Search

This article discusses a rare case of a fishbone causing an intra-abdominal infection in a 39-year-old man. The patient initially presented with fevers, abdominal pain, and vomiting after consuming barbecued fish, chicken, and pork. Imaging tests revealed a liver abscess with a fishbone foreign body and a fistulous tract. The patient underwent percutaneous drainage and closure of the fistula. Antibiotic treatment was administered, and the abscess resolved with the fishbone remaining in place. The article highlights the challenges in diagnosing and treating hepatic abscesses caused by foreign bodies and emphasizes the importance of early detection and percutaneous drainage. Surgical intervention may be necessary in some cases. [Extracted from the article]

Her general practitioner referred her for a transabdominal and transvaginal ultrasound which detected a non-anatomical tubular ring structure, consistent with the NuvaRing contraceptive device within the bladder (Fig. A 22-year-old IT professional, with no significant comorbidities, presented to her general practitioner with concerns that she had inadvertently self-inserted a NuvaRing, a ring shaped combined hormonal contraceptive device, into her bladder. [Extracted from the article]

Background: We aimed to define the published impact, efficacy, cost‐effectiveness and precise role of the Isiris‐α device: the world's first sterile, single‐use grasper integrated flexible cystoscope (SUGIFC) for ureteral stent removal. Methods: After PROSPERO registration (CRD42021228755), the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines were utilized. The search terms "Grasper Integrated Flexible Cystoscope," and "Isiris," within the following databases: PubMed, Scopus, Cochrane Library, Web of Science and EMBASE were searched. Results: In this review, a cumulative total experience (10 publications) included 970 "SUGIFC" procedures (755 patients). However, only 366/970 procedures were actually used for "ureteral stent removal," with the remainder being surveillance cystoscopy only (603/970) or foreign body retrieval (1/970). Procedure‐related and device failures in planned "removal of ureteral stents," was reported in 8/366 (346 patients) and 1/366 (346 patients), respectively. The cost–benefit utilizing the SUGIFC device is advantageous compared to "in‐theatre" stent removals and favours less busy centres where maintenance, repair and replacement costs are more relevant. Other listed benefits include shorter stent indwelling times, shorter procedure duration, lower rates of bacteriuria and urinary tract infections, fewer emergency department visits and lower readmission rates. Technical limitations include the absence of an independent working channel, a narrower visual field and the lack of image universality since the monitor is device‐specific. Conclusion: The SUGIFC device needs to be outweighed against local costs and individual health systems. Its application in ambulatory ureteral stent removal may become significant due to the accessibility and convenience that it offers the attending urologist. [ABSTRACT FROM AUTHOR]

Small bowel magnetic resonance imaging (MRI) was performed to exclude a small bowel lesion as a cause of his recurrent SBO. This did not reveal any small bowel lesions; however, it demonstrated a short segment small bowel stricture in the right iliac fossa (Fig. [Extracted from the article]

We theorize that the ruptured angioplasty balloon has migrated distally from the right common iliac artery to the bifurcation of the right common femoral artery, or the separation event has occurred at the right common femoral artery as the angioplasty balloon has been removed from the patient. A longitudinal arteriotomy of the right common femoral artery was performed, revealing occlusive thrombus surrounding a ruptured angioplasty balloon (Fig. A 74-year-old man presented to the vascular surgery outpatient clinic with worsening right leg claudication, rest pain and paraesthesia 4 months post bilateral external iliac angioplasty, and stenting using a BIOTRONIK Passeo-35 9/40/80 angioplasty balloon was performed by our interventional radiology department (Fig. [Extracted from the article]

Background: Unintentional retention of foreign bodies in surgery is uncommon but potentially serious. Published data regarding the consequence of retained surgical needles is sparse. We aimed to characterize lost surgical needles at our institution. Secondarily, we aimed to determine whether or not retained microsurgical needles can be reliably detected. Methods: Reports of missing surgical needles at our institution were reviewed. Surgical needles of relevant sizes were scattered across an anthropomorphic model at representative anatomical locations. Fluoroscopic images of the field were acquired using two resolution settings. Medical staff in our department attempted to locate needles in these images. Results: A total of 46 323 procedures were performed in the main theatres in the 2.5‐year period. Sixty‐two needles were reported as missing. No patient harm was documented. Needles of chord length 16 mm (5–0) or greater were always detected. High‐resolution fluoroscopy improves detection of needles with chord lengths of 9.3 (7–0) or 6.6 mm (9–0). Needles are consistently better detected in the lower limb for needles of chord length greater than 6.6 mm (9–0). Senior observers under ideal conditions can detect 7.1% of smaller needles. Conclusion: When a needle is lost during surgery, consider the following before ordering fluoroscopy. Needles of chord length greater than 13 mm (6–0) should be reliably detected whilst 3.8 mm (10–0) needles will not. For sizes in between, ideal conditions for detection may include an operating field in the lower limb, high‐resolution fluoroscopy and a senior observer. It may not be necessary or cost effective to identify microsurgical needles with fluoroscopy. [ABSTRACT FROM AUTHOR]

Liver abscess is a relatively rare disease with an estimated incidence of 2-3 cases per 100 000 populations annually. Because of these findings, a computed tomography of the abdomen was performed and a liver abscess in the caudate lobe was revealed. The abscess occupied a big part of the caudate lobe with peripheral enhancement, liquid content and the presence of a hyperdense linear foreign body inside the abscess was confirmed (Fig. [Extracted from the article]

This segment of the bowel was mistakenly interpreted as an FB in the rectum on the radiograph. However, 10%-20% of cases require endoscopic intervention, while 1% or less require surgical procedures due to complications such as bowel perforation or obstruction.3 Medical history obtained from the patient is highly critical in the diagnosis of FB ingestion. (b) Repeat abdominal radiograph post sigmoidoscopy revealing residual foreign bodies in the GI tract. gl The laparotomy was performed with a midline incision. [Extracted from the article]

PENILE SQUAMOUS CELL CARCINOMA FOLLOWING CHILDHOOD HYPOSPADIAS REPAIR: A CASE FOR LONG-TERM F... Alexander Ngoo, David Wong and David Winkle Queensland Children's Hospital, QLD B Purpose: b Hypospadias is the one of the most common birth defects among infant males. Laparoscopic dismembered pyeloplasty with excision was performed in one patient, open spiral flap with excision in one patient and laparoscopic ureterotomy with excision in one patient. We now aim to risk-stratify patients, allowing for closer follow-up of high-risk patients. PS719P UNILATERAL VS BILATERAL INGUINAL HERNIOTOMY: A REVIEW OF CLINICAL DECISION MAKING AT A TERTIA... Alexander Ngoo, Tristan Anderson and Roy Kimble Queensland Children's Hospital, QLD B Purpose: b For paediatric patients presenting with unilateral inguinal hernia, debate continues regarding which patient and surgical factors should influence decisions for unilateral (UIH) or bilateral inguinal herniotomy (BIH). [Extracted from the article]

This case reminds us of the laparoscope itself could be a risk of retained surgical items, and only via performing the abdominal X-ray screening immediately after the surgery in the operating room could detect such retained metal tip of the laparoscope. Patient consent Written informed consent was obtained from the patient. The patient underwent a laparoscopic exploratory, and a metallic foreign body was found in the pelvis (Fig. [Extracted from the article]

Self-insertion of foreign bodies into the urethra has been described previously; however, this is the first instance in which an endoloop has been employed as a method of retrieval. Management can be grouped into three categories2: Manual extraction: by applying external pressure on the urethra, facilitating passage of the foreign body through the distal urethra to allow extraction. CT, computed tomography; US, Ultrasound. gl The most common complication of foreign body insertion into the urethra is a urethral stricture.2 Other complications include urethritis, incontinence and fistula or diverticulum formation.7 Therefore, follow-up is warranted to assess for the development of complications. [Extracted from the article]

Computed tomography (CT) demonstrated trace free fluid in the RIF and moderate fat stranding around the appendix, suspicious for acute appendicitis. His adult appendicitis score1 was 16 (probability of appendicitis is high) and the appendicitis inflammatory response2 score was 6 (indeterminate). [Extracted from the article]

Abdominal exploration revealed ruptured spleen and gastric herniation caused by left hemidiaphragm rupture. Combined with the above symptoms and imaging examinations, we performed exploratory laparotomy and found dense adhesion between the stomach, diaphragm, and abdominal wall. [Extracted from the article]

Bedside retrieval was attempted, but abandoned as the FB was immobile and the patient was very uncomfortable. Computed tomography abdomen showed an intussusception of the sigmoid colon into the proximal end of the FB (Fig. A 59-year-old patient presented to the emergency department with acute abdominal pain, 2 h after insertion of a syringe-type foreign body (FB) per rectum (PR) that can create a vacuum effect. [Extracted from the article]

It is therefore important for surgeons to consider uncommon small bowel pathology in the differential diagnoses of rectal bleeding. A 68-year-old gentleman presented to emergency department with three episodes of bright red rectal bleeding associated with some light-headedness. Small bowel diverticulosis is often jejunal diverticulosis in the literature due to the preferential location of small bowel diverticulosis in the jejunum.3 Rectal bleeding from a jejunal perforation secondary to a foreign body is unusual; to our knowledge, this is the first case described in the literature. [Extracted from the article]

An 84-year-old female was referred to a colorectal surgeon for a colonoscopy following a positive faecal occult blood test organized by her general practitioner. She underwent a colonoscopy which revealed sigmoid diverticulosis and a foreign body at the rectosigmoid junction wedged between a 10-mm ulcerating inflammatory polyp which was partially resected (Fig. 2011; 4: 104 - 7. 6 Hershman M, Shamah S, Mudireddy P, Glick M. Pointing towards colonoscopy: sharp foreign body removal via colonoscopy. [Extracted from the article]

Oesophageal perforation should be considered in patients with non-traumatic pleural empyema of unknown cause. We here present a case of silent oesophageal perforation by a FB presenting as empyema. In conclusion, we present a rare case of pleural empyema secondary to fishbone oesophageal perforation. [Extracted from the article]

The patient underwent an upper gastrointestinal endoscopy the following day and the fishbone was retrieved from a small diverticulum in the third part of the duodenum. A 76-year-old lady was referred to the Emergency Department by a reporting Radiologist after a foreign body microperforation of a duodenal diverticulum was incidentally found during an oncological staging scan. The patient's abdominal computed tomography (CT) was reviewed and demonstrated fat stranding and extraluminal gas locules in the retroperitoneum. [Extracted from the article]

Common nasopharyngeal and upper gastrointestinal foreign bodies include fish bones, chicken bones, food bolus, coin and dental prosthesis.2 An uncommon cause of foreign body is gossypiboma. The computed tomography scan of his sinuses was normal. (b) Gauze fibres extracted from the posterior nasopharyngeal region. gl A magnetic resonance imaging scan performed showed a 2-cm polypoidal lesion from the posterior nasopharyngeal wall with low T2 signal favouring a scar/fibrous tissue with no malignant features (Fig. [Extracted from the article]

Plain film radiographs of the abdomen and chest (erect) showed no obvious foreign body, evidence of bowel obstruction or pneumoperitoneum. Potential complications include bowel perforation, bowel obstruction and local tissue trauma. [Extracted from the article]

A computed tomography (CT) scan demonstrated ill-defined soft tissue thickening in the left pelvis between the bladder and rectum. There is a linear foreign body which has penetrated the left wall of the mid sigmoid colon and extends through the left aspect of the pelvis and terminates in the left obturator internus muscle. Perforation in the upper rectum was rare; with no previously documented cases of subsequent toothpick migration into the obturator internus muscle (which likely accounted for the patient's left buttock pain). [Extracted from the article]

An 82-year-old male, with upper and lower dentures, presented with incidental finding of foreign body in the left lower quadrant on computed tomography (CT) (Fig.) The resected segment of small bowel was opened, revealing the bread clip gripping onto the small bowel mucosa (Fig.). [Extracted from the article]

His routine blood investigations, including complete blood count, random blood sugar, liver and renal blood profile, and serology for viral markers, were normal. A 45-year-old male presented to the surgical outpatient department with complaints of recurrent upper abdominal pain for 6 months following right hemicolectomy performed for carcinoma of the cecum. Tumour marker CEA was also normal. [Extracted from the article]

Anorectal traumas are uncommon and are usually associated with penetrating traumas.1 It is an unusual occurrence to sustain an anorectal injury secondary to blunt trauma.1This is due to the anatomical protection offered by the pelvis.2 Only 5%-10% of rectal injuries are secondary to blunt traumas, with 1%-2% associated with a pelvic fracture.3 Rectal injuries are classified according to anatomical location and severity.4 The anatomical location is defined as either "intra-peritoneal" or "extra-peritoneal".2,4 The severity is classified using the rectal injury scale from the American Association for the Surgery of Trauma.2,4 Management of rectal injuries is complex and often controversial. A 55-year-old lady presented to her nearest hospital with significant blunt anorectal trauma after a fall from a horse. J Trauma Inj. 2017; 30: 216 - 9. 6 Navsaria PH, Graham R, Nicol A. A new approach to extraperitoneal rectal injuries: laparoscopy and diverting loop sigmoid colostomy. [Extracted from the article]

On admission, her white cell count was 10.1 × 10 SP 9 sp /L and C-reactive protein was 34 mg/L. Contrast-enhanced computed tomography (CT) showed a dilated appendix with associated stranding and a trace of free intra-abdominal fluid. She was subsequently taken to the operating theatre which identified an acutely inflamed appendix, and a laparoscopic appendicectomy was performed, with no pellets identified during the division of the appendix. We present two cases that are unique to Indigenous populations living within northern Australia where hunting and eating Magpie geese is an important part of Aboriginal culture and is a significant proportion of the seasonal diet.1 The Magpie geese hunting season is from mid-August to early January, and at our centre both these cases occurred within the first month of the season. [Extracted from the article]

Meckel's diverticulum (MD) is a true diverticulum found in 0.14-4.5% of the population.1 It is the most common congenital abnormality of the gastrointestinal tract, being a remnant of the omphalomesenteric duct.2 In this study, we discuss a rare case of a perforated MD caused by a foreign body and review the literature surrounding this topic. Despite recent advances in imaging, MD is predominantly diagnosed by surgical intervention.5 While treatment of symptomatic MD is usually straightforward, prophylactic removal of the incidentally discovered MD remains a contentious issue. [Extracted from the article]

Suture granulomas are exceptional and may occur in relation to intraluminal retained non-absorbable suture material. The patient underwent endoscopic polypectomy with symptoms relief.2 The barbed V-Loc (Covidien) is an innovative self-anchoring unidirectional suture that obviates the need for knot tying. Since its introduction in 1964, barbed sutures have been applied in different surgical specialties with recent evidence showing a significant reduction in suture and overall operative time.3 However, its safety profile is debated and evidence is puzzled. [Extracted from the article]

Definitive management for liver abscesses secondary to foreign body penetration requires both drainage of the abscess, either surgically or radiologically, and removal of the foreign body to prevent further infection. Hepatic abscess secondary to stomach perforation by a fish bone: a rare cause of hepatic abscess. As a result, most patients are unaware that perforation has occurred or only noted some abdominal pain at the time of perforation. [Extracted from the article]

Ingested foreign bodies usually pass through gastrointestinal tract uneventfully, but rarely cause perforation and lead to deteriorating conditions.1,2 Common causes of foreign body perforation include fish bone, chicken bone and toothpicks; however, very few patients can recall the episode of ingestion of a foreign body.1 Accurate preoperative diagnosis of the ingested foreign body is important for surgical management and reducing morbidity and mortality. We present a case of ingestion of eggshell resulting in small bowel perforation, which was diagnosed intraoperatively and presumed by retrospectively reconstructed three-dimensional (3D) computed tomography (CT) images. [Extracted from the article]