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Lugo-Fagundo C, Ghodasara N, Fishman EK, Azadi JR. CT evaluation of self-induced and retained foreign bodies in the abdomen and pelvis. Clin Imaging 2021; 80:26-35. [PMID: 34224951 DOI: 10.1016/j.clinimag.2021.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 06/03/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
Computed tomography (CT) can both locate and identify foreign bodies as well as pinpoint complications to help direct treatment. Retained foreign bodies in the abdomen and pelvis can lead to perforation, obstruction, intussusception, fistula formation, and abdominal abscess formation. This article reviews the imaging appearance of incidentally found common foreign bodies and the role of CT in identifying unsuspected foreign bodies.
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Affiliation(s)
| | - Nevil Ghodasara
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Elliot K Fishman
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Javad R Azadi
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, USA.
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2
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Retained Foreign Body Causing a Liver Abscess. Case Rep Emerg Med 2020; 2019:4259646. [PMID: 31934467 PMCID: PMC6942747 DOI: 10.1155/2019/4259646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/03/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction A liver abscess caused by fishbone ingestion is extremely rare in the Emergency Department. Case Report We report a case of a middle-aged female who presented to the Emergency Department with nonspecific symptoms. Computed tomography showed a liver abscess that had formed secondary to a fishbone. The patient was treated conservatively initially and subsequently with percutaneous drainage and finally with open drainage. Her condition improved and she was discharged from the hospital with the foreign body still in-situ. Conclusion This case is one of six cases in literature where the patient has been discharged successfully from the hospital with a retained fishbone. It also demonstrates the difficulty of diagnosing a foreign body causing a liver abscess and the multiple treatment modalities used to treat a liver abscess caused by fishbone.
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3
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Chen J, Wang C, Zhuo J, Wen X, Ling Q, Liu Z, Guo H, Xu X, Zheng S. Laparoscopic management of enterohepatic migrated fish bone mimicking liver neoplasm: A case report and literature review. Medicine (Baltimore) 2019; 98:e14705. [PMID: 30882633 PMCID: PMC6426515 DOI: 10.1097/md.0000000000014705] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/29/2019] [Accepted: 02/05/2019] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Accidental ingestion of a foreign body is common in daily life. But the hepatic migration of perforated foreign body is rather rare. PATIENT CONCERNS A 37-year-old man presented with a history of vague epigastric discomfort for about 2 months. DIAGNOSIS A diagnosis of the foreign body induced hepatic inflammatory mass was made based on abdominal computed tomographic scan and upper gastrointestinal endoscopy. INTERVENTIONS The patient underwent laparoscopic laparotomy. During the operation, inflammatory signs were seen in the lesser omentum and segment 3 of liver. B- Ultrasound guided excision of the mass (in segment 3) was performed. Dissecting the specimen revealed a fish bone measuring 1.7 cm in length. OUTCOMES The patient recovered uneventfully and was discharged on day 5 after surgery. LESSONS This study shows the usefulness of endoscopy for final diagnosis and treatment in foreign body ingestion. Early diagnosis and decisive treatment in time are lifesaving for patients with this potentially lethal condition.
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Affiliation(s)
- Jun Chen
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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4
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Gómez Portilla A, Ezurmendia B, Martín E, López de Heredia E, Muriel López J. Fish bone-related intrahepatic abscess. An underdiagnosed condition? Cir Esp 2018; 97:116-118. [PMID: 30031548 DOI: 10.1016/j.ciresp.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/18/2018] [Accepted: 06/03/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Alberto Gómez Portilla
- Hospital Universitario de Araba Sede Santiago Apóstol, Departamento de Cirugía General, Universidad del País Vasco, Vitoria, Álava, España.
| | - Bernardo Ezurmendia
- Hospital Universitario de Araba Sede Santiago Apóstol, Departamento de Cirugía General, Universidad del País Vasco, Vitoria, Álava, España
| | - Ernesto Martín
- Hospital Universitario de Araba Sede Santiago Apóstol, Departamento de Cirugía General, Universidad del País Vasco, Vitoria, Álava, España
| | - Eduardo López de Heredia
- Hospital Universitario de Araba Sede Santiago Apóstol, Departamento de Cirugía General, Universidad del País Vasco, Vitoria, Álava, España
| | - Jesús Muriel López
- Hospital Universitario de Araba Sede Santiago Apóstol, Departamento de Cirugía General, Universidad del País Vasco, Vitoria, Álava, España
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Kim JS, Cha JM, Kwak MS, Yoon JY, Jeon JW, Shin HP, Joo KR, Lee JI, Kim HY. Small Bowel Perforation Caused by Press-through Package. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 70:261-264. [DOI: 10.4166/kjg.2017.70.5.261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jung Seok Kim
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jin Young Yoon
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jung Won Jeon
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyun Phil Shin
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kwang Ro Joo
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Joung Il Lee
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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6
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Affiliation(s)
- Vaid Nikhilesh
- Editor in Chief, APOS Trends in Orthodontics, YMT Dental College and Hospital, India
| | - Shah Pratik
- Department of Orthodontics and Dentofacial Orthopedics, YMT Dental College and Hospital, India
| | - Vandekar Meghna
- Chair and Prof, Department of Orthodontics, YMT Dental College and Hospital, Mumbai, Maharashtra, India
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7
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Seishima R, Okabayashi K, Hasegawa H, Tsuruta M, Hoshino H, Yamada T, Kitagawa Y. Computed tomography attenuation values of ascites are helpful to predict perforation site. World J Gastroenterol 2015; 21:1573-1579. [PMID: 25663776 PMCID: PMC4316099 DOI: 10.3748/wjg.v21.i5.1573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/27/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effect of computed tomography (CT) attenuation values of ascites on gastrointestinal (GI) perforation site prediction.
METHODS: The CT attenuation values of the ascites from 51 patients with GI perforations were measured by volume rendering to calculate the mean values. The effect of the CT attenuation values of the ascites on perforation site prediction and postoperative complications was evaluated.
RESULTS: Of 24 patients with colorectal perforations, the CT attenuation values of ascites were significantly higher than those in patients with perforations at other sites [22.5 Hounsfield units (HU) vs 16.5 HU, respectively, P = 0.006]. Colorectal perforation was significantly associated with postoperative complications (P = 0.038). The prediction rate of colorectal perforation using attenuation values as an auxiliary diagnosis improved by 9.8% compared to that of CT findings alone (92.2% vs 82.4%).
CONCLUSION: The CT attenuation values of ascites could facilitate the prediction of perforation sites and postoperative complications in GI perforations, particularly in cases in which the perforation sites are difficult to predict by CT findings alone.
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8
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Chong LW, Sun CK, Wu CC, Sun CK. Successful treatment of liver abscess secondary to foreign body penetration of the alimentary tract: A case report and literature review. World J Gastroenterol 2014; 20:3703-3711. [PMID: 24707157 PMCID: PMC3974541 DOI: 10.3748/wjg.v20.i13.3703] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/24/2013] [Accepted: 01/20/2014] [Indexed: 02/07/2023] Open
Abstract
Hepatic abscess caused by foreign body penetration of the alimentary tract is rare. We report a case of gastric antrum penetration due to a toothpick complicated by liver abscess formation. A 41-year-old man was admitted to our hospital with the chief complaint of upper abdominal pain for 2 mo. Esophagogastroduodenoscopy performed at a local clinic revealed a toothpick penetrating the gastric antrum. Computed tomography (CT) of the abdomen at our hospital revealed a gastric foreign body embedded in the posterior wall of gastric antrum with regional phlegmon over the lesser sac and adhesion to the pancreatic body without notable vascular injury, and a hepatic abscess seven cm in diameter over the left liver lobe. Endoscopic removal of the foreign body was successfully performed without complication. The liver abscess was treated with parenteral antibiotics without drainage. The patient’s recovery was uneventful. Abdominal ultrasonography demonstrated complete resolution of the hepatic abscess six months after discharge. Relevant literature from the PubMed database was reviewed and the clinical presentations, diagnostic modalities, treatment strategies and outcomes of 88 reported cases were analyzed. The results showed that only 6 patients received conservative treatment with parenteral antibiotics, while the majority underwent either image-guided abscess drainage or laparotomy. Patients receiving abscess drainage via laparotomy had a significantly shorter length of hospitalization compared with those undergoing image-guided drainage. There was no significant difference in age between those who survived and those who died, however, the latter presented to hospitals in a more critical condition than the former. The overall mortality rate was 7.95%.
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9
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Umesan UK, Chua KL, Balakrishnan P. Prevention and management of accidental foreign body ingestion and aspiration in orthodontic practice. Ther Clin Risk Manag 2012; 8:245-52. [PMID: 22701326 PMCID: PMC3373200 DOI: 10.2147/tcrm.s30639] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Among the myriad emergencies that could arise in the dental clinical setting there are a few that occur occasionally despite being entirely preventable. Ingestion or aspiration of dental materials, appliances, or instruments comprises this category. Regardless of incidence, foreign body ingestion or aspiration episodes are recognized as potential complications in the specialty of orthodontics. Despite their infrequent occurrence, the morbidity from a single incident and the amount of specialty medical care that may be needed to manage such incidents is too high to ignore. There is also the associated risk of malpractice litigation given the fact that these incidents are preventable. At present, no clear guidelines exist regarding prevention of this emergency in practice. This article attempts to review relevant literature and aims to formulate certain recommendations based on best available evidence to minimize the incidence of such events, while also suggesting guidelines toward making their management more effective. A flow chart outlining management options and strategies to aid the clinician in the event of such an emergency is also presented.
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10
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Iwai T, Yoshida H, Yokoyama T, Maruyama H, Suzuki S, Matsutani T, Matsushita A, Hirakata A, Sasajima K, Uchida E. Migration of a fish bone into the right renal vein. J NIPPON MED SCH 2012; 78:189-93. [PMID: 21720094 DOI: 10.1272/jnms.78.189] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We describe a patient in whom a fish bone penetrated the duodenum and migrated into the right renal vein. The bone was successfully removed with surgery. The 75-year-old man was admitted to Nippon Medical School Tama Nagayama Hospital because of right upper abdominal pain persisting for 7 days. The patient's medical history was not relevant to the current disorder. Plain radiography showed no abnormalities. Computed tomography revealed a linear object of high intensity that had penetrated the duodenum and migrated into the right renal vein with thrombus. The object was surrounded by a low-density area, suggesting severe inflammation. The patient had eaten fish 1 day before the onset of abdominal pain. We diagnosed duodenal penetration caused by an ingested fish bone. Endoscopic examination showed erosion, but no fish bone or ulceration was detected in the duodenum. The patient was treated conservatively with fasting, peripheral parental nutrition, and intravenous antibiotics. Three days after admission, non-contrast-enhanced computed tomography showed no movement of the foreign body. The patient continued to have pain, and the decision was made to surgically explore the abdomen. Intraoperative ultrasonography showed that the foreign body had migrated completely into the right renal vein with thrombus. Severe inflammation of the right renal vein was observed. Because we could not remove the foreign body without seriously injuring the right renal vein, right nephrectomy was performed. Macroscopic examination of the surgical specimen confirmed the presence of a fish bone with thrombus in the right renal vein. The patient was discharged 9 days after operation, with no complications.
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Affiliation(s)
- Takuma Iwai
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Japan
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11
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Jo YS, Lee GSR, Lee DS, Kim SJ. A misdiagnosed cause of chronic pelvic pain: abscess with foreign body. PAIN MEDICINE 2011; 15:1637-9. [PMID: 21995334 DOI: 10.1111/j.1526-4637.2011.01248.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Chronic pelvic pain may present a diagnostic challenge. SETTING Academic tertiary care center. DESIGN Case report. CASE REPORT A 46-year-old woman presented with pain on micturition and a 15-month history of right-sided pelvic pain aggravated by an abdominal massage. Her course and outcome, aided by use of computed tomography (CT) scan, is described, identifying a 6-cm, mass-like lesion in the right lower quadrant enclosing an ambiguous linear calcified lesion, which on laparotomy revealed a fish bone embedded in a section of the terminal ileum and the perivesical area. CONCLUSION Chronic pelvic pain refractory to treatment merits consideration of CT to examine for foreign body.
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Affiliation(s)
- Yun Sung Jo
- Department of Obstetrics and Gynecology, The Catholic University of College of Medicine, Seoul Department of Surgery, Division of Gastrointestinal Surgery, The Catholic University of College of Medicine, Seoul, Korea
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12
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Fish bone penetration of the duodenum extending into the pancreas: report of a case. Surg Today 2010; 40:676-8. [PMID: 20582523 DOI: 10.1007/s00595-009-4110-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 04/13/2009] [Indexed: 12/24/2022]
Abstract
We report a case of fish bone penetration of the duodenum extending into the pancreatic head, which was successfully treated by surgery. A 73-year-old woman was admitted with upper abdominal dull pain that had persisted for 3 days. Computed tomography showed a linear calcified body, which appeared to penetrate the posterior wall of the duodenal bulb into the pancreatic head. A laparotomy was performed based on the preoperative diagnosis of localized peritonitis caused by penetration of the duodenum into the pancreas by an ingested foreign body. The foreign body was safely removed from both the pancreas and duodenum and was found to be a fish bone, measuring 4 cm in length. Neither an abscess nor hematoma was detected at the site of the pancreatic head. The postoperative course was uneventful. This case demonstrates an unusual presentation of fish bone penetration of the duodenum with a migration to the pancreas.
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13
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Singh JP, Steward MJ, Booth TC, Mukhtar H, Murray D. Evolution of imaging for abdominal perforation. Ann R Coll Surg Engl 2010; 92:182-8. [PMID: 20412668 DOI: 10.1308/003588410x12664192075251] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Gastrointestinal (GI) perforation is a common surgical presentation. In recent years, computed tomography (CT) has been shown to be accurate for predicting the site of GI perforation, and has become the investigation of choice. However the signs may be subtle or only indirectly related to the site or aetiology of perforation. SUBJECTS AND METHODS A MEDLINE and PubMed search was performed for journals before June 2009 with MeSH major terms 'CT' and 'perforation'. Non-English speaking literature was excluded. RESULTS Examples of GI perforation of various aetiologies are reviewed (inflammatory, neoplastic, traumatic and iatrogenic) high-lighting characteristic CT appearances as well as pitfalls in diagnosis. Features of perforation include the presence of free gas or fluid within the supra- and/or inframesocolic compartments, segmental bowel wall thickening, bowel wall discontinuity, stranding of the mesenteric fat and abscess formation. CONCLUSIONS These differentiating features facilitate accurate multidisciplinary pre-operative evaluation, necessary to plan patient management and potential surgical approach.
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Affiliation(s)
- J P Singh
- Department of Radiology, The Whittington Hospital, Royal Free and University College Medical School, London, UK
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14
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Leggieri N, Marques-Vidal P, Cerwenka H, Denys A, Dorta G, Moutardier V, Raoult D. Migrated foreign body liver abscess: illustrative case report, systematic review, and proposed diagnostic algorithm. Medicine (Baltimore) 2010; 89:85-95. [PMID: 20517180 DOI: 10.1097/md.0b013e3181d41c38] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Pyogenic liver abscess is a severe condition and a therapeutic challenge. Treatment failure may be due to an unrecognized ingested foreign body that migrated from the gastrointestinal tract. There has recently been a marked increase in the number of reported cases of this condition, but initial misdiagnosis as cryptogenic liver abscess still occurs in the majority of cases. We conducted the current study to characterize this entity and provide a diagnostic strategy applicable worldwide. To this end, data were collected from our case and from a systematic review that identified 59 well-described cases. Another systematic review identified series of cryptogenic-and Asian Klebsiella-liver abscess; these data were pooled and compared with the data from the cases of migrated foreign body liver abscess. The review points out the low diagnostic accuracy of history taking, modern imaging, and even surgical exploration. A fistula found through imaging procedures or endoscopy warrants surgical exploration. Findings suggestive of foreign body migration are symptoms of gastrointestinal perforation, computed tomography demonstration of a thickened gastrointestinal wall in continuity with the abscess, and adhesions seen during surgery. Treatment failure, left lobe location, unique location (that is, only 1 abscess location within the liver), and absence of underlying conditions also point to the diagnosis, as shown by comparison with the cryptogenic liver abscess series. This study demonstrates that migrated foreign body liver abscess is a specific entity, increasingly reported. It usually is not cured when unrecognized, and diagnosis is mainly delayed. This study provides what we consider the best available evidence for timely diagnosis with worldwide applicability. Increased awareness is required to treat this underestimated condition effectively, and further studies are needed.
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Affiliation(s)
- Nicola Leggieri
- From Service de Maladies Infectieuses et Laboratoire Central de Bactériologie (NL), Hôpitaux Universitaires de Genève, Geneva, Switzerland; Institut Universitaire de Médecine Sociale et Préventive (PMV), Service deRadiologie (AD), Service de Gastroentérologie et d'Hépatologie (GD), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Department of Surgery (HC), Medical University of Graz, Graz, Austria; Service de Chirurgie Viscérale (VM), Hôpital Nord, Marseille, France; and Unité des Rickettsies (DR), Centre Nationale de Recherche Scientifique, Unité Mixte de Recherche, Marseille, France
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15
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Lau G, Kulkarni V, Roberts GK, Brock-Utne J. “Where Are My Teeth?” A Case of Unnoticed Ingestion of a Dislodged Fixed Partial Denture. Anesth Analg 2009; 109:836-8. [DOI: 10.1213/ane.0b013e3181ae06c9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Nicolas R, Eggers G, Komposch G. Orthodontic archwire in the nasal cavity. A case report. J Orofac Orthop 2009; 70:92-7. [PMID: 19194677 DOI: 10.1007/s00056-009-8806-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 09/15/2008] [Indexed: 01/07/2023]
Abstract
We present the unusual case of a patient who lost an orthodontic archwire after having, via manipulation, detached it from the brackets. It was only on a routine radiograph at the end of treatment that the archwire was found in the patient's nasal cavity, where it had failed to cause any symptoms! We discuss the treatment following the inhalation and ingestion of foreign bodies in orthodontics, as well as their prevention.
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Affiliation(s)
- Ramona Nicolas
- Department of Orthodontics, Dental School, University of Heidelberg, Heidelberg, Germany.
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17
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Clarençon F, Scatton O, Bruguière E, Silvera S, Afanou G, Soubrane O, Vignaux O, Legmann P. Recurrent liver abscess secondary to ingested fish bone migration: report of a case. Surg Today 2008; 38:572-5. [PMID: 18516543 DOI: 10.1007/s00595-007-3670-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Accepted: 07/29/2007] [Indexed: 12/28/2022]
Abstract
Pyogenic liver abscess is an unusual cause of fever and abdominal pain, but it is potentially fatal. It is rarely caused by a local event, but rather by hematogenous dissemination or biliary tract disease. We report an uncommon case of liver abscess caused by the migration of a fish bone through the gastrointestinal wall.
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Affiliation(s)
- Frédéric Clarençon
- Department of Radiology A, Université René Descartes Paris 5, Paris, France
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18
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Gastric perforation with an associated subhepatic liver abscess related to an accidentally ingested lobster shell. J Clin Gastroenterol 2008; 42:553-4. [PMID: 18344880 DOI: 10.1097/mcg.0b013e31803238b3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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19
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Repeated colon penetration by an ingested fish bone: report of a case. Surg Today 2008; 38:363-5. [PMID: 18368330 DOI: 10.1007/s00595-007-3629-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Accepted: 06/10/2007] [Indexed: 10/22/2022]
Abstract
A 78-year-old man was admitted to Kumamoto Rosai Hospital with right lower abdominal pain. Abdominal computed tomography (CT) showed penetration of the cecum by a foreign body, which looked like a fish bone, as well as thickening of the right lower abdominal wall. We made an initial diagnosis of penetration of the colon by an ingested fish bone and the patient was managed conservatively with fasting, peripheral parental nutrition, and intravenous antibiotics. By the next day, the right lower abdominal pain had diminished and a repeat CT scan showed that the fish bone had moved to the splenic flexure. However, 2 days later, the patient complained of pain in the left upper abdomen and another CT scan showed repeated penetration of the descending colon by the same fish bone. Thus, we removed the fish bone via endoscopic extirpation. The patient had an uneventful postoperative course and was discharged home 6 days later.
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20
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Ruptured hepatic abscess caused by fish bone penetration of the duodenal wall: report of a case. Surg Today 2007; 37:1018-21. [PMID: 17952539 DOI: 10.1007/s00595-007-3524-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Accepted: 02/02/2007] [Indexed: 12/14/2022]
Abstract
The accidental ingestion of a foreign body into the gastrointestinal tract is not uncommon; however, the development of a hepatic abscess secondary to foreign body perforation is extremely rare. We report the case of a ruptured hepatic abscess caused by fish bone penetration of the duodenal bulb, resulting in generalized peritonitis. A 73-year-old man was admitted to our hospital with generalized abdominal pain and high fever. Computed tomography of the abdomen showed ascites and a heterogeneously enhanced mass with a less-dense center and a linear dense object. We diagnosed a ruptured hepatic abscess caused by a calcified foreign body, which was managed by peritoneal lavage, drainage of the hepatic abscess, and removal of the fish bone, followed by simple closure of the hepatoduodenal fistula. The patient's postoperative course was complicated by systemic inflammatory response syndrome, but he recovered eventually.
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Santos SA, Alberto SCF, Cruz E, Pires E, Figueira T, Coimbra E, Estevez J, Oliveira M, Novais L, Deus JR. Hepatic abscess induced by foreign body: Case report and literature review. World J Gastroenterol 2007; 13:1466-70. [PMID: 17457985 PMCID: PMC4146938 DOI: 10.3748/wjg.v13.i9.1466] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [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
Hepatic abscess due to perforation of the gastrointestinal tract caused by ingested foreign bodies is uncommon. Pre-operative diagnosis is difficult as patients are often unaware of the foreign body ingestion and symptoms and imagiology are usually non-specific. The authors report a case of 62-year-old woman who was admitted with fever and abdominal pain. Further investigation revealed hepatic abscess, without resolution despite antibiotic therapy. A liver abscess resulting from perforation and intra-hepatic migration of a bone coming from the pilorum was diagnosed by surgery. The literature concerning foreign body-induced perforation of the gastrointestinal tract complicated by liver abscess is reviewed.
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Affiliation(s)
- Sofia A Santos
- Department of Gastroenterology, Fernando Fonseca Hospital, Amadora 2720-276, Portugal.
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Abstract
A unique case is described of an ingested fish bone migrating into the common hepatic duct, without perforation. Most foreign bodies are known to pass through the gastrointestinal tract uneventfully. Sharper objects such as fish bones have been known to cause perforation. This is more common, in countries where fish consumption is considerably higher, such as, south east Asia. However, even in these regions there have been no reports of such a proximal migration.
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24
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Goh BKP, Tan YM, Lin SE, Chow PKH, Cheah FK, Ooi LLPJ, Wong WK. CT in the preoperative diagnosis of fish bone perforation of the gastrointestinal tract. AJR Am J Roentgenol 2006; 187:710-714. [PMID: 16928935 DOI: 10.2214/ajr.05.0178] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Foreign body perforation of the gastrointestinal (GI) tract has diverse clinical manifestations, and the correct preoperative diagnosis is seldom made. We report our experience with the use of CT in the preoperative diagnosis of fish bone perforation of the GI tract in seven patients. To our knowledge, this series is the largest to date addressing the role of CT in the diagnosis of fish bone perforation. CONCLUSION Clinical presentation and radiography are unreliable in the preoperative diagnosis of fish bone perforation of the GI tract. This limitation can be overcome with the use of CT, which is accurate in showing the offending fish bone. The accuracy of CT is limited by observer dependence. A high index of suspicion should always be maintained for the correct diagnosis to be made.
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Affiliation(s)
- Brian K P Goh
- Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
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25
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Yamada H, Kondo S, Kamiya J, Nagino M, Miyachi M, Kanai M, Hayata A, Washizu J, Nimura Y. Computed tomographic demonstration of a fish bone in abdominal actinomycosis: report of a case. Surg Today 2006; 36:187-9. [PMID: 16440170 DOI: 10.1007/s00595-005-3110-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Accepted: 03/15/2005] [Indexed: 02/07/2023]
Abstract
A 53-year-old man who had the habit of consuming fish bones was referred to our clinic because of a suspected malignant abdominal wall tumor. Computed tomography (CT) showed a mass (10 x 5 cm) in continuity with the transverse abdominal muscle, containing a small calcification. A laparotomy was performed with a preoperative diagnosis of an inflammatory mass due to fish bone penetration from the sigmoid colon. A fish bone, measuring 2.3 cm in length, was detected within the tumor by specimen radiography. The pathological findings demonstrated actinomycotic colonies. We herein present the first case of a CT demonstration showing a fish bone in an abdominal mass which was pathologically confirmed to be actinomycosis. Evidence of the presence of a foreign body is valuable for diagnosing inflammatory nodules such as actinomycosis and differentiation from malignancies.
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Affiliation(s)
- Hideki Yamada
- Department of Surgery, Division of Surgical Oncology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan
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26
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Rathaus V, Erez I, Zissin R. Ileal perforation due to an ingested fragment of a skewer: preoperative ultrasonographic diagnosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:389-91. [PMID: 16495501 DOI: 10.7863/jum.2006.25.3.389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Valeria Rathaus
- Department of Diagnostic Imaging, Sapir Medical Center, Kfar Saba 44281, Israel.
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27
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Carcacía ID, Cea S, Mallo R. Casos en imagen 1.— Perforación de íleon por cuerpo extraño. RADIOLOGIA 2006; 48:70, 111. [PMID: 17058371 DOI: 10.1016/s0033-8338(06)73138-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- I D Carcacía
- Complejo Hospitalario Universitario de Vigo, Vigo, España.
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28
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Bernard B, Mhanna T, Dugas B, Gasquez P, Valette PJ, Marx P, Sauvage P, Naouri A, Odet E, Bernard P. [Jejunal perforation by a fish bone diagnosed by CT-Scan: report of two cases]. ACTA ACUST UNITED AC 2005; 130:636-9. [PMID: 16083848 DOI: 10.1016/j.anchir.2005.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Accepted: 06/22/2005] [Indexed: 11/23/2022]
Abstract
The authors relate two cases of peritonitis secondary to jejunal perforation by a fish bone. Clinically, the first patient presented signs and symptoms of acute diverticulitis and the second had signs of duodenal perforation. In both cases, the diagnosis was made by the CT-scan revealing a linear radio-opaque object suggestive of a fish bone perforating the jejunum. At laparotomy of the first case, we found a perforation located above several loops of small bowel densely adhered to the nonabsorbable intra-abdominal mesh. Removal of the fish bone, suture of the jejunal perforation, washing and drainage of the abdominal cavity were performed. The mesh was removed and replaced by a polyglycolic acid mesh. In the second case, jejunal perforation occurred in an unaltered small bowel loop and a short intestinal resection was performed. The postoperative course was uneventful for both patients. These clinical cases allow us to discuss the several fish bone perforation site and our patients precipitating factors.
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Affiliation(s)
- B Bernard
- Service de chirurgie digestive, hôpital des Chanaux, boulevard Louis-Escande, 71018 Mâcon cedex, France
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29
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Goh BKP, Yong WS, Yeo AWY. Pancreatic and hepatic abscess secondary to fish bone perforation of the duodenum. Dig Dis Sci 2005; 50:1103-1106. [PMID: 15986862 DOI: 10.1007/s10620-005-2712-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Brian K P Goh
- Department of General Surgery, Singapore General Hospital, Singapore 169608.
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30
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Goh BKP, Jeyaraj PR, Chan HS, Ong HS, Agasthian T, Chang KTE, Wong WK. A case of fish bone perforation of the stomach mimicking a locally advanced pancreatic carcinoma. Dig Dis Sci 2004; 49:1935-1937. [PMID: 15628728 DOI: 10.1007/s10620-004-9595-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Brian K P Goh
- Department of General Surgery, Singapore General Hospital, Singapore.
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31
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Yeung KW, Chang MS, Hsiao CP, Huang JF. CT evaluation of gastrointestinal tract perforation. Clin Imaging 2004; 28:329-33. [PMID: 15471663 DOI: 10.1016/s0899-7071(03)00204-3] [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: 06/01/2003] [Indexed: 11/25/2022]
Abstract
The purpose of this study is to review the computed tomography (CT) appearance of gastrointestinal tract (GI) perforation. Forty-two patients with 10 cases of proximal GI perforation and 32 cases of distal GI perforation were evaluated based on the CT findings of extraluminal air (which was subdivided into the CT-falciform ligament sign crossing the midline and scattered pockets of air), bowel wall thickening (>8 mm in gastroduodenal wall, >3 mm in the small bowel wall, >6 mm in the caliber of the appendix and >5 mm in the colonic wall), associated abscess formation, ascites and adjacent fat stranding. The results were compared using Fisher's Exact Test. Detection of extraluminal air in the upright plain films and CT was analyzed by Z test. Our results showed that CT-falciform ligament sign was more frequent in the proximal GI perforation, while pockets of extraluminal air (excluding the cases accompanying CT-falciform ligament sign), bowel wall thickening and fat stranding were found in higher incidence in distal GI perforation (P<.05). CT detected extraluminal air in more cases than the upright plain films did (69% vs. 19%; Z=4.62>Z(0.01)=2.326). We concluded that CT is a good imaging tool to differentiate the various GI perforations.
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Affiliation(s)
- Kwok-Wan Yeung
- Department of Radiology, Foo-Yin University Hospital, 5, Chung San Road, Tung Kang, Ping Tung, 928 Taiwan, ROC.
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32
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Coulier B, Tancredi MH, Ramboux A. Spiral CT and multidetector-row CT diagnosis of perforation of the small intestine caused by ingested foreign bodies. Eur Radiol 2004; 14:1918-25. [PMID: 15378256 DOI: 10.1007/s00330-004-2430-1] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2004] [Revised: 06/11/2004] [Accepted: 06/18/2004] [Indexed: 01/06/2023]
Abstract
The aim of this retrospective study was to emphasize the performances of spiral CT (HCT) and multidetector-row CT (MDCT) as very effective imaging modalities for the diagnosis of intestinal perforations caused by calcified alimentary foreign bodies. Eight sites of perforations of the ileum by ingested foreign bodies were found in seven patients--one patient presenting with two separate sites of perforation. The diagnosis was successfully made by HCT in four patients and MDCT in the remaining three. Involuntarily and generally unconsciously ingested chicken and fish bones were the implicated calcified foreign bodies. The acute clinical presentations were nonspecific, mimicking more common acute abdominal conditions. A thickened intestinal segment (7/8 sites) with localized pneumoperitoneum (4/8 sites), surrounded by fatty infiltration (4/8 sites) and associated with already present or developing obstruction or sub-obstruction (5/7 patients) were the most common CT signs, but the definite diagnosis was clearly made by the identification of the calcified foreign bodies (7/7 patients). In each patient, this identification was only possible thanks to the scrupulous analysis of very thin overlapping reconstructions obtained not only in the perforation sites (6/8 sites), but also through the entire abdomen (2/8 sites). Our report emphasizes the high performances of CTA and MDCT in identifying intestinal perforation caused by calcified alimentary foreign bodies. Moreover, the high specificity of the CT diagnosis made it possible to avoid surgerical exploration in three patients.
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Affiliation(s)
- Bruno Coulier
- Department of Diagnostic Radiology, Clinique St Luc, Rue St Luc 8, Bouge, Namur, Belgium.
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33
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Mishra A, Bhatnagar D. Clasp knife in the gut: a case report. BMC Surg 2003; 3:12. [PMID: 14667247 PMCID: PMC317327 DOI: 10.1186/1471-2482-3-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2003] [Accepted: 12/10/2003] [Indexed: 11/22/2022] Open
Abstract
Background A wide range of foreign bodies has been retrieved from the gut and reported. The presentation may be in the form of complications like intestinal obstruction, perforation and formation of abscesses etc but there is no case report of a half open clasp knife being retrieved from the ileum, the patient having thrived, in spite of its presence for a period of eight months. Case presentation A 30-year-old administrative clerk had undergone emergency abdominal surgery eight months previously under mysterious circumstances at a remote district hospital and had recovered completely. Later the blade of a knife was accidentally detected when an X ray of the abdomen was done during a routine follow-up visit to his family physician. Surgery revealed a clasp knife in the ileum, which was retrieved. The presence of an entero-enteric fistula short circuiting the loop was the secret of his earlier survival. Conclusions To the best of our information this is the first case-report of a clasp knife in the gut and of the patient thriving in spite of its presence. We report here the dramatic sequence of events.
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Affiliation(s)
- Anuj Mishra
- Department of Surgery, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi 110029, India
| | - Dinesh Bhatnagar
- Department of Surgery, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi 110029, India
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34
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Abstract
BACKGROUND Hepatic abscesses often result from a perforation of the gastrointestinal tract. Although rare, this may occur via puncture by a foreign body. The object may directly extend from the stomach or duodenum into the liver, or rarely, the object may perforate the bowel distal to the duodenum and indirectly extend to the liver leading to the formation of an abscess. CASE REPORT A 44-year-old man developed an hepatic abscess. Although the abscess was identified on computed tomography, various imaging studies were unable to identify the cause of the infection. After an extended ICU course, the patient was deemed stable enough to undergo a colonoscopy that demonstrated a foreign body penetrating through the wall of the sigmoid colon. CONCLUSIONS Here we describe the first report of a foreign body leading to a hepatic abscess where the object was identified by colonoscopy. In addition, we present a comprehensive literature review examining the method of identification of gastrointestinal foreign bodies that led to liver abscesses. These findings emphasize that in cases of hepatic abscesses of unknown etiology, direct visualization by colonoscopy may be a useful tool to elucidate the cause of the abscess.
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Affiliation(s)
- Karl Y Bilimoria
- Department of Medicine, Indiana University School of Medicine, University Hospital, 2300, Indianapolis, Indiana 46202, USA.
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35
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Aisa. P. Casos en imagen 4.—Absceso hepático secundario a perforación gástrica por cuerpo extraño. RADIOLOGIA 2003. [DOI: 10.1016/s0033-8338(03)77866-7] [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]
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36
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Dibiase AT, Samuels RH, Ozdiler E, Akcam MO, Turkkahraman H. Hazards of orthodontics appliances and the oropharynx. J Orthod 2000; 27:295-302. [PMID: 11099566 DOI: 10.1093/ortho/27.4.295] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Occasionally orthodontic appliances or parts of orthodontic appliances have caused problems with either the airway or the gastrointestinal tract. The type of appliances that have caused problems and their clinical management are discussed. A case is described in which an upper removable appliance with inadequate retention became lodged in a patient's pharynx lacerating the palatine tonsils. Suggestions are made to try and avoid the problems that were encountered in this case and others reported in the literature in patients undergoing orthodontic treatment.
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Affiliation(s)
- A T Dibiase
- Department of Orthodontics and Restorative Dentistry, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
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37
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Broome CJ, Peck RJ. Hepatic abscess complicating foreign body perforation of the gastric antrum: an ultrasound diagnosis. Clin Radiol 2000; 55:242-3. [PMID: 10708622 DOI: 10.1053/crad.1999.0339] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- C J Broome
- Department of Diagnostic Imaging, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
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38
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Horii K, Yamazaki O, Matsuyama M, Higaki I, Kawai S, Sakaue Y. Successful treatment of a hepatic abscess that formed secondary to fish bone penetration by percutaneous transhepatic removal of the foreign body: report of a case. Surg Today 1999; 29:922-6. [PMID: 10489138 DOI: 10.1007/bf02482788] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We describe herein the case of a hepatic abscess that developed secondary to fish bone penetration which was successfully treated without laparotomy. A 61-year-old man was admitted to our hospital with a high fever that had persisted for 2 weeks in spite of medication. Abdominal ultrasonography (AUS) and computed tomography (CT) of the abdomen revealed a hepatic abscess with a linear calcified foreign body and gas. Percutaneous abscess drainage was performed under ultrasonographic guidance. After drainage, the patient became afebrile, and AUS and CT findings demonstrated that the abscess cavity had decreased in size, but still contained the foreign body. Under ultrasonographic guidance and fluoroscopy, we inserted endoscopic forceps into the sinus tract and succeeded in removing the foreign body from the liver. It was found to be a fish bone that was 2.8 cm long and 0.3 cm wide.
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Affiliation(s)
- K Horii
- Department of Surgery, Osaka City General Hospital, Osaka, Japan
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39
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Cheah W, Fan M, Goh P. Surg Laparosc Endosc Percutan Tech 1999; 9:223-225. [DOI: 10.1097/00019509-199906000-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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40
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41
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Peh WC, Helpert C, Chan CW. Bamboo skewer perforation of the bowel: computed tomography appearances. AUSTRALASIAN RADIOLOGY 1997; 41:308-10. [PMID: 9293688 DOI: 10.1111/j.1440-1673.1997.tb00681.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 25-year-old Chinese woman presented with a painful left-lower-quadrant abdominal mass. Computed tomography (CT) demonstrated a dense forked foreign body within an extraluminal mass. A 2.5 cm bamboo skewer surrounded by inflamed omentum was found at laparotomy. Different CT densities of bamboo skewers were obtained when exposed to air, water and 2% Gastrografin in an in vitro experiment. Awareness of the possible variations in appearances of wooden foreign bodies in and around the bowel may aid their CT diagnoses.
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Affiliation(s)
- W C Peh
- Department of Diagnostic Radiology, University of Hong Kong, Queen Mary Hospital, Hong Kong.
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42
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Nemcek AA. CT of Acute Gastrointestinal Disorders. Radiol Clin North Am 1989. [DOI: 10.1016/s0033-8389(22)02161-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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