body, the place where it impacted, which is almost always in anatomical or acquired narrowness of the digestive tract, or by the presence of complications. To confirm the diagnosis, different imaging and endoscopic studies are necessary, the latter with a therapeutic value. Treatment depends on factors such as age, ingestion time, location, presence of complications, the nature of the foreign body, the amount and the lacerating, toxic or corrosive potential. In most cases foreign bodies are expelled spontaneously and have a favorable prognosis, but there is a group of patients left for whom surgical treatment is necessary. After conducting a search for quality systematic reviews and taking into account the experience of Matanzas province's Pediatric Surgery Service in the treatment of these patients, this guideline was created and it was discussed and approved at the IV National Symposium of Pediatric Surgery. The publication of this guideline would allow Pediatric Surgery services to use it as a reference and apply it in their own institutions with the consequent benefit for patients(AU)

Cuerpos extraños ingeridos intencionalmente por un prisionero. Informe de caso / Foreign bodies intentionally ingested by a prisoner. A case presentation

RESUMEN: La ingestión intencional de cuerpos extraños es frecuente entre prisioneros. Es un fenómeno asociado a un aumento de la morbimortalidad y los costos. Generalmente no requiere de intervención específica, aunque pueden aparecer complicaciones severas, que requieren, en ocasiones, tratamiento quirúrgico urgente. Se presenta un paciente masculino, de 24 años de edad, sin antecedentes relevantes, recluido en la prisión de máxima seguridad de la provincia Camagüey. Se introdujo por la boca un alambre de 40 cm de longitud, con un gancho en su punta. Presentó sialorrea y molestias retroesternales. Al examen físico se encontró normalidad de sus parámetros vitales, sin alteraciones en el examen del tórax, con abdomen doloroso a la palpación profunda del cuadrante inferior derecho. Se realizaron radiografías simples de tórax posteroanterior, lateral, y de abdomen simple, se encontraron un cuerpo extraño desde la boca hasta el tercio inferior del esófago torácico y otro cuerpo extraño ubicado en la pelvis, que refirió haber ingerido intencionalmente hace un año. Se realizó laparotomía urgente y extracción de ambos cuerpos extraños. El paciente evolucionó satisfactoriamente sin desarrollar complicaciones. La ingestión intencional de cuerpos extraños en la población penal es un problema de salud complejo. La prevención es uno de los pilares fundamentales de su tratamiento. Es importante un alto índice de sospecha sobre la ingestión de múltiples objetos, en este grupo de pacientes la cirugía es frecuentemente requerida.

ABSTRACT The conscious ingestion of foreign bodies is frequent among prisoners. It is a phenomenon associated with an increase in morbidity - mortality and costs. Generally, it does not require specific intervention, although severe complications may appear, which sometimes require urgent surgical treatment.to present the case of a prisoner with recurrent intentional ingestion of multiple foreign bodies, one of them not previously diagnosed. Case presentation: A 24-years-old male patient, with no relevant history, held in the Camagüey province maximum security prison. The wire was introduced through the mouth 40 cm long, with a hook at its tip. Referring to hypersalivation and retrosternal discomfort. The physical examination found normality of his vital parameters, without alterations in the chest examination, with a painful abdomen on deep palpation of the right lower quadrant. A posteroanterior and lateral chest X-ray was performed, finding a foreign body from the mouth to the lower third of the thoracic esophagus, an abdominal X-ray where another foreign body was located in the pelvis, which he reported having intentionally ingested a year ago. An urgent laparotomy was performed and both foreign bodies were removed. The patient evolves satisfactorily without developing complications. The intentional ingestion of foreign bodies in the prison population is a complex health problem. Prevention is one of the fundamental pillars of its treatment. A high index of suspicion on the ingestion of multiple objects is important; in this group of patients surgery is frequently required.

Tratamiento del cuerpo extraño rectal en un Servicio de Urgencia / Rectal foreign body treatment at an urgency service

Resumen Introducción: El cuerpo extraño rectal (CER) es un problema de difícil manejo para el cirujano general. La vía anal es la puerta de entrada más habitual seguido de la oral. La sospecha clínica es fundamental para el diagnóstico, pudiendo apoyarse de imágenes. El tratamiento es su extracción por vía transanal o por vía anterior. Objetivos: Caracterizar, describir y presentar el tratamiento de los pacientes con CER que consultaron en urgencia del Hospital el Pino (HEP) entre los años 2011 y 2016. Material y Método: Estudio serie de casos. Se realiza revisión de fichas clínicas de pacientes con CER en un periodo de 5 años en el Servicio de Urgencia del HEP. Se identificó a los pacientes tratados en box y a aquellos tratados en pabellón. Se caracterizó según variables demográficas, tratamiento, complicaciones y días de hospitalización. Resultados: Se identificaron 18 pacientes, 13 hombres y 5 mujeres de 45 años (± 36-51) y 34 años (± 23-64) respectivamente. En 1 de ellos fue posible extracción manual transanal en box sin anestesia y en 17 se requirió tratamiento en pabellón, donde 12 fue por vía transanal y 5 por abordaje abdominal. En ningún caso se identificó lesión intestinal. Evolución postoperatoria adecuada. Días de hospitalización promedio 1,8 días. Conclusión: Este es un problema infrecuente y de difícil manejo. Existe mayor frecuencia en hombres de edades media siendo la puerta de entrada la vía anal en todos los casos. En la mayoría se requirió extracción en pabellón bajo anestesia siendo el abordaje transanal el más utilizado y con buenos resultados.

Introduction: The rectal forcing body (RFB) is a problem which involves a difficult management for surgeons. Anal via is the most frequent entrance area, followed by the oral via. Clinical suspicion is fundamental for diagnosis and it is possible to support it using imaging. Treatment considers extraction through transanal or frontal via. Aim: To describe and present the treatment of patients with rectal foreing body in the Urgency Service of El Pino Hospital during years 2011 to 2016. Materials and Method: Case studies. Clinical records revision of patients with rectal foreing body in the Urgency Service of El Pino Hospital considering a 5-year period. Patients are identified as those treated in the box and in a surgical pavilion. Patients were classified according to demographic variables, received treatment, associated complications and hospitalization time. Results: 18 patients are identified, 13 men and 5 women, 45 (± 36-51) and 34 (± 23-64) years respectively. It was possible to manually extract via trans-anal at box, in one of these cases; 17 of them required treatment at surgical pavilion, where 12 were via trans-anal and 5 via abdominal. None of these cases had intestinal injury. Post-surgery evolution was adequate. Average hospitalization was 1.8 days. Conclusion: RFB is a non-frequent problem which requires high diagnose suspicious to be able to carry out proper treatments. It is more frequent in middle age men, with transanal input. In most cases, the extraction was done in surgical pavilion and required anesthesia and were done via trans anal with good results.

Treatment options and outcomes of penile constriction devices

ABSTRACT Purpose: To study the effect of penile constriction devices used on a large series of patients who presented at our emergency facility. We explored treatment options to prevent a wide range of vascular and mechanical injuries occurring due to penile entrapment. Materials and Methods: Between January 2001 and March 2016, 26 patients with penile entrapment were admitted to our facility and prospectively evaluated. Results: The time that elapsed from penile constrictor application to hospital admission varied from 10 hours to 6 weeks (mean: 22.8 hours). Non-metallic devices were used by 18 patients (66.6%) while the other nine (33.4%) had used metallic objects. Acute urinary retention was present in six (23%) patients, of whom four (66.6%) underwent percutaneous surgical cystotomy and two (33.4%) underwent simple bladder catheterization. The main reason for penile constrictor placement was erectile dysfunction, accounting for 15 (55.5%) cases. Autoerotic intention, psychiatric disorders, and sexual violence were responsible in five (18.5%), five (18.5%), and two (7.4%) cases, respectively. The mean hospital stay was 18 hours (range, 6 hours to 3 weeks). Conclusion: Penile strangulation treatment must be immediate through the extraction of the foreign body, avoiding vascular impairments that can lead to serious complications. Most patients present with low-grade injuries and use penile constrictors due to erectile dysfunction. Removal of constrictor device can be challenging. The use of specific tools for achieving penile release from constrictors is a fast, safe and effective method. Patients with urinary retention may require urinary diversion.

Fish Bone Foreign Body: The Role of Imaging

Abstract Introduction Fish bone foreign body (FFB) impaction in the upper aerodigestive tract is a common cause for emergency department referral. Its management varies in both diagnosis and treatment paradigms. Fish bone foreign bodies are more commonly found in the oropharynx in cases of patients < 40 years old, and in the esophagus in cases of patients > 40 years old. Symptoms are typically non-indicative for the location of the FFB, with the exception of foreign body sensation at/superior to the cervical esophagus. A lack of findings during the physical examination is routinely followed by imaging, with computed tomography (CT) being the preferred modality. In practice, many patients undergo unnecessary imaging studies, including CT scans. Objectives To identify patients with suspected fish bone impaction who do not require CT imaging and can be safely discharged. Data Synthesis We have searched the PubMed database for the following medical subject headings (MeSH) terms: fish bone, fish foreign body AND oropharynx, hypopharynx, esophagus, flexible esophagoscopy, and rigid esophagoscopy. Our search in the English language yielded 32 papers. Case reports were included, since they highlighted rare and serious complications. Conclusion In patients > 40 years old suspected of fish bone impaction, noncontrast CT is recommended and should be urgently performed, even in the presence of ambiguous symptoms. However, in patients < 40 years old presenting within 24 hours from ingestion, imaging has little diagnostic value due to the low probability of esophageal fish bones. For this specific subgroup, in the absence of clinical findings, discharge without imaging studies may be considered safe. (AU)