Interesting F/Bs (foreign bodies) I encountered

Some foreign bodies may be found in the rectum that were initially swallowed but then present with complications in the rectum. Yesterday, I had seen a Burmese worker complaining of a bone piece in his anal canal. At first I cannot believe him when he complained of pain in anus and he could feel the big fish bone stuck across the anus. I even try to explain that it may be the tip of the Sacrum/Coccyx bone. Photo by Ko Min Min

But as it is my duty to check the patient, I prepared for routine PR and Proctoscopy. I was surprised to find out and confirm the sharp Fish bone because although we learned theoretically about this possibility of swallowed FB found in the Anus-Rectum most of the sharp FB or Fish bone used to give trouble upstairs.

When I was working a night duty in Pudu, a couple (living together) came in and the male partner told me to check his girl friend and to remove the vibrator from her private part,. The girl about 25 yr old looked too scared and was soaked with a lot of blood. Bleeding was from anus and the man told me that he had tried to remove but unsuccessful. I could only feel with the tip of the examining finger, just see but slippery to pull down with the forceps. It was deep in the rectum and because of the danger of Rectum injury I refused to try again and advised them by explaining them that if there were a tear in rectum, it may be connected with the pelvic cavity and could lead to peritonitis, septicaemia and even death. They refused to go back and both of them entered the clinic toilet. As I had dozens of pts waiting, I just ignored and continue my work. After about 30 minutes, they came out, the man holding the vibrator but the girl was soaked with blood. I offered to write a letter to the hospital but they refused and just worked out of the clinic.

Rectal foreign bodies are typically inserted and the majority of cases are the result of erotic activity. Typically found objects are vibrators, dildoes, light bulbs, candles, shot glasses, and bottles. Patients may be very embarrassed to disclose the circumstances regarding the foreign body insertion and there may have been multiple attempts at removal. The image shown demonstrates a vibrator in the rectum along with a pair of salad tongs that became lodged after attempts at self-removal. http://www.medscape.com/features/slideshow/foreign-objects

Ear_ Cotton bud, rubber of the pencil, beans, cockroaches but most interesting finding was about 200 dead ants I managed to wash out with Ear Syringe. One retired Senior Police Officer of a State.

Leaches entered through vigina into uterus of a 12 year old girl, a peasent who used to help her parents planting of Paddy plants. She sometimes need to work in leech infested Paddy Fields with water above her knee length. She was thin and short, her size looked as if she were 8-10 yrs old. I was working as a House Surgeon together with, if I am not wrong, the famous composer Dr Sai Kham Leik. We used a small Nasal Speculum as usual Cusco’s speculum for vaginal examination were too large for that small girl.

Nose F/B_This interesting story was told by my daughter about the House Series  A young girl about 4 yr old accidently put a small toy Cat into her nose. to rescue the cat lost in the nose she put a Fire-fighter into it but when he was also lost she realized that the Fire-fighter without the ladder could not climb up. She decided to put in the ladder for the Fire-fighter to climb up and rescue her cat.

At the clinic at the front  portion of our house, I had seen an old Motor car accident victim, who went to the nearest GP of an O&G specialist to stitch up the wound. There were few dozens of glass pieces in his shin for about three years.

Eye FB

While working in UHKL or UMMC A&E, I had witness a car accident girl about 25 yrs, while test driving the newly bought a Mercedes, head on collision with the four wheel drive MPV. Two small glass pieces penetrated the upper eye lid, eye ball and dislodged in the brain. She was brought in unconscious with shock.

I had seen numerous patients with Iron particles in the cornea. Most of them are Myanmar workers doing welding and grinding. I had removed more than 99% of them but some deep seated or even badly infected with pus in Anterior Chamber of Eye, deep at the back of the cornea were referred to the Ophthalmologists.

Body packers and body stuffers are individuals who ingest drugs to avoid detection. Heroin and cocaine are the most common drugs. Body packers engage in planned ingestion of drugs, often wrapped in latex condoms or gloves. Drugs are ingested at one location and are then defecated at another location, typically in another country. Body stuffers impulsively ingest less carefully wrapped drugs to avoid imminent detection and are at high risk for toxicity. Drugs may also be hidden in the anus or vagina. If the packets rupture, the person is at risk for death as a result of the massive release of illicit substances. Hospitalization for patients who ingest drug packets should be considered. Whole-bowel irrigation will aid passage of the packets. The image shown demonstrates multiple cocaine capsules (asterisks) within the stomach and intestines. Image courtesy of Wikimedia Commons.

Foreign bodies in the ear are a relatively common presentation in the emergency department for children. Hearing aid components or insects are the most commonly found items in adults. In children, anything small enough to fit in the ear canal may be found, but most commonly food, toys, beads, stones, insects, and seeds. If patients cannot indicate that they have a foreign body in the ear, they may present with ear pain or discharge, hearing loss, or a sense of fullness. Objects are typically lodged within the ear canal itself (shown), although if there is perforation of the tympanic membrane, the object may be found in the inner ear. Physical examination findings will depend on the object and length of time it has been in the ear. Inanimate objects that have been in the ear for a short period of time typically present with no abnormal finding other than the object itself. Bleeding or erythema may be present if the object has damaged the ear. If the object has been in place for a while, erythema, swelling, and foul-smelling discharge may be present. Insects may injure the canal or tympanic membrane by scratching or stinging.

Nasal foreign bodies are commonly encountered in emergency departments, particularly for pediatric patients. Nasal foreign bodies carry the risk of being dislodged into the airway. The most common locations for nasal foreign bodies are just anterior to the middle turbinate or below the inferior turbinate.

A nasal foreign body can lead to local inflammation and subsequent pressure necrosis and epistaxis. Obstruction of the sinus passages can lead to a secondary sinusitis. Nasal foreign bodies may be difficult to recognize because they produce less prominent initial symptoms. Metallic button batteries are of special concern as they can cause destruction by low-voltage electrical currents, electrolysis-induced release of sodium hydroxide and chlorine gas, and even liquefaction necrosis if their alkaline contents leak out. These complications are unfortunately relatively common and can develop in as little as 12 hours.

Visualization with a head lamp and a nasal speculum can typically identify the foreign body. A number of different removal techniques are available. For easily visualized nonspherical and nonfriable objects, direct mechanical removal with forceps or hooked probes is preferred. Balloon catheter removal is the next most common method in which a Foley or Fogarty catheter is passed beyond the object, inflated, and then retracted (shown). The positive pressure technique involves occlusion of the unaffected naris and then the administration of pressure through a bag-valve-mask, by a parent’s mouth, or via a specialized device. Removal with suction or glue is recommended for objects that are easily visualized with smooth surfaces. Most removals can be performed by non-specialists although referral to an otolaryngologist is recommended for cases of failed removal or if there is significant damage to adjacent structures.

Retained vaginal foreign bodies may be an occult cause of gynecologic complaints in women. Young patients may have unusual small objects retained in the vagina, but in older patients the most commonly retained objects are tampons. Depending on the object found, sexual abuse needs to be a consideration, especially in young children or patients with psychiatric disorders. Patients with foreign bodies may report chronic vaginal discharge, bleeding, or foul-smelling odor. These symptoms are typically the result of subsequent inflammation and infection. Women with retained highly absorbent tampons may be at risk for toxic shock syndrome. Pelvic examination with a speculum or plain x-rays (shown) are typically sufficient to confirm the location of the foreign body. Removal is usually sufficient to resolve symptoms and no additional measures are required. Image courtesy of Wikidoc.

 

Foreign body. From Wikipedia, the free encyclopedia

Foreign body  is any object originating outside the body.

If objects are not removed in a timely manner, there may be subsequent infection or ocular necrosis. Although corneal foreign bodies may be treated by nonspecialists on a case-by-case basis, all patients with intraocular foreign bodies need to be referred to an ophthalmologist. Corneal lesions can typically be removed by direct visualization with a cotton-tipped applicator or needle in the emergency department (shown). Patients with intraocular foreign bodies typically require surgical intervention with a paracentesis or vitrectomy by an experienced ophthalmologist. The greatest limiting factor in the prognosis is often the amount of damage that occurs during the initial injury, but overall the majority of patients recover most of their eyesight.

 

Foreign bodies in humans

Most references to foreign bodies involve propulsion through natural orifices into hollow organs.

Foreign bodies can be inert or irritating. If they irritate they will cause inflammation and scarring. They can bring infection into the body or acquire infectious agents and protect them from the body’s immune defenses. They can obstruct passageways either by their size or by the scarring they cause. Some can be toxic.

Both children and adults experience problems caused by foreign objects getting stuck in their bodies. Young children, in particular, are naturally curious and may intentionally put shiny objects, such as coins or button batteries, into their mouths. They also like to stick things in their ears and up their noses.

Alimentary tract

One of the most common locations for a foreign body is the alimentary tract.

It is possible for foreign bodies to enter the tract from the mouth, or from the rectum.

Airways

It is also possible for a foreign body to enter the airways.[

In one study, peanuts were the most common obstruction.

Eyes

Airborne particles can lodge in the eyes of people at any age. These foreign bodies often result in allergies which are either temporary or even turn into a chronic allergy. This is especially evident in the case of dust particles.

It is also possible for larger objects to lodge in the eye. The most common cause of intraocular foreign bodies is hammering.

Skin/tissue

With sufficient force (as in firing of bullets), a foreign body can become lodged into nearly any tissue. Splinters are common foreign bodies in skin. Staphylococcus aureus infection often causes boils to form around them.

Tetanus prophylaxis may be appropriate.

Other

Foreign material in a blood vessel due to an embolization procedure.

Talcosis of the lung due to intravenous drug use. H&E stain.

Foreign bodies can also become lodged in other locations:

Foreign Bodies

http://www.merckmanuals.com/professional/sec02/ch014/ch014c.html

A variety of foreign bodies may enter the GI tract. Many pass spontaneously, but some become impacted, causing symptoms of obstruction. Perforation may occur. The esophagus is the most common (75%) site of impaction. Nearly all impacted objects can be removed endoscopically, but surgery is occasionally necessary.

Undigestible objects may be intentionally swallowed by children and demented adults. Denture wearers, the elderly, and inebriated people are prone to accidentally swallowing inadequately masticated food (particularly meat), which may become impacted in the esophagus. Smugglers who swallow drug-filled balloons, vials, or packages to escape detection (body packers or body stuffers) may develop intestinal obstruction. The packaging may rupture, leading to drug overdose.

Esophageal foreign bodies: Foreign bodies usually lodge in an area of esophageal narrowing such as at the cricopharyngeus or aortic arch or just above the gastroesophageal junction. If obstruction is complete, patients retch or vomit. Some patients drool because they are unable to swallow secretions.

Immediate endoscopic removal is required for sharp objects, coins in the proximal esophagus, and any obstruction causing significant symptoms. Also, button batteries lodged in the esophagus may cause direct corrosive damage, low-voltage burns, and pressure necrosis and thus require prompt removal.

Rectal foreign bodies: Gallstones, fecaliths, and swallowed foreign bodies (including toothpicks and chicken and fish bones) may lodge at the anorectal junction. Urinary calculi, vaginal pessaries, or surgical sponges or instruments may erode into the rectum. Foreign bodies, sometimes bizarre and/or related to sexual play, may be introduced intentionally but become lodged unintentionally. Some objects are caught in the rectal wall, and others are trapped just above the anal sphincter.

Sudden, excruciating pain during defecation should arouse suspicion of a penetrating foreign body, usually lodged at or just above the anorectal junction. Other manifestations depend on the size and shape of the foreign body, its duration in situ, and the presence of infection or perforation.

Foreign bodies usually become lodged in the mid rectum, where they cannot negotiate the anterior angulation of the rectum. They can be felt on digital examination. Abdominal examination and chest x‑rays may be necessary to exclude possible intraperitoneal rectal perforation.

If the object can be palpated, a local anesthetic is given by sc and submucosal injections of 0.5% lidocaine Some Trade Names
XYLOCAINE
Click for Drug Monograph
or bupivacaine Some Trade Names
MARCAINE
SENSORCAINE
Click for Drug Monograph
. The anus is dilated with a rectal retractor, and the foreign body is grasped and removed. If the object cannot be palpated, the patient should be hospitalized. Peristalsis usually moves the foreign body down to the mid rectum, and the above routine can be followed. Removal via a sigmoidoscope or proctoscope is rarely successful, and sigmoidoscopy usually forces the foreign body proximally, delaying its extraction. Regional or general anesthesia is infrequently necessary, and laparotomy with milking of the foreign body toward the anus or colotomy with extraction of the foreign body is rarely necessary. After extraction, sigmoidoscopy should be done to rule out significant rectal trauma or perforation. Removal of a rectal foreign body may be of high risk and should be done by a surgeon or gastroenterologist skilled in foreign body removal.

Sometimes, foreign bodies scratch the esophagus but do not become lodged. In such cases, patients may report a foreign body sensation even though no foreign body is present.

See also_ Rectal Foreign Bodies http://www.well.com/~cynsa/newbutt.html

 

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One Response to “Interesting F/Bs (foreign bodies) I encountered”

  1. Balls and Walnuts » The foreign body blog Says:

    [...] many blogs on foreign body extraction, I’m afraid. Here’s one from rural Nepal, and here’s another from a blog oddly entitled, “Dr Ko Ko Gyi’s Blog / Autobiography of Dr Abdul Rahman [...]

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