|
1
|
Yu GZ, Ly M, Beal MA, Naylor A, Bhalla S, Raptis DA. Imaging the Spectrum of Mediastinitis. Semin Roentgenol 2025; 60:161-169. [PMID: 40280656 DOI: 10.1053/j.ro.2025.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 12/29/2024] [Accepted: 01/14/2025] [Indexed: 04/29/2025]
Affiliation(s)
- Gary Z Yu
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO
| | - Maria Ly
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO
| | - Michael A Beal
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO
| | - Adam Naylor
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO
| | - Demetrios A Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO.
| |
Collapse
|
|
2
|
Batıhan G, Kına S. Foreign Body in the Posterior Mediastinum: Successful Minimally Invasive Removal of a Transesophageally Migrated Piece of Dishwashing Scourer. Arch Bronconeumol 2024; 60:238-241. [PMID: 38310074 DOI: 10.1016/j.arbres.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 02/05/2024]
Affiliation(s)
- Güntuğ Batıhan
- Kafkas University Medical Faculty, Department of Thoracic Surgery, Turkey.
| | - Soner Kına
- Kafkas University Medical Faculty, Department of Anesthesiology, Turkey
| |
Collapse
|
|
3
|
Abraham ZS, Mahamba D, Kahinga AA. Pulmonary manifestations masquerading a longstanding neglected metallic foreign body in the esophagus of a paediatric patient from Tanzania: Rare case report. Int J Surg Case Rep 2023; 110:108683. [PMID: 37634433 PMCID: PMC10509800 DOI: 10.1016/j.ijscr.2023.108683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION Paediatric foreign body (FB) ingestion remains to be a common encounter in otorhinolaryngology and may manifest with pulmonary manifestations. Pulmonary manifestations masquerading chronic esophageal FBs in children is rare in clinical practice. This is perhaps the first documented case in Tanzania. CASE PRESENTATION The patient was a 6-year old boy with a 6-month history of ingesting a metallic object. The child was reported to have presented with sudden onset of drooling of saliva and difficulty in swallowing that lasted for several hours. While preparing to visit a hospital, no more drooling of saliva was noted thus the visit was cancelled. A month later the patient presented with recurrent episodes of dry cough associated with wheezing and unresponsive to medical treatment. Upon attending other health facilities no chest X-ray was ordered but rather prescribed antibiotics, mucolytics, antihistamines and antileukotrienes without relief. Chest x-ray was indicated and revealed an esophageal metallic object. Rigid esophagoscopy under general anaesthesia yielded the rusted metallic object in piece meals. Postoperative antibiotic, analgesic and an oral corticosteroid were prescribed. Postoperative visits were uneventful. CLINICAL DISCUSSION The patient underwent esophagoscopy and the rusted` metallic object was extracted in piece meals. Postoperative antibiotic, analgesic and oral corticosteroid were prescribed. Postoperative visits were uneventful. CONCLUSION It is always important to suspect FB ingestion in a child with a history of sudden onset of drooling of saliva and difficulty in swallowing. Imaging should be advocated to avoid delayed diagnosis otherwise pulmonary manifestations can masquerade the diagnosis of chronic esophageal FBs.
Collapse
Affiliation(s)
| | - Dina Mahamba
- Department of Paediatrics and Child Health-University of Dodoma, School of Medicine and Dentistry, Dodoma, Tanzania
| | - Aveline Aloyce Kahinga
- Department of Otorhinolaryngology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| |
Collapse
|
|
4
|
Ari K, Hussain SZM, Mohammad AW, Nassif R. A Prolonged History of Denture Impaction for 12 Weeks In Situ. Cureus 2022; 14:e26002. [PMID: 35859950 PMCID: PMC9288201 DOI: 10.7759/cureus.26002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/06/2022] Open
Abstract
Foreign body ingestion has serious consequences if left untreated. Impacted dentures for a prolonged period can lead to life-threatening complications. Therefore, prompt diagnosis and immediate intervention are lifesaving. Our patient presented to his local accident and emergency department after having swallowed his dentures during a meal. Initial investigations and workup detected no abnormalities and he was discharged back to the community. Twelve weeks following ingestion, he had developed dysphagia and weight loss which prompted an urgent referral for oesophago-gastro-duodenoscopy (OGD). This identified the dentures impacted within the upper oesophagus and initial attempts at removal were unsuccessful, therefore he required hospital admission for alternative feeding in the interim. A joint procedure with the Ear, Nose and Throat and upper gastrointestinal surgeons was carried out to successfully remove the dentures endoscopically. The patient made an immediate recovery, resuming his normal oral diet with appropriate follow up after discharge. It is suspected our patient had an impacted denture for a period of 12 weeks without sustaining any life-threatening complications, which makes this case rather unique. This case highlights the importance of thorough and careful clinical history taking and examination.
Collapse
|
|
5
|
Hussain SZM, KK AMRUTHA, Mohammad AW, Khan M. Migratory Foreign Bodies in the Aerodigestive Tract: The Importance of CT Imaging. Cureus 2022; 14:e21595. [PMID: 35228953 PMCID: PMC8868031 DOI: 10.7759/cureus.21595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
Accidental ingestion of foreign bodies forms a major part of otorhinolaryngological emergencies. It is dangerous, as the foreign bodies tend to perforate the aerodigestive tract. Since endoscopy is diagnostic as well as therapeutic, it is preferred over computed tomography (CT) scan, especially in developing countries. We present a case of a middle-aged man who presented with fever, neck swelling, and a five-day history of accidental ingestion of a foreign body. He underwent upper gastrointestinal endoscopy, which came out as normal. CT) imaging was performed, which showed migration of the foreign body to the parapharyngeal space and resulting abscess formation. The abscess was drained, and the foreign body was removed transcervically. We discuss this case to stress the role of CT imaging in the diagnosis of foreign bodies of the upper aerodigestive tract and propose an algorithm for the management of such cases. Upper gastrointestinal endoscopy alone would be insufficient to diagnose perforating and migrating foreign bodies, which may cause severe complications if left undiagnosed.
Collapse
|
|
6
|
Aoyagi R, Iio K, Hataya H. Chronic Dysphagia, Wheezing, and Poor Weight Gain in a 2-Year-Old Male Patient. Gastroenterology 2022; 162:51-53. [PMID: 34555380 DOI: 10.1053/j.gastro.2021.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/13/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Rui Aoyagi
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
| | - Kazuki Iio
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hiroshi Hataya
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| |
Collapse
|
|
7
|
Carratola M, Hart CK. Pediatric tracheal trauma. Semin Pediatr Surg 2021; 30:151057. [PMID: 34172217 DOI: 10.1016/j.sempedsurg.2021.151057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Tracheal trauma is an uncommon but potentially serious cause of airway injury in children. Presentation may be acute in cases of blunt or penetrating trauma, or delayed in cases of chronic irritation or indwelling endotracheal tubes. Symptoms include dyspnea, progressive respiratory distress, neck and chest swelling and ecchymosis, and dysphonia. Workup is pursued as allowed by the patient's clinical status and may include plain radiography, computed tomography, and endoscopy. Accuracy and efficiency of diagnosis is paramount for those at risk of rapid decompensation. Treatment may include observation, elective and strategic intubation, or primary surgical repair.
Collapse
Affiliation(s)
- Maria Carratola
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229, USA
| | - Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229, USA.
| |
Collapse
|
|
8
|
Kiyosaki K, Wall J, Sidell DR. Prolonged esophageal foreign body: Management strategies in the setting of complicated tracheoesophageal fistula. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
|
9
|
Lookabaugh S, Wakeman D, Pegoli W, Chaturvedi A, McKenna Benoit M. Chronic stridor secondary to erosion of esophageal foreign body into mediastinum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
|
10
|
James V, Hamzah HB, Ganapathy S. Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children. J Vis Exp 2018. [PMID: 30272654 DOI: 10.3791/58468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Coins are the most common ingested metallic foreign bodies among children. The goal of this protocol is to assess the accuracy and feasibility of using a handheld metal detector to detect ingested metallic foreign bodies in children. We propose that by introducing handheld metal detector screening early in the triage process of children with high suspicion of metallic foreign body ingestion, the number of radiographs being ordered to localize the metallic foreign body can be reduced in this radio-sensitive population. The study protocol requires the screening of the participants for history of foreign body ingestion and exclusion of patients with respiratory distress or metallic implants. The patient changes to hospital gown and items that could contain metal like eyeglasses, earrings, pendants, and ornaments are removed. The patient is positioned in the center of the room away from other metallic interferences. The working status of the handheld metal detector is first confirmed by eliciting a positive audio-visual signal. Then the screening is done in an erect position with head in extension to expose the neck, from the level of the chin to the level of the hip joint, to cover the anatomical areas from neck to pelvis in a zig-zag manner both anteriorly and posteriorly. A positive audio-visual signal is carefully noted during the scanning for the presence of metallic foreign body. Relevant radiographs are ordered as per the area detected on the metal detector screening. The handheld metal detector was able to precisely identify all the coins among the ingested metallic foreign bodies in our study. The handheld metal detector could not consistently detect non-coin metallic foreign bodies. This protocol demonstrates the accuracy of handheld metal detector in the identification and localization of coins and coin like metallic foreign bodies.
Collapse
Affiliation(s)
- Vigil James
- Children's Emergency, KK women's and Children's Hospital;
| | | | | |
Collapse
|
|
11
|
Yahyaoui S, Jahaouat I, Brini I, Sammoud A. Delayed diagnosis of esophageal foreign body: A case report. Int J Surg Case Rep 2017; 36:179-181. [PMID: 28601031 PMCID: PMC5466546 DOI: 10.1016/j.ijscr.2017.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Foreign body (FB) ingestion, a common and serious problem in children, can present with a wide variety of symptoms. This paper describes and discusses the case of an esophageal foreign body (EFB), in which the patient presented with primarily respiratory clinical signs causing delayed diagnosis. PRESENTATION OF CASE A six month old boy presented with three months history of harsh cough, stridor and pulmonary congestion. He was repeatedly treated with steroids and antibiotics. His symptoms worsened progressively. On examination, he was tachypneic with suprasternal recession, scattered crepitations, diffuse wheeze and a continuous stridor. Chest X-ray was normal. The flexible bronchoscopy showed a posterior external compression on the middle wall of the trachea. The CT scan was normal. The contrast X-ray study of the esophagus revealed an endoluminal filling defect. The esophagoscopy revealed narrowing at 12cm of dental arch, and a bourgeoning yellow mass easily bleeding on contact. Esophageal biopsies were obtained, and histology was inconclusive. A surgical exploration was planned, but the infant forced out a pistachio shell after a chest physiotherapy session. DISCUSSION Ingestion of FB by small children is a common problem. The majority of EFBs pass harmlessly through the gastrointestinal tract; however, some EFBs can cause significant morbidities. The diagnosis may be delayed leading to several complications especially if the ingestion of the FB is unwitnessed and when the clinician does not think of FB ingestion as part of the differential diagnosis of chronic respiratory signs. CONCLUSION This case highlights, the importance of recognizing, the rare and often forgotten respiratory symptoms of EFB body to avoid diagnostic delay especially in unwitnessed FB ingestion.
Collapse
Affiliation(s)
- Salem Yahyaoui
- Department of Pediatrics C, Children Hospital of Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia.
| | - Imen Jahaouat
- Department of Pediatrics B, Children Hospital of Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia.
| | - Ines Brini
- Department of Pediatrics B, Children Hospital of Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia.
| | - Azza Sammoud
- Department of Pediatrics C, Children Hospital of Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia.
| |
Collapse
|
|
12
|
The utility of a handheld metal detector in detection and localization of pediatric metallic foreign body ingestion. Int J Pediatr Otorhinolaryngol 2017; 92:1-6. [PMID: 28012507 DOI: 10.1016/j.ijporl.2016.10.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 10/27/2016] [Accepted: 10/29/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To test the ability of a handheld metal detector (HHMD) to identify the presence and location of ingested metallic foreign bodies (MFBs) in children. METHODS Prospective case series enrolling children suspected of metallic foreign body ingestion presenting to the Emergency Department. Thirty-eight children were enrolled and the HHMD was used to detect the presence and location of a MFB. Results were compared to standard radiographic studies. RESULTS Thirty-seven of the 38 ingested foreign bodies were MFBs. Of the 37 MFBs, the HHMD positively identified 33, and 4 were missed by HHMD but identified on radiography. When positive, the location indicated by HHMD correlated 100% with radiograph. There were 33 true positives, 0 false positives, 4 false negatives, and 1 true negative. This resulted in a sensitivity of 89% (95% CI of 75%-96%) and specificity of 100% (95% CI of 2.5%-100%). CONCLUSION Our study demonstrates the accuracy of HHMD in the identification and localization of metallic foreign bodies. We propose an emergency room foreign body protocol that uses HHMD as an early screening tool in triage in order to expedite the process of obtaining Otolaryngology consultation and potentially shorten the wait time to the operating room or discharge. In instances were outside films are previously performed, HHMD use may be able to minimize the overall radiation exposure to children by obviating the need for repeat radiographs. As the sensitivity is not 100%, a negative HHMD screening does not negate the need for a standard radiograph in order to avoid missed MFBs. HHMD is best suited for detection of coins, which accounts for the majority of the MFB ingestions, and may not be suitable for all metallic objects since the amount of metal may decrease its sensitivity.
Collapse
|
|
13
|
Endoscopic foreign body removal in the upper gastrointestinal tract: risk factors predicting conversion to surgery. Surg Endosc 2015; 30:106-13. [PMID: 25805240 DOI: 10.1007/s00464-015-4167-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 03/02/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND/AIMS Most foreign bodies of the upper gastrointestinal tract (UGIT) are successfully removed by endoscopic techniques without complications. However, some require conversion to surgery due to failure of endoscopic removal. The aim of this study was to analyze the risk factors predicting the need to convert to surgery after inability to endoscopically remove the foreign body. PATIENTS AND METHODS The medical records of 885 patients treated between January 2006 and March 2014 for suspected foreign bodies in the UGIT were retrospectively reviewed. Patient characteristics, the type of foreign bodies, clinical outcomes, and risk factors predicting the conversion to surgery were analyzed. RESULTS While endoscopic removal was successful in 94.7% (665/702) of the patients, the remaining 5.3% (37/702) needed conversion to surgery. There were no procedure-related deaths. According to the multivariate logistic regression analyses, older age (>70 years, p = 0.004), location (upper esophagus, p = 0.001), larger size (maximal diameter > 30 mm, p = 0.005), and longer impaction time (>40 h, p < 0.001) were significant risk factors predicting conversion to surgery due to inability to remove the foreign body endoscopically. CONCLUSIONS Most of the foreign bodies in the UGIT were successfully removed by endoscopic techniques. However, surgical removal might need to be considered in patients with age >70 years, and those with foreign bodies in the upper esophagus, maximal diameter >30 mm, and impaction time >40 h, due to the possible high failure rate of endoscopic removal.
Collapse
|
|
14
|
A case of battery ingestion in a pediatric patient: what is its importance? Case Rep Pediatr 2015; 2015:345050. [PMID: 25692063 PMCID: PMC4322660 DOI: 10.1155/2015/345050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/11/2015] [Accepted: 01/12/2015] [Indexed: 12/01/2022] Open
Abstract
This is a case of a two-year-old boy who has been suffering from food regurgitation and frequent vomiting over the past seven months which were progressively worsening with time. He was initially diagnosed with gastroesophageal reflux disease and treated accordingly but responded only minimally. Investigations and interventional procedures including a chest X-ray showed a metallic round object in the upper esophagus consistent with a button battery which was removed via a thoracotomy after an esophagoscopy was not successful. This child would not have developed such serious complications and would not have required major surgery had the foreign body been identified and removed early on.
Collapse
|
|
15
|
Schramm JC, Sewell RK, Azarow KS, Raynor SC, Abdessalam SF. Chronic cervical esophageal foreign bodies in children: surgical approach after unsuccessful endoscopic management. Ann Otol Rhinol Laryngol 2014; 123:19-24. [PMID: 24574419 DOI: 10.1177/0003489414521145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We reviewed the surgical management of chronic cervical esophageal foreign bodies (CCEFBs) in a pediatric population after failed endoscopic retrieval. METHODS A descriptive analysis via a retrospective chart review of patients with CCEFBs who failed initial endoscopic management was performed between 2008 and 2013. Details were recorded regarding presenting symptoms, time from symptom onset to diagnosis of the CCEFB, surgical approach, and complications. RESULTS Three patients with CCEFBs unsuccessfully managed with endoscopy were identified. The range of ages at diagnosis was 14 months to 4.5 years. The foreign bodies (FBs) were present for at least 1 month before diagnosis (range, 1 to 10 months). Respiratory symptoms were predominant in all cases. Neck exploration with removal of the FB was performed in each case. Complications included esophageal stricture necessitating serial dilations (patient 1), left true vocal fold paresis that resolved spontaneously (patient 3), and tracheoesophageal fistula with successful endoscopic closure (patient 3). No long-term sequelae were experienced. CONCLUSIONS A high index of suspicion is required to recognize CCEFBs in children with respiratory distress. Although endoscopic management remains the first-line treatment, it may fail or may not be possible because of transmural FB migration. In this setting, neck exploration with FB removal is a safe and effective alternative.
Collapse
Affiliation(s)
- Jordan C Schramm
- Department of Otolaryngology-Head and Neck Surgery (Schramm, Sewell), College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | | | | |
Collapse
|
|
16
|
Pai K, Pillai S, Bhandarkar A, Anand A, Sabhahit H. Migrating Ingested Foreign Body of the Upper Aerodigestive Tract with Resultant Septic Shock: Case report and literature review. Sultan Qaboos Univ Med J 2013; 13:606-10. [PMID: 24273677 DOI: 10.12816/0003326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/09/2013] [Accepted: 06/18/2013] [Indexed: 11/27/2022] Open
Abstract
Complications due to foreign body ingestion are rare; however, if present, these can cause significant morbidity to the patient. An overlooked ingested foreign body could present as an emergency and may prove fatal. We present a case of an accidentally ingested foreign body with delayed presentation, which migrated to the neck and produced a cervical abscess presenting as septic shock. The patient required prompt stabilisation followed by surgical intervention. The patient's vital signs returned to normal on the second post-operative day, and he was discharged the following day.
Collapse
Affiliation(s)
- Keshav Pai
- Kasturba Medical College, Manipal, India
| | | | | | | | | |
Collapse
|
|
17
|
Singh A, Panda SS, Panda M, Srinivas M. Upper oesophageal foreign body with acute respiratory distress. BMJ Case Rep 2013; 2013:bcr-2013-010342. [PMID: 23833004 DOI: 10.1136/bcr-2013-010342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Foreign body (FB) ingestion, a common and serious problem in children can present with a wide variety of symptoms. Oesophageal FB leading to severe acute respiratory distress is uncommon and requires urgent surgical intervenetion. We report an 8-month-old female child who presented with severe respiratory distress to casualty and was found to have a FB in her upper oesophagus.
Collapse
Affiliation(s)
- Amit Singh
- Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | | |
Collapse
|
|
18
|
Glover P, Westmoreland T, Roy R, Sawaya D, Giles H, Nowicki M. Esophageal diverticulum arising from a prolonged retained esophageal foreign body. J Pediatr Surg 2013; 48:e9-12. [PMID: 23414903 DOI: 10.1016/j.jpedsurg.2012.11.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 11/05/2012] [Accepted: 11/08/2012] [Indexed: 12/24/2022]
Abstract
Esophageal foreign body impaction (EFBI) is a rare condition in childhood which needs urgent removal. However, if left untreated, its chronic impaction may lead to serious secondary complications. Symptoms associated with chronic EFBI are attributed to airway disease or gastroesophageal reflux, which further delays definitive diagnosis and management. We present a girl with ingestion of a bottle cap diaphragm that was embedded in her esophagus resulting in esophageal narrowing and a secondary diverticulum formation. As the disk was unable to be removed using standard grasping forceps, the authors used an injector needle to impale the disk and successfully removed it without any complications.
Collapse
Affiliation(s)
- Porter Glover
- Division of Pediatric Gastroenterology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | | | | | | | | | | |
Collapse
|
|
19
|
Park YK, Kim KO, Yang JH, Lee SH, Jang BI. Factors associated with development of complications after endoscopic foreign body removal. Saudi J Gastroenterol 2013; 19:230-4. [PMID: 24045597 PMCID: PMC3793475 DOI: 10.4103/1319-3767.118136] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/AIMS We analyzed the clinical characteristics of patients who underwent endoscopic foreign body removal and the risk factors of complications. PATIENTS AND METHODS The medical records of 415 patients treated from January 2000 to August 2011 for suspected foreign bodies were retrospectively reviewed. Patient characteristics, endoscopic findings, clinical outcomes, and risk factors of complications were analyzed. RESULTS Foreign bodies were detected endoscopically in 315 patients. Fish bone fragment (36.9%) and coins (15.3%) were the most common type of foreign bodies in adults and children, respectively. Complications associated with endoscopic procedure occurred in 26 patients (8.3%); 20 of the patients were treated conservatively and the other six patients underwent surgical treatment. Perforation (14%) was the most common complication. By univariate and multivariate analysis, the risk factors associated with complication after endoscopic foreign body removal were long duration from ingestion to endoscopy ( P = 0.009) and existence of initial mucosal injury ( P = 0.018). CONCLUSIONS Most foreign bodies were successfully removed by endoscopy without complication, but long duration from ingestion to endoscopy and mucosal injury were risk factors of complications of endoscopic foreign body removal. Patients with these risk factors could require more careful treatment.
Collapse
Affiliation(s)
- Yu-Kyung Park
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyeong-Ok Kim
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Yeungnam University College of Medicine, Daegu, Korea,Address for correspondence: Dr. Kyeong Ok Kim, Department of Internal Medicine, Yeungnam University College of Medicine, 317-1, Daemyeong-dong, Nam-gu, Daegu 705-717, Korea. E-mail:
| | - Jae-Hong Yang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Yeungnam University College of Medicine, Daegu, Korea
| | - Si-Hyung Lee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Yeungnam University College of Medicine, Daegu, Korea
| | - Byung-Ik Jang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Yeungnam University College of Medicine, Daegu, Korea
| |
Collapse
|
|
20
|
Cole S, Kearns D, Magit A. Chronic esophageal foreign bodies and secondary mediastinitis in children. Ann Otol Rhinol Laryngol 2011; 120:542-5. [PMID: 21922979 DOI: 10.1177/000348941112000809] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this study was to review the clinical presentation, diagnosis, and management of chronic esophageal foreign bodies complicated by mediastinitis in children. METHODS A retrospective study of children with a chronic esophageal foreign body and secondary mediastinal complications diagnosed at Rady Children's Hospital in San Diego over a 12-month period is reported. RESULTS Three patients received a diagnosis of an esophageal foreign body, retained from 1 to 12 months, and mediastinitis. Each patient presented primarily with respiratory signs and had been treated previously for alternate diagnoses (ie, asthma, reflux, and upper respiratory tract infection) by emergency or pediatric providers. The diagnosis of a foreign body was made after a chest radiograph was examined. Operative airway evaluation confirmed tracheal narrowing in all patients, and a computed tomographic scan of the chest was performed after removal of the foreign body to confirm mediastinal involvement. After medical and/or surgical treatment, the patients were released from the hospital tolerating soft diets. There were no reports of long-term complications in our series of patients. CONCLUSIONS It is critical to rule out esophageal and airway foreign bodies in pediatric patients with respiratory symptoms that do not respond to medical treatment. Timely recognition of an esophageal foreign body generally allows for removal with minimal morbidity, whereas the incidence of serious complications increases significantly when the diagnosis is delayed. Our series provides support for conservative management of mediastinal complications after removal of chronically retained esophageal foreign bodies in children.
Collapse
Affiliation(s)
- Stephanie Cole
- Department of Otolaryngology, Naval Medical Center San Diego, San Diego, California, USA
| | | | | |
Collapse
|
|
21
|
Gore MR, Phillips JD, Zdanski CJ. Esophageal foreign body mimicking a mediastinal mass. Otolaryngol Head Neck Surg 2011; 144:823-4. [PMID: 21493373 DOI: 10.1177/0194599810393863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mitchell R Gore
- Department of Otolaryngology and Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | | | | |
Collapse
|
|
22
|
Abstract
The aim of this study is to assess patients treated for esophageal foreign bodies. The charts of patients (n=177), between January 1994 and April 2009, were investigated retrospectively. Patients' age and gender, locations and types of foreign bodies (FBs) and interventions were taken into consideration. Fifty-seven percent of the patients were male. The youngest patient was 6 months, whereas the oldest was 83 years old. The median age was 9 years. Half of the patients were in their first decade. Treatment took place 11 h (ranging from 1 to 120 h) after impaction of the FB. One hundred fifty-two FBs were removed in 177 patients. Our negative esophagoscopy (n=25) rate was 14%. The FBs were radiopaque in 75% (n=114) and were commonly (71%; n=109) located in the cervical esophagus. Metallic coins (n=81-53%) were the most commonly observed inorganic FB while bones and/or meat impaction (n=54-35%) were the most frequent organic FB. A total of 182 endoscopic interventions were performed on these patients. One hundred eleven of them were esophagoscopy and the remaining 71 were direct laryngoscopy. The FB was pushed into the stomach in 11 patients. Our morbidity rate was 1.6% (n=3). Iatrogenic perforation occurred in two patients. There was no mortality. Esophageal FBs may vary in type: sharp or round objects, metallic, plastic or organic material. FBs are commonly found at pharyngoesophageal junction and usually removed by McGill forceps. Rigid esophagoscopy is used for children and adults because of its large working channel. Rigid instruments are considered reliable and safe for extracting foreign bodies.
Collapse
Affiliation(s)
- A Nadir
- Department of Thoracic Surgery Emergency Medicine, School of Medicine, Cumhuriyet University Gastroenterology, Sivas Nümune Hospital, Sivas, Turkey
| | | | | | | | | |
Collapse
|
|
23
|
Antón-Pacheco JL, Berchi FJ. Acquired tracheo-esophageal fistula in a child caused by an unsuspected esophageal foreign body. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.pedex.2008.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
|
24
|
Hiradfar M, Khorram B. Post-Heller myotomy mucosal perforation because of missed intraluminal esophageal foreign body: a case report. J Pediatr Surg 2008; 43:963-4. [PMID: 18485977 DOI: 10.1016/j.jpedsurg.2008.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 01/12/2008] [Indexed: 11/28/2022]
|
|
25
|
Huiping Y, Jian Z, Shixi L. Esophageal foreign body as a cause of upper gastrointestinal hemorrhage: case report and review of the literature. Eur Arch Otorhinolaryngol 2007; 265:247-9. [PMID: 17701046 DOI: 10.1007/s00405-007-0419-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 07/26/2007] [Indexed: 11/29/2022]
Abstract
Foreign body ingestion is a common complaint in the emergency department. Severe upper gastrointestinal (GI) hemorrhage is a rare complication of foreign body ingestion and is always considered to signal aortoesophageal fistula (AEF). We report a rare case of a 65-year-old man with upper GI hemorrhage caused by an ingested duck bone 10 days previously. Instead of AEF, massive erosion and edema were found in the esophagus, highlighting the potentially complex pathology of foreign body ingestion. A literature review of the recognized clinical features of esophageal foreign body is described. Some practical points and pitfalls in the management of esophageal foreign body are presented. For patients with a history of esophageal foreign body ingestion, the clinician must maintain a high index of suspicion and must endeavor to obtain a full history.
Collapse
Affiliation(s)
- Ye Huiping
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China.
| | | | | |
Collapse
|
|
26
|
Li ZS, Sun ZX, Zou DW, Xu GM, Wu RP, Liao Z. Endoscopic management of foreign bodies in the upper-GI tract: experience with 1088 cases in China. Gastrointest Endosc 2006; 64:485-92. [PMID: 16996336 DOI: 10.1016/j.gie.2006.01.059] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2005] [Accepted: 01/15/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Reports on endoscopic management of ingested foreign bodies of the upper-GI tract in China are scarce. OBJECTIVE To report our experience and outcome in the management of ingestion of foreign bodies in Chinese patients. SETTING AND PATIENTS Between January 1980 and January 2005, a total of 1088 patients (685 men and 403 women; age range, 1 day to 96 years old) with suspected foreign bodies were admitted to our endoscopy center. INTERVENTIONS All patients underwent endoscopic procedure after admission. MAIN OUTCOME MEASUREMENTS Demographic and endoscopic data, including age, sex, and referral sources of patients, types, number and location of foreign bodies, associated upper-GI diseases, endoscopic methods, and accessory devices for removal of foreign bodies were collected and analyzed. RESULTS A total of 1090 foreign bodies were found in 988 (90.8%) patients. The types of foreign bodies varied greatly: mainly food boluses, coins, fish bones, dental prostheses, or chicken bones. The foreign bodies were located in the pharynx (n = 12), the esophagus (n = 577), the stomach (n = 441), the duodenum (n = 50), and the surgical anastomosis (n = 10). The associated GI diseases (n = 88) included esophageal carcinoma (33.0%), stricture (23.9%), diverticulum (15.9%), postgastrectomy (11.4%), hiatal hernia (10.2%), and achalasia (5.7%). A rat-tooth forceps and a snare were the most frequently used accessory devices. The success rate for foreign-body removal was 94.1% (930/988). CONCLUSIONS Ingestion of foreign bodies is a common clinic problem in China. Endoscopy procedures are frequently performed, and a high proportion of patients with foreign bodies require endoscopic intervention.
Collapse
Affiliation(s)
- Zhao-Shen Li
- Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | | | | | | | | | | |
Collapse
|
|
27
|
Seo YS, Park JJ, Kim JH, Kim JY, Yeon JE, Kim JS, Byun KS, Bak YT. Removal of press-through-packs impacted in the upper esophagus using an overtube. World J Gastroenterol 2006; 12:5909-12. [PMID: 17007065 PMCID: PMC4100680 DOI: 10.3748/wjg.v12.i36.5909] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Foreign bodies in the upper esophagus should be removed as soon as possible to avoid serious complications. However, removals of foreign bodies in the upper esophagus are very difficult, especially if they have sharp edges, such as press-through-packs (PTPs). We experienced four cases of the impacted PTPs in the upper esophagus which was successfully extracted endoscopically with the overtube. Because two edges of PTPs were so firmly impacted in the esophageal wall in all cases, the PTPs were not movable in the upper esophagus. However, after insertion of the overtube, PTPs became movable and were successfully extracted and no serious complications occurred after extraction of PTPs. In one case, insertion of the overtube rapidly expanded the upper esophagus and PTP progressed to the gastric cavity and it could be extracted with the endoscopic protector hood. The endoscopic removal with the overtube was a simple, safe and effective technique for the removal of the impacted PTPs in upper esophagus.
Collapse
Affiliation(s)
- Yeon-Seok Seo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Gurodong-gil 97, Guro-gu, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
|
28
|
Lee JB, Ahmad S, Gale CP. Detection of coins ingested by children using a handheld metal detector: a systematic review. Emerg Med J 2006; 22:839-44. [PMID: 16299189 PMCID: PMC1726630 DOI: 10.1136/emj.2004.022301] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
To determine if the use of a handheld metal detector (HHMD) can safely reduce the number of radiographs requested in cases of coins ingested by children, a search was performed to identify prospective studies of the ability of an HHMD to identify the presence or absence of ingested coin in children (17 years or younger). Outcome measures were presence or absence of coin on metal detector screening, and accuracy of coin localisation. Inclusion and exclusion criteria were defined. Mantel-Haenszel (fixed effect model) pooling with 95% confidence intervals (CI) was used to calculate overall sensitivities and specificities. In total, 11 studies met the inclusion criteria. The overall sensitivity of the HHMD at detecting the presence of coins was 99.4% (95% CI 98.0 to 99.9%) and accuracy at localisation was 99.8% (98.5 to 100.0%). The overall specificity of the HHMD was 100% (76.8 to 100%). Use of the HHMD is an accurate, radiation free, and cost effective method of identifying and localising coins ingested by children. An algorithm for investigating children with coin ingestion is proposed.
Collapse
Affiliation(s)
- J B Lee
- Accident and Emergency Department, St James's University Hospital, Leeds LS9 7TF, UK.
| | | | | |
Collapse
|
|
29
|
Abstract
The management of mediastinitis involves directing appropriate antibacterial therapy against the potential bacterial pathogens. The increased recovery of anaerobic bacteria from mediastinal infections has led to a greater appreciation of their role in this condition and to re-evaluation of the proper treatment of this condition. Mediastinitis caused by anaerobic bacteria generally emerges following perforation of the oesophagus, extension of retropharyngeal abscess, suppurative parotitis, cervical cellulitis or abscess of dental origin. The bacteria recovered from these infections are often of oral origin and involve mixed aerobic-anaerobic oral flora. The predominant anaerobic isolates include Bacteroides spp., Peptostreptococcus spp., pigmented Prevotella and Porphyromonas spp. and Fusobacterium spp. Treatment includes surgical intervention, antibacterial therapy and supportive measures. Appropriate management of mediastinal infections due to aerobic and anaerobic infections requires the administration of antibacterials that are effective against both the aerobic and anaerobic components of the infection. Selection of antibacterials for the treatment of mediastinitis is determined by bacteriological studies.
Collapse
Affiliation(s)
- Itzhak Brook
- Georgetown University School of Medicine, Washington, DC 20016, USA.
| |
Collapse
|
|
30
|
Woolley SL, Smith DRK. History of possible foreign body ingestion in children: don??t forget the rarities. Eur J Emerg Med 2005; 12:312-6. [PMID: 16276264 DOI: 10.1097/00063110-200512000-00013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Foreign body ingestion in children is a common presenting complaint to the emergency department. Although the majority of ingested foreign bodies pass through the gastrointestinal tract unaided, some children will require either non-surgical or surgical intervention. Retained oesophageal foreign bodies may cause a multitude of problems, including mucosal ulceration, inflammation or infection, and more seriously paraoesophageal or retropharyngeal abscess formation, mediastinitis, empyema, oesophageal perforation and aorta-oesophageal fistula formation. We present a case of a 12-month-old child in whom delayed diagnosis of glass ingestion resulted in the development of a retropharyngeal abscess, oesophageal perforation and mediastinitis. Such complications following foreign body ingestion in children are rare but potentially fatal. A high index of suspicion must be maintained in young children presenting with a possible history of foreign body ingestion as a delayed diagnosis may lead to significant morbidity and mortality. We review the literature surrounding paediatric retropharyngeal abscesses and mediastinitis.
Collapse
Affiliation(s)
- Sarah L Woolley
- Consultant Emergency Department, Bristol Royal Infirmary/Bristol Children's Hospital, Bristol, UK.
| | | |
Collapse
|
|
31
|
Mignosa C, Agati S, Gitto P, Salvo D, Trimarchi ES. Cardiac tamponade: rare presentation of acquired pericardial-esophageal fistula. J Thorac Cardiovasc Surg 2005; 130:1711. [PMID: 16308021 DOI: 10.1016/j.jtcvs.2005.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Accepted: 07/07/2005] [Indexed: 11/18/2022]
Affiliation(s)
- Carmelo Mignosa
- Pediatric Cardiac Surgery Unit, San Vincenzo Hospital, Taormina, Italy
| | | | | | | | | |
Collapse
|
|
32
|
Abstract
In the pediatric literature, only 1 case of cervical spondylodiscitis from an ingested foreign body is reported and this was caused by a blunt radiolucent foreign body. The authors now describe a unique case of a 13-year-old teenaged boy who presented with neck pain 6 days after accidental ingestion of a sewing pin. Uncomplicated removal of this pin was followed in 36 days by the development of cervical spondylodiscitis that failed conservative management and required surgical debridement and arthrodesis. Physicians should be aware of the possibility of this complication in any patient that presents with neck pain after foreign body ingestion.
Collapse
Affiliation(s)
- George M Wadie
- Division of Pediatric Surgery, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA.
| | | | | | | |
Collapse
|
|
33
|
Abstract
OBJECTIVE Exact localization of ingested metal objects is necessary to guide therapy. This study prospectively evaluates the accuracy of foreign body (FB) identification and localization by metal detector (MTD) in a systematic topographic fashion. METHODS Patients who presented after an alleged or witnessed metal FB ingestion were scanned with an MTD. In case of a positive signal, the location was recorded in a topographic diagram, and radiographs were obtained. The diagnostic accuracy of the MTD scan for FB identification and topographic localization was determined by chi(2) analysis, and concordance was calculated by the McNemar test and expressed as kappa. RESULTS A total of 70 MTD examinations were performed on 65 patients (age 6 months to 16 years); 5 patients were scanned twice on different days. The majority had swallowed coins and button batteries (n = 41). Of these, 29 items were correctly identified, and 11 of 12 were correctly ruled out (coins and button batteries: sensitivity, 100% [95% Confidence Interval 95% to 100%]; specificity, 91.7% [95% CI 76% to 100%], kappa = 0.94). When all metallic objects were included, 41 of 46 were correctly identified, and 22 of 24 were correctly ruled out (sensitivity, 89.1% [95% CI 80% to 98%]; specificity, 91.7% [95% CI 81% to 100%], kappa = 0.78). Five miscellaneous objects were not identified (sensitivity for items other than coins and button batteries 71% [95% CI 49% to 92%], kappa = 0.56). Localization by MTD was correct in 30 of 41 identified objects (73%). The error rates of junior and senior pediatric surgery residents did not differ significantly (P =.82). CONCLUSIONS Ingested coins and button batteries can be safely and accurately found by metal detector. For these indications, the MTD is a radiation-free diagnostic alternative to conventional radiographs. Other items, however, cannot be ruled out reliably by MTD. In these cases, radiographic imaging is still indicated.
Collapse
Affiliation(s)
- Oliver J Muensterer
- Department of Pediatric Surgery, Dr von Hauner Children's Hospital, University of Munich, Munich, Germany
| | | |
Collapse
|
|
34
|
Akman C, Kantarci F, Cetinkaya S. Imaging in mediastinitis: a systematic review based on aetiology. Clin Radiol 2004; 59:573-85. [PMID: 15208062 DOI: 10.1016/j.crad.2003.12.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2003] [Revised: 12/10/2003] [Accepted: 12/14/2003] [Indexed: 10/26/2022]
Abstract
Mediastinitis refers to inflammation of the tissues located in the middle chest cavity. It can be secondary to infectious or non-infectious causes and depending on the aetiology may be acute or chronic. The majority of cases of acute mediastinitis are secondary to oesophageal perforation and open chest surgery. Less common causes include tracheal, bronchial perforation or direct extension of infection from adjacent tissues. Chronic or slowly developing mediastinitis mostly arise from tuberculosis, histoplasmosis, other fungal infections, cancer, or sarcoidosis. In a minority of cases the aetiology is lymphatic obstruction or an autoimmune disease. Radiological imaging plays an essential role in the diagnosis and therapeutic approach to mediastinitis. Generally, the initial radiological work-up includes radiographic studies either with or without contrast material. However, conventional chest radiography may be misleading in the diagnosis of mediastinitis. Cross-sectional imaging techniques are generally required for diagnosis and evaluation of the site and extent of mediastinal involvement. Computed tomography and magnetic resonance imaging may also guide the choice of the optimal therapeutic approach.
Collapse
Affiliation(s)
- C Akman
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
| | | | | |
Collapse
|
|
35
|
Mathur NN, Kumar S, Bothra R. Intramural foreign body in oesophagus. Int J Pediatr Otorhinolaryngol 2004; 68:837-9. [PMID: 15126028 DOI: 10.1016/j.ijporl.2004.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2003] [Revised: 01/14/2004] [Accepted: 01/17/2004] [Indexed: 11/29/2022]
Abstract
Intramural foreign body in oesophagus is very rare and is mostly associated with complications leading to high morbidity and mortality. Recently we came across a coiled metallic wire discovered unexpectedly in a chest X-ray of a 6-month-old male baby. This was further investigated and was found to be located intramurally in the oesophagus. It was successfully removed with rigid oesophagoscopy performed under telescopic guidance. No such foreign body has been reported in an infant so far in English literature.
Collapse
Affiliation(s)
- N N Mathur
- Department of ENT, Lady Hardinge Medical College and associated Smt. SK & KS Children's Hospital, New Delhi, India.
| | | | | |
Collapse
|
|
36
|
Miller RS, Willging JP, Rutter MJ, Rookkapan K. Chronic esophageal foreign bodies in pediatric patients: a retrospective review. Int J Pediatr Otorhinolaryngol 2004; 68:265-72. [PMID: 15129936 DOI: 10.1016/j.ijporl.2003.09.021] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Chronic esophageal foreign bodies (CEFB) are associated with a high incidence of morbidity and mortality in adults. However, the presentation, management and outcome of chronic esophageal foreign bodies in children are not well described. METHODS We performed a retrospective chart review of children with chronic esophageal foreign bodies admitted to the Children's Hospital Medical Center, Cincinnati, OH, between May 1990 and January 2002. A chronic esophageal foreign body was defined as a foreign body estimated to have been present for over 1 week. RESULTS Over the inclusion period, 522 children were admitted with esophageal foreign bodies, 41 (8%) of which were chronic. The most common foreign bodies were coins. Seventy-six percent of patients presented with a primary complaint of respiratory symptoms, with respiratory distress being the most common followed by asthmatic symptoms and cough. Twenty-two percent of patients had primarily gastrointestinal symptoms including nausea/vomiting and dysphagia. One patient was asymptomatic on presentation. A perforated esophagus was identified in 18 patients, with 17 of these being a technically perforated esophagus and one case being a classic esophageal perforation. There were no deaths or permanent morbidity in this series. CONCLUSIONS Respiratory symptoms are more common than gastrointestinal symptoms in pediatric patients with chronic esophageal foreign bodies. Removal by rigid esophagoscopy is recommended. A small proportion of cases require open removal of the foreign body. Conservative management is appropriate for the technically perforated esophagus. A good outcome should be anticipated for the majority of cases.
Collapse
Affiliation(s)
- Robert Sean Miller
- Department of Otolaryngology/Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, PO Box 670528, 45267-0528 Cincinnati, OH, USA.
| | | | | | | |
Collapse
|
|
37
|
Abstract
A 73-year-old woman complaining of sudden hoarseness visited our hospital 17 days after the onset. The upper gastrointestinal contrast study showed a shallow ulcer crater with moderate bulging in the upper thoracic esophagus. Endoscope and computed tomography revealed an esophageal foreign body, a Press Through Pack (PTP), in the esophageal ulcer. The PTP could be removed endoscopically. Two months after extraction of the PTP, the patient was taking normal food orally and was discharged. The esophageal perforation, looking like a diverticle, was still present more than 1 year after the onset.
Collapse
Affiliation(s)
- T Sudo
- Department of Surgery, Kurume University School of Medicine, Kurume-city, Fukuoka, Japan
| | | | | | | | | |
Collapse
|
|
38
|
Abstract
Abnormalities of the esophagus are common, and complications associated with these disorders and diseases can involve the mediastinum, tracheobronchial tree, and lungs. The most common complications include mediastinitis secondary to esophageal perforation or postoperative anastomotic leak, or both; empyema due to fistula formation; and aspiration pneumonia. The authors reviewed the radiologic appearances of those and other common thoracic complications associated with esophageal disorders to facilitate early detection, diagnosis, and management. Computed tomographic (CT) findings of acute mediastinitis secondary to esophageal perforation may include esophageal thickening, extraluminal gas, pleural effusion, single or multiple abscesses, and extraluminal contrast medium. The radiologic manifestations of pneumonia secondary to tracheoesophageal fistula are variable, depending on the spread and severity of the aspiration. The most common radiographic pattern is that of bronchopneumonia with scattered air-space opacities. CT has been regarded as the imaging modality of choice for the evaluation of suspected esophagopleural fistula, because the site of communication between the pleural space and the esophagus can often be seen. An awareness of the radiologic manifestations of these complications is thus required to facilitate early diagnosis.
Collapse
Affiliation(s)
- Ana Giménez
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Avda Sant Antoni M. Claret 167, 08025 Barcelona, Spain.
| | | | | | | | | |
Collapse
|
|
39
|
Hostetler MA, Barnard JA. Removal of esophageal foreign bodies in the pediatric ED: is ketamine an option? Am J Emerg Med 2002; 20:96-8. [PMID: 11880871 DOI: 10.1053/ajem.2002.31572] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The objective of the study was to evaluate our experience with esophageal foreign body (EFB) removal comparing the use of ketamine-midazolam (K-M) and fentanyl-midazolam (F-M) in the emergency department (ED), to admission and general anesthesia (GA) in the operating room (OR). A retrospective review of all children undergoing EFB removal at our institution during a 2-year period was conducted. A total of 93 patients were identified: K-M 57/93 (61.2%), F-M 28/93 (30.1%), GA 5/93 (5.4%), and 3/93 (3.2%) by other means. Mean procedure durations were 4.8 min for K-M and 7.0 min for F-M. Mean lengths of stay (LOS) for ED procedures were 3.6 hrs for K-M and 5.7 hrs for F-M, versus 17.7 hrs if admitted. Transient hypoxemia occurred in 10.7% of K-M and 15.4% of F-M. Removal of EFBs in the ED may obviate the need for admission. In our experience, the use of K-M is associated with fewer airway complications, shorter removal times, and an overall shorter LOS.
Collapse
Affiliation(s)
- Mark A Hostetler
- Department of Pediatrics, Division of Emergency Medicine, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | | |
Collapse
|
|
40
|
Arya A. An unusual presentation of impacted esophageal foreign body. Indian J Pediatr 2001; 68:1167. [PMID: 11838577 DOI: 10.1007/bf02722939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|