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A 7-year-old girl presented to the emergency room (ER) with alleged history of aspiration of a toy magnet. The challenge was to safely extract the foreign body. A bronchoscopic approach with forceps, or Dormia basket, or Fogarty catheter, was considered, but these approaches had disadvantages, such as slipping or impaction of the object, and oxygen desaturation. Applying principles of removal of intraocular metallic objects in ophthalmologic surgery using magnetism, the object was removed with the help of another larger surface magnet. The location of the foreign body was confirmed by bronchoscopy. A Fogarty catheter was introduced distal to the object, under bronchoscopic guidance. A strong surface magnet was then placed on the surface of the chest and under C-arm guidance, the object was moved from the bronchus to the trachea. Once at the vocal cords, the Fogarty catheter was inflated to prevent it from slipping back and the magnet was extracted using forceps., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

The treatment of foreign bodies in the upper third of the esophagus is well codified and it is more often based on endoscopic treatment. This specific instrument as well as gastroenterologists trained in its use are sometimes missing in African countries. Physicians have to use alternative approaches to treat this disease. This study aimed to evaluate the procedure for the removal of foreign bodies in the upper third of the esophagus carried out by anaesthetists-resuscitators in a medical and surgical center in Chad. Thirty seven cases of foreign body removal in children aged 0-15 years were analyzed. Coins and lithium batteries were removed in 92% and 8% of cases respectively. Foley balloon catheter was used in 43.2% of cases and laryngoscopy forceps in 56.8% of cases. One case of therapeutic failure requiring cervicotomy was recorded in each group. Four minor complications were reported in the "laryngoscopy forceps group", no complication in the "Foley" group. Physicians must have adequate preparation for the removal of a foreign body in the upper third of the esophagus. In case of unavailability of endoscope, other alternative techniques can be used with a satisfying success rate. In case of failure, surgery may be necessary.

Background: Esophageal foreign body retrieval is typically performed by rigid or flexible esophagoscopy. Despite evidence supporting the efficacy and safety of balloon extraction, it is rarely performed. We sought to establish the financial benefits of this minimally invasive approach., Methods: A retrospective review of 241 children with esophageal coins between 2011 and 2013 was performed. Coins were removed via endoscopy or fluoroscopic-guided balloon retrieval. Timing, symptoms, facility cost, and patient charges were compared., Results: Two hundred patients had attempted balloon retrieval with 80% success. Forty-one patients went directly for operative removal. Patients with respiratory difficulty (p=0.05), wheezing (p<0.01), or fever (p=0.03) were more often taken directly for endoscopic retrieval. The median cost and charges for attempted balloon extraction were $484 and $1647. The median cost and charges for primary endoscopy were $1834 and $6746. The median total cost and charges of attempted balloon extraction including ED, OR, transport, admission, and balloon retrieval were $1231 and $3539 versus $3615 and $12,204 in the primary endoscopy group (p<0.001, p<0.001). Seventeen percent of patients who underwent attempted balloon retrieval were admitted prior to removal compared to 76% who underwent primary endoscopy (p<0.001)., Conclusions: Fluoroscopic guided balloon extraction of esophageal coins is a financially prudent choice which shortens hospital stay., Level of Evidence: III., Type of Study: Retrospective treatment and economic study., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Foreign body ingestion continues to be a common problem that contributes significantly to high morbidity and mortality worldwide. Coins are the most common foreign body lodged in the oesophagus. This study was conducted to describe our experience of removal of coins from oesophagus with Foley catheter under ketamine effect., Methods: This was a retrospective study conducted at District Head Quarter Hospital, Buner. Foley's catheter was used to remove the coins under ketamine effect., Results: Coins were successfully removed from 188 children without complications. Amongst these children 101 (53.72%) were male and 87 (46.28%) were female. The mean age of these children was 3.79 years. The coin was removed in first attempt in 154 (81.91%) cases. In 34 (18.08%) cases more than one attempts were required. The mean time for the removal of coin (i.e., initiation of catheter to removal of coin) was 55.30 seconds. The most commonly ingested coin was a one rupee coin (139, 73.93%), followed by two rupee coin (47, 25%), and 5 rupee coin (2, 1.06%)., Conclusion: The coin impacted at the cricopharyngeus or upper oesophagus can be safely, easily, and quickly removed by Foley catheter under ketamine effect.

Entrapment of guidewires by inferior vena cava filters can occur during the blind insertion of a jugular or a subclavian central venous catheter. Recently, few case reports have been published in the radiology literature. In addition, others have described endovascular techniques aimed at removing entrapped guidewires, avoiding the possibility of vena cava rupture. Given that a temporary hemodialysis venous catheter is frequently used as a first access, the possibility of entrapping the dialysis catheter guidewire should not be neglected., (© 2011 The Authors. Hemodialysis International © 2011 International Society for Hemodialysis.)

Case Description: A 2.96-kg (6.5-lb) 9-month-old spayed female domestic longhair cat was admitted for removal of a tracheal foreign body., Clinical Findings: The cat had moderate respiratory distress but otherwise appeared to be healthy. Thoracic radiography revealed a foreign body in the trachea., Treatment and Outcome: The cat was anesthetized and endoscopy of the trachea was performed in an attempt to retrieve the foreign body. Endoscopic removal was unsuccessful because of the shape and smooth texture of the foreign body. Surgical removal of the foreign body was not considered ideal because of its location and the risks associated with tracheotomy. Fluoroscopic-guided placement of an over-the-wire balloon catheter caudal to the foreign body was followed by inflation of the balloon and gradual traction in an orad direction, which resulted in successful removal of the foreign body (identified as a piece of landscaping gravel). The cat required supplemental oxygen and supportive care following removal of the foreign body., Clinical Relevance: A fluoroscopic technique was used as a minimally invasive alternative to endoscopy or open-chest surgery for removal of a foreign body from the trachea of a cat. Use of this technique allowed uninterrupted ventilation of the cat throughout the procedure.

Bullet embolus is a rare complication of penetrating missile trauma. Removal of the bullet previously required surgery. We report the case of a 14-year-old with an hepatic vein bullet embolus following a gunshot wound to the left buttock. A transjugular approach was used to extract the bullet percutaneously with an Amplatzer gooseneck snare.

Inadvertent embolization of guide wires and catheter fragments are relatively common due to the widespread usage of central venous catheters. A variety of percutaneous techniques has been proposed to retrieve intravascular foreign bodies. The majority of described methods have been dependent on a free end or exposed portion of the foreign body to grasp, snare, or hook. We report the simple use of a balloon catheter to relocate a catheter fragment without a free end that was wedged into a small pulmonary branch to a larger branch. In the larger branch, the fragment was then easily engaged with a standard snare device.

Background: Intravascular embolization of device fragments is a rare but potentially serious complication., Method: A systematic search of the PubMed and MEDLINE databases for all articles pertaining to central catheter related embolization published in English between 1985 and 2007 was made., Results: A total of 215 cases of intravenous catheter embolization were identified. There were 143 totally implanted venous devices (TIVD) or port catheters and 72 percutaneous venous catheters (PVC). Sites of catheter fragments following embolization were the superior vena cava or peripheral veins (15.4%), the right atrium (27.6%), right ventricle (22%), and pulmonary arteries (35%). Clinical signs of catheter embolization included catheter malfunction (56.3%), arrhythmia (13%), pulmonary symptoms (4.7%), and septic syndromes (1.8%), but 24.2% of cases were asymptomatic. The causes of intravascular catheter embolization were pinch-off syndrome (40.9%), catheter injury during explantation (17.7%), catheter disconnection (10.7%), and catheter rupture (11.6%). In 19.1% of cases, the cause of catheter embolization could not be identified. Most embolized catheter fragments (93.5%) were removed percutaneously. In 4.2% of cases, fragments were retained in the vascular bed; in 2.3%, embolized fragments were removed surgically via thoracotomy., Conclusion: Intravascular catheter embolization can go undiagnosed for prolonged periods. Patients might be asymptomatic or may develop severe systemic clinical signs. The mortality rate is 1.8%. There were no significant differences in clinical features of embolization between TIVD and PVC groups.

Rectal foreign body impaction in infancy is extremely rare, and the literature does not describe a standard treatment procedure. Extraction by fiberoptic rectosigmoidoscope is advocated as the treatment of choice but is not free of possible complications. It should be also taken into consideration that the type of foreign body has an impact on the timing of treatment. We report a 50-day-old male presenting with a retained broken tip of a mercury thermometer in the rectum. A novel method of diagnostic approach and treatment is discussed.

A coin in the oesophagus is a common paediatric emergency in Zambia. There are very few specialist surgeons and hospitals where endoscopic removal can be carried out in many resource-limited countries. The technique described here allows the removal of an ingested coin using an ordinary Foley's catheter. The use of this technique under fluoroscopic guidance has been described in literature. However, fluoroscopic facilities and trained radiologists are not commonly available in many parts of Africa. This technique is simple, safe and has a success rate close to that achieved by endoscopic removal.

Removal of a rectal foreign body (FB) has become increasingly common in the recent times. Nature of rectal FB is limited only by the imagination of the patient concerned. Many techniques have been described for removal and various theories have been put forward to explain the mechanics of the procedure. We report a case where a new technique had been employed.

Background: Acute esophageal food impaction (EFI) may be treated by endoscopic extraction of the food bolus either en bloc or in a piecemeal fashion. We have found this endoscopic extraction technique to be unsatisfactory., Objective: Our purpose was to demonstrate the use of through-the-scope (TTS), wire-guided esophageal balloon dilation to treat EFI., Design: Case reports defining the technique and results of esophageal balloon dilation to treat EFI., Setting: Tertiary referral center., Patients: Eleven patients presenting with EFI., Interventions: Through-the-scope (TTS), wire-guided esophageal balloon dilation to relieve EFI. Main outcome measurements Endoscopic resolution of EFI., Results: TTS, wire-guided esophageal balloon dilation successfully dislodged the EFI in all 11 patients. The procedure took <5 minutes to complete in all cases. There were no major procedure-related complications., Limitations: Small number of patients., Conclusions: We have found TTS, wire-guided esophageal balloon dilation to be a simple, quick, safe, and effective technique to treat EFI.

Double balloon endoscopy (DBE) was developed as a new technique for visualization and intervention of the entire small intestine. It has been world-widely reported that DBE is very useful for not only diagnosis but also endoscopic therapy. In this chapter, hemostatic procedure, polypectomy, dilation therapy for benign strictures, reduction of intussusception, removal of foreign bodies, and therapeutic ERCP in long-limb surgical bypass patients are described introductively. Diagnostic DBE is thought to be safe with a low complication rate, but it is reported that the complication rate in therapeutic DBE is higher than that associated with colonoscopy. The thin wall of the small intestine can explain this. Endoscopic therapy in the small intestine should be performed with special care to avoid complications such as bleeding and perforation.

This paper reports our experience with endovascular techniques for the retrieval of lost or misplaced intravascular objects. Over 12 years, 78 patients were referred for interventional retrieval of intravascular foreign objects. In this retrospective study, radiological procedure records and patients' medical records were reviewed to determine the exact removal procedure in every case, to report success rates, and to identify significant procedure-related complications. Written, informed consent was obtained from all patients prior to the intervention; this retrospective analysis was performed according to the guidelines of the Institutional Review Board. Thirty-six of seventy-eight foreign objects (46%) were located in the venous system, 27 of 78 (35%) in the right heart, and 15 of 78 (19%) in the pulmonary arteries. For foreign object removal, in 71 of 78 (91%) cases a snare loop was used, in 6 of 78 (8%) cases a sidewinder catheter combined with a snare loop was used, and in 1 case (1%) a sidewinder catheter alone was used for foreign object removal. In 68 of 78 (87%) cases, primary success was achieved. In 3 of 78 cases (4%), foreign objects were successfully mobilized to the femoral vessels and surgically removed. In 7 of 78 cases (9%), complete removal of the foreign object was not possible. In 5 of 78 cases (6%), minor complications occurred during the removal procedure. In conclusion, endovascular retrieval of lost or misplaced intravascular objects is highly effective, with relatively few minor complications. On the basis of our findings, these techniques should be considered as the therapy of choice.

Numerous and varied foreign bodies have been described in the lower urinary tract. Techniques previously used to remove these objects have included open and endoscopic removal. We present a novel endoscopic technique using a ureteral catheter as a lasso to remove a retained foreign body, in this case a retained Foley catheter.

Purpose: We report our experience of the retrieval of intravascular foreign body objects by the percutaneous use of the Gemini Dormia basket., Methods: Over a period of 2 years we attempted the percutaneous removal of intravascular foreign bodies in 26 patients. Twenty-six foreign bodies were removed: 8 intravascular stents, 4 embolization coils, 9 guidewires, 1 pacemaker lead, and 4 catheter fragments. The percutaneous retrieval was achieved with a combination of guide catheters and the Gemini Dormia basket., Results: Percutaneous retrieval was successful in 25 of 26 patients (96.2%). It was possible to remove all the intravascular foreign bodies with a combination of guide catheters and the Dormia basket. No complication occurred during the procedure, and no long-term complications were registered during the follow-up period, which ranged from 6 months to 32 months (mean 22.4 months overall)., Conclusion: Percutaneous retrieval is an effective and safe technique that should be the first choice for removal of an intravascular foreign body.

The most common cause of a retained Foley catheter is failure of the balloon to deflate. If noninvasive means are unsuccessful, balloon puncture is required. We present a safe and efficient technique using flexible video cystoscopy for balloon puncture and removal of any free fragments formed.

A case of subsequent percutaneous repair using a local closure device with a collagen block (VasoSeal(R)) and temporary balloon tamponade after inadvertent subclavian artery misplacement of a 12F Shaldon catheter is reported. Balloon occlusion safely prevented displacement of collagen into the vascular lumen by occluding the 12F entry site. Furthermore, collagen-induced coagulation was facilitated.

Background: Children with esophageal foreign bodies are frequently seen by pediatric surgeons. Choking and dysphagia are common presentations; however, esophageal perforation has been reported. Historically, rigid esophagoscopy with extraction of the foreign body has been the recommended treatment. Alternatively, Foley balloon extraction is a safe and effective approach., Methods: Over a 16-year period, 555 children presented with an esophageal foreign body. Retrospective analysis of the medical record was undertaken. Statistics were by univariate analysis., Results: Two hundred ninety-eight boys and 257 girls presented with a mean age of 3.24 years. Dysphagia (37%) and drooling (31%) were the most common symptoms. Foreign bodies were lodged in the superior esophagus in 73%, and 88% of the objects were coins. Balloon extraction with fluoroscopy was performed in 468 children. Eighty percent of the objects were successfully removed with a mean fluoroscopy time of 2.2 min, and 8% were advanced into the stomach. The overall success rate was 88%, with failures necessitating rigid esophagoscopy under general anesthesia. Children younger than 1 year were the most likely to fail (25% failure rate). Airway aspiration never occurred. Significant savings in patient charges were observed with this approach., Conclusions: Balloon extraction of pediatric esophageal foreign bodies is a safe and cost-effective procedure. This technique is applicable for infants, children, and adolescents. Experienced practitioners should be able to achieve greater than 80% success rate.

Purpose: To compare the capturing ability of the Texan foreign body retrieval device with that of the Amplatz gooseneck snare in a swine model and to analyze their capturing mechanisms., Materials and Methods: The Texan device with a < or = 30-mm adjustable loop was compared with the 5-mm, 15-mm, and 35-mm Amplatz snares for retrieval of foreign bodies from the iliac vein, infrarenal aorta, inferior vena cava, and stomach. Capture times by two investigators were compared., Results: All 24 attempts with the Texan device were successful, as were 21 of 23 attempts with the Amplatz snare; two attempts with the 5-mm Amplatz snare were abandoned, and the failures were attributed to the suboptimal size of the snare. Other than the two abandoned attempts, there was no difference between the capturing performances of the Texan device and the 5-mm, 15-mm, and 35-mm Amplatz snares when they were compared side by side. In all vascular interventions, however, the Texan device performed significantly better in capture times than did the 5-mm and 15-mm Amplatz snare (P = .015). In all interventions, the Texan device performed significantly better in capture times than did all three sizes of the Amplatz snare (P= .012)., Conclusion: The overall performance of the Texan device based on its capturing ability was significantly better than that of the Amplatz snares. The adjustability of the loop and the more versatile capturing technique made capture and retrieval of foreign bodies easier.

The nondeflating catheter balloon is infrequently encountered by urologists and can pose quite a challenge. We describe a new technique for its removal using the holmium:yttrium-aluminum-garnet laser when noninvasive methods have failed.

Numerous methods have been described for retrieving fractured guidewires from the coronary circulation. We report a case of a fractured rotational atherectomy guidewire retained within a coronary artery. The standard technique of snaring the proximal end of the retained fragment was impossible because its radiolucency rendered it invisible. The snare was passed beyond the retained fragment and retracted to capture the distal tip. When snaring a foreign body, identifying the most accessible part is critical to the success of the procedure.

The incidence of swallowed foreign body is high in children and young adults. The common age of occurrence is below 10 years of age. It is a well known paediatric emergency often requiring urgent oesophagoscopy. Majority of swallowed foreign bodies (FBs) are impacted at sites known conventionally as constrictions. The commonest FB swallowed by children is coins; by adults - bones, fish bones and large bolus of meat, and in the older age group - dentures. The most common presenting symptoms are drooling of saliva, dysphagia and odynophagia. The anatomic proximity of the upper airway and oesophagus permit the development of respiratory symptoms like cough and stridor. Long standing foreign body impaction with weight loss, consolidated lungs and failure to thrive are documented presentations of FB in the oesophagus. We present a case of a 20 year old male who inadvertently swallowed a coin which got impacted at the thoracic inlet - one of the conventional areas of constriction. He presented late with cough, stridor, odynophagia and weight loss. The presentation of weight loss that could arise from unduely prolonged odynophagia rather than from complications like fistula, empyema thoracis or ominous predisposing lesions like malignancy was noted. The case highlighted the oddity of an adult swallowing a coin, its impaction in the, oesophagus of an apparently healthy adult and the non-surgical retrieval of the FB by fluoroscopic guidance.

Lower oesophageal foreign body meat bolus obstruction is potentially life-threatening. We report a case in a 94-year-old woman in which conservative measures and flexible oesophagoscopy were unsuccessful. Rigid oesophagoscopy was considered technically difficult and so clearance by interventional radiology was attempted. Through the mouth a radiologically guided balloon catheter was introduced. It was passed beyond the bolus to dilate the site of obstruction, before being withdrawn and inflated above the bolus, pushing it into the stomach. Although successful in this case, the technique is previously unreported and so its complication rate is unknown. It is therefore presented only to be considered when other treatments are neither effective nor possible.

We present a novel approach for a common ENT emergency. Under nasendoscopic guidance, a fishbone lodged in the pharynx can be removed with a suction catheter passed nasally.

Two children aged three and seven years presented to the department of Otolaryngology with total dysphagia following the accidental swallowing of a steel ball bearing and a plastic ball. These rare spherical foreign bodies were removed successfully by oesophagoscopy under general anaesthesia using an innovative method involving a balloon angiographic catheter.

Foreign body aspiration is a common problem in children necessitating prompt recognition and early treatment to minimize the potentially serious and sometimes even fatal consequences. We report the case of a 7 year old girl with a peanut lodged in her right main bronchus. Bronchoscopy identified the foreign body which was then removed by the combined use of a Fogarty balloon catheter and extraction forceps. This case differs from previous reports, in that the foreign body and forceps were removed separately from the balloon catheter, which theoretically should minimize the risks associated with this procedure.

We report the case of a patient who developed an obstructing calculus embedded at the ureteropelvic junction after treatment of ureteropelvic junction obstruction with the Acucise cutting balloon catheter. Within the length of the stone, we found a wire consistent with the cutting wire. To our knowledge, this is the first report of a fractured and retained cutting wire resulting in calculus formation.

Introduction: The spreading of interventional procedures and the frequent use and replacement of central venous catheters have contributed to a relative increase in the occurrence of intravascular foreign bodies (FBs). Their retrieval is justified by potential complications related to their characteristics, location and permanence. The high morbidity related to surgical retrieval, especially in case of intravenous FBs (often located in the right cardiac chambers or the pulmonary artery) has contributed to the spreading of interventional retrieval procedures. The purpose of percutaneous retrieval is: 1) to hook the FB to stop its migration to more critical districts; 2) to extract it through the percutaneous access route or, if the latter is unfeasible, 3) to simplify surgical retrieval., Material and Methods: We report our experience with 15 patients presenting an FB [intravenous (i.v.) in 11 cases and intra-arterial (i.a.), in 4]. Retrieval was performed mainly with snare-loop catheters (13 cases, together with a pig-tail catheter in 3 patients) and also with Dormia baskets (3 cases, together with a snare loop in 1 case). To ensure the percutaneous retrieval, we used introductors with a greater caliber than that of the FB, the latter generally being a 6-7 F intravenous catheter. The percutaneous approach was mostly transfemoral (right femoral in 9 cases and bilateral femoral, left femoral, axillary and left jugular in 1 case each)., Results: Percutaneous retrieval was successful in all the i.v. cases and in 1 ia case. The other 3 ia cases required surgical removal under local anesthesia after percutaneous hooking and displacement of the FB to a more accessible site. No major complications were observed during retrievals., Conclusions: Based on our personal results and in agreement with the major international reports, we believe that percutaneous retrieval should be considered the treatment of choice for FBs. The procedure success depends on an accurate diagnostic approach, good knowledge of materials and techniques and the operator's experience, as well as the possibility of an interdisciplinary collaboration of the interventional radiologist with the surgeon and anesthesist.