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A 31-year-old man with a history of hypertrophic cardiomyopathy and alcohol septal ablation one week before was presented after an out of hospital cardiac arrest in the setting of an anterior wall ST-elevation myocardial infarction. Immediate coronary angiography showed an unidentified foreign object within the left anterior descending coronary artery (LAD), later identified as the cover of a balloon that had been unintentionally inserted and abandoned within the LAD during the alcohol septum ablation one week earlier. Intracoronary imaging confirmed the presence of endothelial damage and thrombus formation within the LAD explaining acute myocardial infarction. The patient was treated by surgical retrieval of the balloon cover, extended septal myectomy and coronary artery bypass grafting (CABG) of the LAD. This case is both an example of unintentional neglect of unexpected objects, and the importance of multimodality imaging and multidisciplinary teamwork to get to a correct diagnosis and treatment.

Iliopsoas abscesses (IPA) are uncommon, with an associated mortality rate of up to 20%. We describe the case of a 55-year-old man war veteran who presented with an unusual cause of IPA secondary to retained foreign body (FB). His initial trauma 30 years before was a result of a blast injury with shrapnel penetration suffered after inadvertently driving over a landmine as an ambulance driver in a conflict region. A CT scan was performed, revealing a 13 mmx8 mm radio-opaque FB within the right psoas at the level of the fifth lumbar vertebra with a surrounding collection. Subsequent open surgical exploration removed two gravel fragments. Given the knowledge of a traumatic blast injury with retained FB and repeated episodes of sepsis, surgical exploration is warranted. To our knowledge, this is the first case of recurrent IPA secondary to a retained FB from a historical trauma.

An endoscope is a useful adjunct for the retinal surgeon to overcome haze of a compromised anterior segment. It allows early surgery in trauma and infections which translates to better results. Intraocular glass foreign body is a challenging condition, demanding highly skilled surgical expertise. We present endoscopic removal of an intraocular foreign glass body in a badly traumatised and infected eye. The surgical challenge was accentuated by an imaging misdiagnosis of ‘twin metallic foreign bodies’.

Foreign body aspiration (FBA) can be encountered in all age groups, especially in children under 3 years of age. In this study, we aimed to evaluate our results in children and adults who underwent rigid bronchoscopy due to a history of foreign body aspiration.In a single-center study, 822 consecutive patients with suspected foreign body aspiration and undergoing rigid bronchoscopy between January 2000 and August 2021 in our clinic were retrospectively evaluated.There were 451 (54.9%) male and 371 (45.1%) female patients. The mean age was 8.1 ± 14.0 (range 1 month-84 years). 525 (63.9%) of the cases consisted of cases under 3 years old, including 3 years old. There were 726 (88.3%) pediatric patients (≤18 years old), and 96 (11.7%) adult patients. The most important symptoms were cough in 690 (83.9%) cases and wheezing in 492 (59.9%) cases. The most frequently aspirated foreign bodies in children were sunflower seeds (14.2%, n = 71), food particles (11.4%, n = 57) and needles (52%, n = 10.4). The most frequently aspirated foreign bodies in adults were needles (39.5%, n = 28), non-needle metallic objects (21.1%, n = 15) and food particles (11.3%, n = 8). No mortality was observed in any of the patients who underwent rigid bronchoscopy.FBA is higher in children and direct radiological findings are less than in adults. Current findings show that FBAs in children are more difficult to diagnose and more dangerous clinically.

To review the clinical management and outcomes of magnet ingestions at a large tertiary children's hospital. To determine the association of frequency of high-powered magnet ingestion with the regulation of these magnets.Children18 years who presented to the emergency room and were admitted to the Children's Hospital of Philadelphia for ingestion of single or multiple magnets from January 2008 to December 2020 were included. Demographics, symptoms, management, and outcomes were analyzed. The frequency of magnet ingestion was compared over 3 eras: (1) pre-ban (2008-2012), (2) intra-ban (2013-2016), and (3) post-ban (2017-2020).There were 167 magnet ingestions, including 99 with multiple magnets. Most patients (59%) were male and median age was 6 (interquartile range, 3-9) years. Most single magnet ingestions (86%) were discharged with outpatient monitoring, and none experienced severe outcomes. Multiple magnet ingestions led to significant morbidity including hospitalizations (68%), endoscopic procedures (48%), surgical procedures (14%), and severe outcomes (12%). Most patients (75%) were asymptomatic, however, there was a higher risk of surgery and severe complications based on the presence of symptoms ( P = 0.003). The rate of surgical intervention was higher with ≥3 magnets (31.7%) compared to 2 magnets (2.4%) ( P0.003). Additionally, we found an 160% increase in children with magnet ingestions in the post-ban period ( P = 0.021).Multiple magnet ingestion is associated with high morbidity and rate of severe outcomes. There is a relationship between public policy of magnet sale and frequency of magnet ingestion.

There are only a few case reports of foreign bodies (FBs) in the tongue. Delayed diagnosis or misdiagnosis is commonly reported. The purpose of this study was to identify the demographic, clinical, and radiological features that might facilitate the diagnosis of retained FBs in the tongue.A retrospective case series was performed. Clinical and imaging data of patients with FBs in the tongue at Wuhan University Hospital of Stomatology were reviewed. The outcome variable was a preliminary, radiological, intraoperative, or pathological diagnosis. Covariates included age, sex, FB-related history, symptoms and signs, duration, and computed tomography (CT) imaging features. Descriptive statistics were computed for each study variable.Thirty-five patients were included. The sample's mean age was 54.5 ± 11.2 years, included 19 males (54.3%). Eighty percent of the patients reported FB-related history with a mean duration of 4 weeks. More than 70% of the patients presented with tongue swelling. Approximately half of the 35 cases were preliminarily misdiagnosed, and 15 of them were initially suspected to be tumors. After CT examinations, 33 of the 35 cases were diagnosed as FB. Characteristic CT imaging feature of the FB was a radiopaque line. Most FBs were located at the anterior two-thirds and marginal area of the tongue and in an oblique direction. The depth of FB was 0.61 ± 0.42 cm. The superficial ends of most FBs were close to the surface of the dorsum and the tongue margin.The possibility of a retained FB should be included in the differential diagnosis of a nonhealing wound or tongue enlargement when a radiopaque line is present on CT images of patients presenting with or without FB-related history. It may be easier to detect a FB in the tongue when a CT imaging postprocessing protocol, including thin-slice reconstruction and multiplanar reformation visualization and careful interpretation, is used.

Introduction: Corneal foreign bodies are one of the commonest forms of ocular trauma, the majority of which occur due to occupational exposure. The aim of this study was to study the profile of patients with corneal foreign bodies. Materials and methods: A hospital based prospective study was conducted among 60 patients presenting to the ophthalmology outpatient department in Dhulikhel Hospital-Kathmandu University Hospital (DH-KUH) over a time span of 6 months. Demographic data of patients, clinical characteristics of foreign bodies and associated complications were noted. Results: Most of the patients were males (n=55) belonging to the 21-30 age group (n=24). Majority of them were workers in metal industries (n=26). Welding and cutting metal were implicated as the most common mode of injury (n=53). Conclusion: By virtue of this study, we identified the high risks associated with sustaining this form of ocular trauma. The incidence and hence the prevalence of corneal foreign body can be gradually levelled down if we aware the people about the associated complications and advise them to use protective eye wears (PEW).

Objective. This study is aimed at investigating the epidemiology and risk factors of acute hemorrhagic conjunctivitis (pinkeye) in Huangshi Port District of Huangshi City. Methods. A total of 593 cases of acute hemorrhagic conjunctivitis from January 2019 to December 2021 were selected as the observation group. The epidemiological characteristics (age of onset, season, occupation, clinical manifestations, and etiological characteristics) were analyzed. A total of 425 healthy subjects (nonacute hemorrhagic conjunctivitis) were selected as the control group. The general data of the two groups were compared, and the risk factors affecting the occurrence of acute hemorrhagic conjunctivitis were analyzed by logistic regression. Results. The onset age of acute hemorrhagic conjunctivitis was mainly concentrated in 0-20-year-old and 60-year-old age groups, and the onset season was mainly concentrated in April to August, with the highest incidence in May. The proportions of middle school students and workers in patients with acute hemorrhagic conjunctivitis were higher than those of other occupations (both P < 0.05 ). Ocular conjunctival congestion, tingling, and foreign body sensation were the main clinical manifestations of patients with acute hemorrhagic conjunctivitis. Among the 593 conjunctival swab samples collected in this study, the positive rates of HEV70 and CVA24v were higher than those of adenovirus nucleic acid (both P < 0.05 ). The proportion of people aged ≤40 years old, male, working outdoors, using potable water equipment, contact history of patients with acute conjunctivitis, history of chemical substances entering eyes, combined with immune system diseases, and public toilet utilization rate ≥ 1 times/d in the observation group was higher than that in the control group (all P < 0.05 ), and the proportion of people washing hands before eating and after toilet was lower than that in the control group ( P < 0.05 ). Multiple logistic regression analysis showed that working place outdoors, use of potable water equipment, contact history of patients with acute conjunctivitis (all P < 0.05 ), and use of public toilets ≥ once a day were risk factors for the occurrence of acute hemorrhagic conjunctivitis, and washing hands before eating and after toilet was a protective factor ( P < 0.05 ). Conclusion. The onset age of acute hemorrhagic conjunctivitis was mainly concentrated in 0-20-year-old and 60-year-old age; the onset season was mainly concentrated in summer and autumn; adenovirus is the main pathogenic bacteria; ocular conjunctivitis congestion, tingling, and foreign body sensation were the main clinical manifestations; working place outdoors, use of potable water equipment, contact history of patients with acute conjunctivitis (all P < 0.05 ), and use of public toilets ≥ once a day were risk factors for the occurrence of acute hemorrhagic conjunctivitis, while washing hands before eating and after toilet was a protective factor.

To describe causes, clinical signs, experience and endovascular techniques for extraction of intravenous foreign bodies (IFB) and literature review.This retrospective study was based on data collected from the medical records of 51 consecutive patients (26 women and 25 men) treated from July 2007 to May 2020 at a single quaternary center in Brazil and case series with data, published in the literature since 2000 on IFB removal, of at least 5 patients. The average patient age was 43.54 years (range, 2 months to 84 years). The different retrieval method using the following was used in the procedure: gooseneck snare, guidewire, balloon, and custom snares.The retrieval process rate was 100%. Thirty-one port-a-caths, 6 guidewires, 4 double lumens, 3 permcaths, 3 Shiley® catheters, 1 intra cath, 2 peripherally inserted central catheters, and one stent were extracted. The locations where the IFBs were most frequently trapped were the right atrium (39.2%), the pulmonary artery (17.64%), the superior vena cava (13.72%), and the right ventricle (16.12%). Single venous access was used in 67.07% of the patients. Femoral access, which was the most commonly used approach, was used in 85.71% of the patients. The loop was used in 64.70% of the patients. A fractured catheter was the main IFB in 60.76% of the cases (31 patients). Only one complication related to the extraction of an IFB was noted in a single patient who suffered from atrial fibrillation (1.96%). The 30 day mortality rate was zero.Percutaneous IFB removal should be considered as an alternative for the treatment and retrieval of IFBs because it is a minimally invasive procedure that is relatively simple, safe, and has low complication rates.

OBJECTIVE To determine the proportion of abnormal results for a point-of-care pancreas-specific lipase assay screening test in dogs lacking clinical evidence of acute pancreatitis with and without gastrointestinal foreign body obstruction (GIFBO). ANIMALS 50 client-owned dogs with acute abdomen syndrome between April 2019 and January 2021. PROCEDURES In this prospective observational cohort study, dogs were enrolled into a control non-GIFBO group (n = 25) or GIFBO group (25) on the basis of clinical diagnostics performed at presentation. Dogs with evidence of pancreatitis were excluded. Data collected included signalment, body weight, clinical signs, hematologic test results, abdominal imaging findings, and intraoperative findings. SNAP canine pancreatic lipase (cPL) tests were performed for all dogs within 24 hours of presentation and prior to any surgical procedure. Results were analyzed across all dogs for any clinical associations. RESULTS The proportions of abnormal SNAP cPL test results in the GIFBO and non-GIFBO groups were 12% (3/25) and 16% (4/25), respectively, with no significant difference. The only differences between groups were that GIFBO canines were more likely to be male (P = 0.02) and had a slightly longer duration of clinical signs at presentation (P = 0.01). Abnormal SNAP cPL test results were associated with increasing age (P = 0.01). CLINICAL RELEVANCE SNAP cPL test results are mostly reliable but can still be abnormal in a small percentage of dogs with GIFBO. Abnormal results in dogs without pancreatitis occurred more frequently in older dogs of the present study. Abdominal imaging is advised for dogs with abnormal SNAP cPL test results.

The aim of the present study was to analyse clinical data of children referred for disc battery ingestion in order to assess short- and long-term reported injuries and to identify outcome predictors and trends, define the urgency of intervention and refine treatment guidelines.The records of all children admitted to Santobono-Pausilipon Children's Hospital, Naples, Italy for disc battery ingestion from January 2016 to December 2020 were retrospectively reviewed. Odds ratio were computed to assess the association between the different study variables and the rate of complications.We enrolled 118 children. Mild to major complications related to the ingested disc batteries were reported in 12/118 (10.2%) patients. Disc battery oesophageal retention, disc battery diameter20 mm, together with age below 1 year and symptomatic presentation were the most important factors associated with poor clinical outcome.Our data confirm that ingested disc batteries are a serious health hazard and require a timely and qualified medical evaluation. We have identified three predictors of outcome severity: oesophageal retention, large-diameter cells and symptom onset. Disc batteries lodged beyond the oesophagus appear substantially harmless and we may support a more conservative approach.

Foreign body impaction is a frequent indication of urgent endoscopy. One of the reasons for impaction is eosinophilic oesophagitis (EE). To analyze characteristics of oesophageal foreign body impactions and their relationship with eosinophilic oesophagitis.In this retrospective study, urgent endoscopies in a tertiary care centre were analyzed. We included all urgent endoscopies due to bolus and foreign body impactions performed between September 1st 2018 and September 1st 2020. We reviewed clinical data of all patients who were diagnosed with EE and compared it to impactions that were due to other motives. The mean follow-up time was 18.7 months.693 urgent endoscopy procedures were performed. 239 (34%) of these were due to foreign body ingestion. Mean age of the patients was 63 years old and 135 (63%) were men. EE was diagnosed in 36 (17%) patients. The factors associated with EE were age, to be younger than 50 years (OR, 7.3; 95% CI, 1.1-48.4; p=0.04), asthma/rhinitis/atopic dermatitis (OR, 8.9; 95% CI, 2.3-35.3; p=0.002), findings in the endoscopy as trachealization (OR, 9.7; 95% CI, 1.3-70.9; p=0.03) and psychotropic/calcium channel blocker drugs (OR, 0.09; 95% CI, 0.009-0.9; p=0.04). 15 (7%) patients died. In 6 of them death was impaction-related. None patients with EE died.Foreign body impaction in the upper gastrointestinal tract due to EE is a frequent cause of urgent endoscopy. Being under 50 years of age, having asthma/rhinitis/atopic dermatitis, trachealization on the oesophagus and not taking psychotropic/calcium channel blocker drugs are factors associated with the diagnosis of EE. Mortality in the follow-up of patients without EE is important.

Dry socket or alveolar osteitis is one of the most common complication following tooth extraction. Patients usually reports of pain, which typically starts on third or fourth postoperative day and responds to simple irrigation and placement of zinc oxide eugenol (ZOE) pack, which provides an obtundent effect. The pack should be loosely kept in the extraction socket and should be changed periodically to allow healing. This report presents a case of retrieval of foreign body, which actually was a ZOE pack from maxillary sinus, 6 months after the patient underwent extraction of upper left maxillary first molar.

Swallowed partial dentures in elderly patients is an emergency situation that requires a swift response. Here, we report a case involving a patient with severe intellectual disability who swallowed his denture, which lodged at the oesophagus inlet. After failure of endoscopic removal, denture with clasp was removed using long forceps through intraoral approach under intravenous sedation. At the pharynx and oesophagus inlet level, removal of foreign body via intraoral approach should be preferentially considered over open surgery for faster patient recovery.

Ingestion of magnetic foreign bodies in pediatric settings has become more common in the last years due to the marketing of various toys containing small magnetic parts. Most magnets, especially if a single element is ingested, usually pass through the gastrointestinal tract without complications. However, ingestion of multiple magnets or magnets and small metallic components may require a prompt intervention due to the risk of attraction across bowel layers, leading to pressure necrosis, perforation, and even death. Routinely, serial radiological evaluations are needed to follow the progression of magnets through the intestine, while the role of small bowel ultrasound is regarded as marginal. Here we report a case of a 5-years old boy who ingested 8 magnets and in which small bowel ultrasound was pivotal for the correct assessment of magnets location to correct address the surgical approach.

BackgroundThe increased popularity of reusable drinking bottles may have safety implications when used by children. This paper discusses the lessons learnt from managing two cases of children presenting to our ENT department who required surgical intervention for complications arising from their use.Case reportThis paper presents a case series of two five-year-old children who attended the emergency department with circumferential entrapment of their tongue within plastic drinking bottle lids of similar design. The unique anaesthetic and surgical challenges surrounding these cases are discussed.ConclusionThese represent the only reported cases of circumferential entrapment of the tongue by a foreign body requiring general anaesthesia where orotracheal intubation was contraindicated. A creative general anaesthetic approach was taken using ketamine and Optiflow high-flow nasal oxygen therapy. A reproducible surgical technique using powered cutting instruments is also discussed.

Background Ingestion of fish bones leading to gastric perforation and inducing abscess formation in the caudate lobe of the liver is very rare. Case presentation A 67-year-old man presented to our hospital with a 2-day history of subxiphoid pain. There were no specific symptoms other than pain. Laboratory tests showed only an increase in the number and percentage of neutrophils. Contrast-enhanced Computerized tomography (CT) of the abdomen showed two linear dense opacities in the gastric cardia, one of which penetrated the stomach and was adjacent to the caudate lobe of the liver, with inflammatory changes in the caudate lobe. We finally diagnosed his condition as a caudate lobe abscess secondary to intestinal perforation caused by a fishbone based on the history and imaging findings. The patient underwent 3D laparoscopic partial caudate lobectomy, incision and drainage of the liver abscess, and fishbone removal. The procedure was successful and we removed the fishbone from the liver. The patient was discharged on the 9th postoperative day without other complications. Conclusions Liver abscess caused by foreign bodies requires multidisciplinary treatment. Especially when located in the caudate lobe, we must detect and remove the cause of the abscess as early as possible. Foreign bodies that perforate the gastrointestinal tract can penetrate to the liver and cause abscess formation, as in this case. When exploring the etiology of liver abscesses, we should investigate the general condition, including the whole gastrointestinal tract.

BACKGROUND/AIM Plastic biliary stents that remain in situ for more than 12 months, termed forgotten biliary stents (FBSs), can cause complications such as cholangitis, stent migration, stent occlusion and perforation. We evaluated the incidence, complications, and management of FBSs in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). MATERIALS AND METHODS The medical records of patients who underwent ERCP procedures at the Gastroenterology Endoscopy Department of Kocaeli University Medical Faculty from December 2016 to December 2020 were analysed retrospectively. Data on patient characteristics, indications for ERCP and stenting, stent types, stenting duration, and complications were obtained from the hospital?s database. RESULTS A total of 48 cases with FBSs were analysed. The mean age (SD) of the patients was 71.23 years (12.165), the male to female ratio was 23/25 (0.92), and the mean stenting duration was 27.12 (range: 12?84) months. The most common indication for biliary stenting was irretrievable choledochal stones (40/48). Among the FBS patients in whom ERCP was performed, the most common presenting condition was cholangitis (22/34). Stone formation (79%) and proximal stent migration (26.4%) were the most frequent complications. The patients in the FBS group were significantly older than those in whom stents were removed in a timely manner (71.23 vs. 62.43 years, p < 0.001). Endoscopic treatment was possible in all cases; surgery was not required in any case. The most common cause of FBSs cited by patients was not having been informed about the need for long-term management of their stents (n = 14, 29.2%) Conclusion: FBSs are potentially problematic, particularly in older patients. Communication with the patient to remind them of the need for stent management is important for preventing FBSs.

Introduction Insertion of foreign objects into the rectum is a well-described phenomenon and not an uncommon referral to the general surgeon on call. Although usually not life-threatening, there can be consequences following migration of the object or perforation of the large bowel. This study looks at the incidence of removal of foreign objects from the rectum over the last decade and the financial burden it presents to the NHS. Methods Hospital Episode Statistics for 2010–2019 were used to calculate the number of rectal foreign bodies that required removal in hospital. Data for age groups and genders have been compared. Results A total of 3,500 rectal foreign bodies were removed over the course of 9 years. Males accounted for 85.1% of rectal foreign bodies whilst 14.9% were females. This equates to 348 bed-days per annum. Admission peaks were observed in the second and fifth decades of life. Conclusion This study shows that the incidence of rectal foreign bodies is higher in men and has been increasing over the period studied. Most foreign bodies can be removed trans-anally with the use of anaesthesia, with only a small proportion of patients requiring hospital stay over 24 hours (mean length of stay = 24 hours). Nearly 400 rectal foreign body removals are performed each year with an annual cost of £338,819, illustrating the effect this has on NHS resources.

Rationale Superabsorbent polymers are marketed as toys, and cases of ingestion in children are increasingly reported. Even if these cases are usually considered benign, bowel obstruction has been reported. Objective To investigate the exposure characteristics, clinical presentation, management, and outcome of patients who developed bowel obstruction following ingestion of superabsorbent polymer-made products. Methods Databases were searched (no start date - 2020/01/31) using the following keywords: ("superabsorbent" OR "polymer" OR "hydrogel" OR "crystal" OR "jelly" OR "Orbeez" OR "beads") AND ("ingestion" OR "obstruction" OR "perforation") AND ("intestinal" OR "bowel"). All cases of bowel obstruction following superabsorbent polymer-made product ingestion were included. Results Report selection: We found 25 reports reporting 43 cases of bowel obstruction following superabsorbent polymer-made product ingestion. All the reports were retrospective, including 20 case reports and 4 case series. Patient characteristics and clinical presentation: Age ranged from 6 to 36 months, and the female/male sex ratio was 1.3. The median delay between the ingestion of the product and the onset of the first symptoms (available in only four reports) was 1.0 [0.7;1.8] day (from 15 h to 2 days). The median delay between the onset of gastrointestinal symptoms and hospital admission, available for all but 15 patients, was 3 [2;4] days (from 15 h to 30 days). The reported symptoms were persistent vomiting in all cases, associated with constipation (11/43), diarrhea (1/43), abdominal pain (1/43), and clinically assessed dehydration (14/43). Abdominal palpation found abdominal tenderness or distension in 11/43 and 28/43 patients, respectively. An abdominal mass was palpated in 3/43 patients. Two patients presented with fever, and three patients developed seizures. Characteristics of exposure: Ingestion of superabsorbent polymer-made products was reported by relatives on hospital admission in only 10/43 cases. Based on imaging and/or surgically/endoscopically removed products, all were bead-shaped objects. The median number of beads removed (available in 27/43) was 1 [1-2] (range from 1 to 6). Their median diameter (available in 21/43 patients) at the time of the diagnosis of bowel obstruction - i.e., at hydrated state - was 30 [30;36] mm (range from 25 to 65 mm). Imaging findings: Abdominal radiography, performed in 31/43 patients, never showed evidence of foreign body ingestion Abdominal computed tomography scanning, performed in 10/43 patients, visualized an intraluminal mass in 5/10 cases. Abdominal ultrasound performed in 34/43 patients allowed visualization of a rounded intraluminal image that corresponded to a bead in 28/34 patients but led to a correct diagnosis of foreign body-induced bowel obstruction in only 15/34 cases. One case reported the contributory use of abdominal MRI. Beads were always located in the small bowel (from the duodenum to the terminal ileum). Removal of beads: Bead removal required endoscopy in 2/43 cases and surgery in 41/43 cases (enterotomy or resection in 36/43 and 5/43 cases, respectively). In 3/36 cases, additional enterotomy was performed to remove beads that had not been found during the first surgery. The delay between the onset of gastrointestinal symptoms and removal procedures ranged from 1 to 7 days. Outcome: Except for two fatal cases, the outcome was favorable. Conclusions Ingestion of superabsorbent polymer-made beads can be responsible for fatal bowel obstruction in children related to the increase in bead size within the intestinal tract. Diagnosis is made difficult by the radiolucent properties of the beads. The management of bowel obstruction probably most often requires endoscopic or surgical procedures. Children under 4 years of age are probably the most at risk of developing bowel obstruction.

Traumatic mating, that is, copulation that involves wounding the partner's body, is a widespread phenomenon that is particularly prevalent in hermaphroditic animals. Traumatic mating is generally a collateral side effect of diverse strategies (from physical anchorage to injection of substances to manipulate the partner), but the trauma could also be adaptive by itself if it delays remating by the injured partner. In the Tricladida (the clade of planarian flatworms), reciprocal sperm transfer is often assumed to occur by means of a 'regular' nontraumatic copulation, that is, insertion of the penis through the partner's gonopore and deposition of the ejaculate into its genital atrium, with subsequent sperm migration to the oviducts. However, while studying the anatomy of Brazilian land planarians for taxonomic purposes, we found foreign bodies, reminiscent of spermatophores, implanted within the parenchyma of Choeradoplana albonigra (Riester, 1938). Herein, we describe and illustrate several lines of morphological evidence indicating that these foreign bodies likely represent a novel case of intragenital copulatory wounding (e.g., structural and histochemical similarity to land planarians spermatophores; implantation at the level of the gonopore; vestiges of rupture of the genital atrium's wall), corroborating that traumatic mating is pervasive and underreported in Metazoa. We also propose two different hypotheses to explain such copulatory wounding, viz., that it concerns (1) a regular mating strategy or (2) an accidental effect of the copulation. In any event, this land planarian may prove useful as a novel, noninsect terrestrial model organism to investigate the evolution of traumatic mating.

Background Spontaneous pneumomediastinum (SPM) occurs in cases of mediastinal leaks that are not caused by trauma, mechanical ventilation, or other surgical procedures. In most cases, in the pediatric population a trigger can be identified, most commonly asthma. SPM caused by foreign body aspiration is not a common entity. It is usually a benign condition that generally resolves without severe sequela, but in some cases, severe morbidity and mortality have been documented. Treatment is usually conservative and includes rest, analgesics, and treatment of any underlying pathologies. Case Report We report a case of a 19-month-old boy who presented to the emergency department with acute facial swelling and wheezing with no history of foreign body aspiration. This misleading presentation led the medical staff in the emergency department to initially treat the patient for anaphylaxis. The diagnosis was made only after imaging modalities demonstrated SPM with a suspected foreign body in the right main stem bronchus. Why Should an Emergency Physician Be Aware of This? Providers should consider SPM from an aspirated foreign body in young children with respiratory distress and acute facial swelling, especially when crepitus is present. © 2021 Elsevier Inc.

Background The goals of this work were to report the demographic characteristics of patients with clinically diagnosed endophthalmitis with or without intraocular foreign bodies (IOFBs) and to analyze the causative microorganisms. Methods A retrospective analysis was conducted on 1257 patients with clinically diagnosed posttraumatic endophthalmitis who were admitted to Zhongshan Ophthalmic Center between January 1, 2013, and August 31, 2020. Results Of the 1257 patients with clinically diagnosed posttraumatic endophthalmitis, 452 (36.0%) patients had IOFBs. Male dominance was more common among the patients with IOFBs than the patients without IOFBs. The average age of the patients with IOFBs was older than that of the patients without IOFBs. The most common microbial pathogens in these two groups were Gram-positive cocci and Gram-negative bacilli. Gram-positive bacilli were more common in the patients with IOFBs than in those without IOFBs (17.9 vs. 9.4%), and Bacillus spp. accounted for 12.6 and 5.5%, respectively. Fungi were less abundant in the patients with IOFBs than in those without IOFBs (8.0 vs. 15.6%). Conclusions Patients with IOFBs were mostly male and older than those without IOFBs. Gram-positive bacilli were more common and fungi were less common in patients with IOFBs than in those without IOFBs.

Meckel's diverticulum is the most common congenital defect of the gastrointestinal tract. It is most often silent or asymptomatic. However, acute abdominal signs of obstruction, inflammation, hemorrhage and perforation are possible in other cases. Different foreign bodies can cause perforation of Meckel's diverticulum. We present an 18-year-old male who presented to the emergency department with abdominal pain within 48 previous hours. After evaluation, acute appendicitis was diagnosed and he underwent laparoscopic appendectomy. Meckel's diverticulum perforated by a fish bone was intraoperatively discovered. Incidental appendectomy and segmental resection of the ileum were performed.Дивертикул Меккеля является наиболее распространенным врожденным дефектом желудочно-кишечного тракта. Чаще всего он протекает тихо или бессимптомно. Однако в других случаях возможны признаки обструкции, воспаления, кровотечения и перфорации. Различные Инородные тела могут вызывать перфорацию дивертикула Меккеля. Мы представляем 18-летнего мужчину, который поступил в отделение неотложной помощи с болями в животе в течение 48 лет. отделение с болью в животе в течение 48 предыдущих часов. После обследования был диагностирован острый аппендицит, и ему была проведена лапароскопическая аппендэктомия. Интраоперационно был обнаружен дивертикул Меккеля, перфорированный рыбьей костью. Случайная аппендэктомия и сегментарная резекция подвздошной кишки.

To report anterior-segment optical coherence tomography (ASOCT) characteristics of different types of corneal and anterior chamber (AC) foreign bodies (FBs) and their usefulness in diagnosis and management.This is a retrospective descriptive clinical study involving 11 eyes of 11 patients who presented at the outpatient department of a tertiary ophthalmic care center from January 2017 to January 2022. All patients had a diagnosed or suspected corneal FB. All participants underwent a comprehensive ophthalmological examination, followed by slit-lamp photography and ASOCT. FB removal was done where required by an external, internal, or combined approach.The mean age of patients was 28.2 (7-53) years. Ten were male, and one was female. Seven patients had a definitive positive history of injury; in one, there was a history suggestive of trauma, one had the post-operative complication of scleral buckling surgery, and two patients had a history of insect fall in the eyes. Three patients had acute, four had sub-acute, and four had chronic presentations. Descemet's membrane (DM) breach was suspected in three cases of deep FB, which was later confirmed on ASOCT. In two cases, DM was presumed to be intact clinically, but ASOCT showed an AC penetration. The FB was removed in seven patients, one via slit-lamp, one via an external approach, two via an internal approach, and three via a combined approach.ASOCT facilitates non-invasive rapid imaging of ocular tissue at various depths, provides an accurate assessment of FB characteristics, and thereby serves as an additional tool in our armamentarium for diagnosis and management of deep corneal and AC FBs.

BACKGROUND This study aimed to analyze the clinical characteristics of tracheobronchial foreign bodies in children in Shenzhen and to explore the diagnosis and treatment methods for special cases. MATERIAL AND METHODS This study included a total of 715 children who were diagnosed with tracheobronchial foreign bodies at Shenzhen Children's Hospital between October 2016 and October 2021. Data on sex, age, inducement, symptoms, foreign body type, foreign body location, foreign body retention time, foreign body history, and complications were recorded and analyzed. RESULTS Tracheal foreign bodies were found to occur primarily in children aged 0-2 years (90.6%). The overall incidence rates were 69.1% and 30.9% in boys and girls, respectively. Among them, 42.5% of the foreign bodies were detected in the left bronchus and 45.6% in the right bronchus. Inducements included playing while eating (n=398, 55.7%) and also crying (n=209, 29.2%). Operations were performed on 710 (99.3%) children, including 80 (11.2%) immediate surgeries and 2 tracheotomies. One child had no vital signs upon admission and died after emergency foreign body removal. All of the other children who underwent surgery recovered well postoperatively. CONCLUSIONS This study presents the characteristics and methods of diagnosis and treatment of tracheobronchial foreign bodies in pediatric patients in Shenzhen. Tracheobronchial foreign bodies are a major cause of accidental injury in infants and young children. In critical cases, airways should be immediately and rapidly cleared with multidisciplinary collaboration. In addition, public safety awareness should be strengthened, particularly among parents, teachers, and other child caregivers, to reduce and prevent instances of tracheobronchial foreign body accidents in children.

BACKGROUND Pneumatic nail guns were first introduced in the 1950's, which revolutionized the construction industry. Since that time, nail gun injuries have been reported predominantly in the extremities with rare cases of thoracic and head injuries. A nail gun can easily propel nails through human tissue with velocities varying based on propellant and object. There are limited case reports on the appropriate management of thoracic nail gun injuries. CASE REPORT A 30-year-old man presented to the Emergency Department with right-sided chest pain seven and a half hours after getting struck in the right lateral thorax with a pneumatic nail gun. The patient was hemodynamically stable and without respiratory distress. A chest X-ray was taken and showed a right pneumothorax with a retained radio-opaque object at the right lung hilum. A CT angiogram subsequently showed the object abutting the right middle lobe branch of the pulmonary artery. Cardiothoracic surgery was called and the patient was taken urgently to the operating room for right thoracotomy, finding the nail deep in the right fissure at the hilum with the nail head in contact but not puncturing the right middle lobe branch of the pulmonary artery. The patient was extubated and recovered well postoperatively. CONCLUSIONS This case demonstrates the critical nature of nail gun injuries and can better inform the trauma protocols used to treat these injuries. Even in a delayed presentation, there should be a high suspicion of traumatic lung and cardiac injuries due to the velocities obtained with pneumatic nail guns.

Ingestión; Imanes; Urgencias de pediatría Ingestion; Magnets; Paediatric emergencies Ingestió; Imants; Urgències de pediatria Introduction The ingestion of magnetic objects can cause complications in children, and there are no epidemiological or clinical data on the subject in Spain. Objectives To determine the incidence, epidemiological characteristics and management of magnet ingestion in paediatric emergency departments in Spain. Material and methods Prospective observational multicentre study conducted over a 3-year period. The study universe consisted of patients aged less than 14 years. Results The incidence was 4.8 cases per 100 000 emergency care episodes. Of the 72 patients included (mean age, 7.2 years), 54% were male. Seven percent had neuropsychiatric disorders. Sixty-one percent of the magnets were spherical and 69% came from toys. The size was variable, most frequently between 5 and 10 mm (50%), and ranging from 3 to 30 mm. Eighty-six percent of patients were asymptomatic. The most frequent symptom was abdominal pain. Eighty-three percent of the patients sought medical care within 6 h of ingestion and 92% within 24 h. Thirty-one percent of the cases were of multiple ingestion. Endoscopy was required for extraction in 15% of cases, a proportion that rose to 36% in the group of cases of multiple ingestion. None of the patients required surgery. We did not observe any gastrointestinal complications of magnet ingestion. Conclusions The ingestion of multiple magnets is less frequent than single magnet ingestion, and we did not observe any complications despite the lower frequency of procedures compared to other studies. Introducción Las ingestas de objetos imantados pueden presentar complicaciones en el niño, no existiendo datos epidemiológicos ni clínicos en España. Objetivos Conocer la incidencia de ingesta de objetos imantados en los Servicios de Urgencias Pediátricos Españoles, sus características epidemiológicas y su manejo. Material y métodos Estudio observacional prospectivo multicéntrico realizado durante 3 años. Población de referencia menores de 14 años. Resultados La incidencia fue de 4,8/100.000 urgencias. De los 72 pacientes incluidos (edad media de 7,2 años), el 54% fueron varones. El 7% presentaron antecedentes neuropsiquiátricos. El 61% de los imanes fueron esféricos y el 69% procedían de juguetes. El tamaño fue variable con un predominio de los imanes entre 5 y 10 mm (50%). El 86% fueron asintomáticos. El síntoma más frecuente fue el dolor abdominal. El 83% de los pacientes consultaron en menos de 6 horas y el 92% en las primeras 24 horas. El 31% fueron ingestas múltiples. El 15% precisó intervención endoscópica, cifra que ascendió al 36% en los casos de ingestas múltiples. No se realizó ninguna intervención quirúrgica. No se observó ninguna complicación gastrointestinal secundaria. Conclusiones Las ingestas de imanes múltiples son menos frecuentes que las simples y en este estudio no se han observado complicaciones a pesar de que las intervenciones realizadas han sido menores que en otros estudios. The study was funded through the 2016 annual grant of the Research Network of the Sociedad Española de Urgencias de Pediatría (RiSEUP-SPERG), for an amount of euro4000.

Accidental consumption of foreign body is a common presenting complain among patients especially in young age group. Majority of patients can be discharged safely after reassurance while a fraction of patient requires observation and further management. Here we report a case of a 35-year-old gentleman who presented to the out-patient department of our hospital in June 2021 for accidental ingestion of toothbrush. After detailed history and physical examination upper gastrointestinal endoscopy was planned for the patient. Failed endoscopic removal was considered the indication for surgery. A supraumbilical midline incision was used to remove the toothbrush. Following the surgical removal, he was managed conservatively and was discharged without significant complications. We describe this case in detail in addition to reviewing the pertinent literature.

Foreign body inhalation (FBI) is a serious and common emergency in children. Such children present in the emergency room (ER) with cough, shortness of breath, choking, or wheezing but rarely present with pneumomediastinum.Three children aged 2 to 5 years (2 girls and 1 boy) were seen in our ER complaining of FBI. Emergency bronchoscopy removal of the inhaled foreign body was performed; however, all 3 patients developed pneumomediastinum.A foreign body inhalation complicated by Pneumomediastinum/pneumothorax.All the patients underwent emergency bronchoscopy and foreign body removal. After the ER intervention, 2 children were placed in the pediatric intensive care unit, and the pneumomediastinum resolved without intervention. The third patient required an operation for chest tube placement, which was then observed in the pediatric intensive care unit, and had several chest radiography follow-ups. After 5 days, the patient exhibited clinical improvement, and the chest tube was removed.In this case series, we present 3 cases of children aged 2 to 5 years seen in our ER with a history of different types of organic FBI complicated by pneumomediastinum/pneumothorax. Pneumomediastinum/pneumothorax is a rare complication of FBI in pediatric patients. However, such complications require multidisciplinary collaboration for early diagnosis and intervention.

Impaction of dentures has potentially significant morbidity and management challenges. This study sought to leverage on the occurrence of swallowed dentures to advance discussions on its management and prevention.A 5-year retrospective review of patients seen on account of impacted dentures at the Ear, Nose, and Throat Department of the Korle-Bu Teaching Hospital was done. Variables obtained included age, sex, location of impacted denture, treatment done, denture type, number of teeth, and complications. Variables were analyzed, and descriptive summaries were reported.There was a record of 898 cases of impacted foreign bodies which presented to the department. Fifty-five (6.1%) records were on account of impacted dentures. These consisted of 25 (45%) males and 30 (55%) females. Ranging from 23 to 98 years, the mean and median ages were 55.7 (±18.1) years and 56.5 years respectively. There were no complications, and no identifiable predisposing patient conditions. All prostheses were removable acrylic dentures, and some observations included worn-out and loose dentures, while several had their prostheses dislodging in the process of swallowing tablet medications with water.Swallowed dentures are not rare occurrences in Ghana. Denture wearers should, therefore, be encouraged to get professional reviews, especially when prostheses get unretentive, while dental professionals are urged to incorporate measures in their fabrication to reduce the occurrence of swallowed dentures.bRésumé/bbContexte:/bL'impaction des prothèses dentaires présente des problèmes de morbidité et de gestion potentiellement importants. Cette étude visait à tirer parti de la survenue de prothèses avalées pour faire avancer les discussions sur sa prise en charge et sa prévention.bMéthodes:/bUne étude rétrospective sur 5 ans des patients vus en raison de prothèses impactées au service des oreilles, du nez et de la gorge de l'hôpital universitaire de Korle Bu a été réalisée. Les variables obtenues comprenaient l'âge, le sexe, l'emplacement de la prothèse incluse, le traitement effectué, le type de prothèse, le nombre de dents et les complications. Les variables ont été analysées et des résumés descriptifs ont été rapportés.bRésultats:/bOn dénombre 898 cas de corps étrangers impactés qui se sont présentés au service. Cinquante-cinq (6,1 %) dossiers concernaient des dentiers impactés. Il s'agissait de 25 (45 %) hommes et 30 (55 %) femmes. Allant de 23 à 98 ans, les âges moyen et médian étaient respectivement de 55,7 (±18,1) ans et 56,5 ans. Il n'y a eu aucune complication et aucun état prédisposant identifiable du patient. Toutes les prothèses étaient des prothèses amovibles en acrylique, et certaines observations incluaient des prothèses usées et desserrées, tandis que plusieurs avaient leurs prothèses se délogant en avalant des médicaments en comprimés avec de l'eau.bConclusion:/bLes dentiers avalés ne sont pas rares au Ghana. Les porteurs de prothèses dentaires devraient donc être encouragés à obtenir des examens professionnels, en particulier lorsque les prothèses deviennent non rétentives, tandis que les professionnels dentaires sont invités à intégrer des mesures dans leur fabrication pour réduire l'apparition de prothèses avalées.bMots-clés:/bDentier, Œsophage, Ghana, impacté, avalé.

Objective Oesophageal foreign bodies (EFBs) are a common emergency issue in paediatrics, and few studies have revealed its clinical features and treatment methods. We conducted this retrospective study to provide our 10-year clinical evidence for the diagnosis and treatment of EFB and reduce the incidence of complications. Methods We retrospectively reviewed all paediatric cases diagnosed with EFB from January 2012 to December 2021 at Shenzhen Children’s Hospital. The age and sex of the patients, types of foreign bodies (FBs), preoperative examination, location and duration of FB impaction, clinical symptoms, surgical methods, therapeutic effects and complications were analysed. Results Among the 1355 cases, 759 were boys and 596 were girls, with a median age of 2.9 years (4 months to 16 years). The shortest FB lodged time was 1 hour, while the longest time was 3 months. The types of foreign bodies included coins and blunt objects (812,59.9%), bones and sharp objects (278,20.5%), button batteries (86,6.3%), food impactions (84,6.2%), toys (51,3.8%) and plastic objects (44,3.2%). A total of 720 of 812 cases impacted by coins and blunt subjects were successfully treated with a Foley catheter without any complications. A total of 558 patients underwent rigid oesophageal endoscopy under general anaesthesia, and foreign bodies were successfully removed in 525 cases. No FB was found in 33 cases, and FBs pushed into the lower digestive tract during operation in 5 cases. Oesophageal injury was found in 130 cases (23.3%). Our study showed that the age of the patient, time of foreign body incarceration, type of foreign body, location of the lodged foreign body, and fever or cough were risk factors leading to oesophageal foreign body complications, and the differences were statistically significant (P Conclusion Children with EFB have a risk of complications, especially if the FB is a button battery. The appropriate surgical method should be selected through the analysis of the clinical characteristics of the foreign body in the oesophagus and the risk factors for complications to reduce the incidence of complications. Health education and effective care are the keys to the prevention of EFB.

Rationale Non-missile penetrating injuries caused by foreign bodies, such as knives or sharp wood, are infrequent. We report a 49-year-old male suffering from severe craniocervical penetrating injury by a steel bar was successfully treated by surgery. Chief complaint The male patient was a 49-year-old builder. Although working on the construction site, an approximately 60 cm steel bar penetrated the patient's brain vertically through the left top of the head presenting with unconsciousness and intermittent irritability. Diagnosis Computed tomography of the head showed the entrance and exit of the skull damaged by the steel bar. Three-dimensional reconstruction showed that the steel bar entered the skull from the posterior left coronal suture and penetrated the ipsilateral occipital bone, about 5 cm into the neck soft tissue. Intervention We successfully performed the operation and removed the steel bar. Outcomes The patient was followed up for 5 years; muscle strength returned to normal. Lessons Penetrating injuries caused by steel bars are rare, which always cause severe intracranial injury combined with peripheral tissue injury, by sharing our experience in the treatment of this rare case, we hope to provide a reference for similar injuries in the future.

INTRODUCTION "Push" or "pull" techniques with the use of snares, forceps, baskets, and grasping devices are conventionally used to manage esophageal food bolus impaction (FBI). A novel cap-assisted technique has recently been advocated to reduce time taken for food bolus (FB) removal. This study aimed to compare the effectiveness of the cap-assisted technique against conventional methods of esophageal FB removal in a randomized controlled trial. METHODS Consecutive patients with esophageal FBI requiring endoscopic removal, from 3 Australian tertiary hospitals between 2017 and 2019, were randomized to either the cap-assisted technique or the conventional technique. Primary outcomes were technical success and FB retrieval time. Secondary outcomes were technical success rate, en bloc removal rate, procedure-related complication, length of hospital stay, and cost of consumables. RESULTS Over 24 months, 342 patients with esophageal FBI were randomized to a cap-assisted (n = 171) or conventional (n = 171) technique. Compared with the conventional approach, the cap-assisted technique was associated with (i) shorter FB retrieval time (4.5 ± 0.5 minutes vs 21.7 ± 0.9 minutes, P < 0.001), (ii) shorter total procedure time (23.0 ± 0.6 minutes vs 47.0 ± 1.3 minutes, P < 0.0001), (iii) higher technical success rate (170/171 vs 160/171, P < 0.001), (iv) higher rate of en bloc removal (159/171 vs 48/171, P < 0.001), and (v) lower rate of procedure-related mucosal tear and bleeding (0/171 vs 13/171, P < 0.001). There were no major adverse events or deaths within 30 days in either group. The total cost of consumables was higher in the conventional group (A$19,644.90 vs A$6,239.90). DISCUSSION This multicenter randomized controlled trial confirmed that the cap-assisted technique is more effective and less costly than the conventional approach and should be first-line treatment for esophageal FBI.

Objectives: The purpose of this study was to assess the nationwide incidence of ear foreign body (FB) presentations to the emergency department (ED) and analyze the most common FB consumer products encountered. Methods: The National Electronic Injury Surveillance System (NEISS) was evaluated for ED visits that included “ear foreign bodies” from 2010 through 2019. The most frequent foreign bodies were identified and organized by demographics. Results: A total of 20,545 ear FB cases were found, with an estimated 608,860 ED visits nationwide. Female patients (56%) were more likely to have jewelry and first aid equipment FBs. Males between the ages of 5 and 15 years were significantly ( P Conclusion: Ear FBs represent a substantial proportion of healthcare expenditures. Although children are the most commonly affected individuals, all ages require further education and preventive measures.

A 3-year-old male domestic shorthair cat presented with sudden ataxia. Neurologic examination showed complete loss of proprioception in the thoracic and pelvic limbs. Computed tomography and magnetic resonance imaging revealed a non-metallic foreign body penetrating the spinal cord. The foreign body was removed by the ventral approach to the atlanto-occipital junction. Mild improvement of proprioception was observed the day after surgery. In a follow-up two months after surgery, the owner reported a complete recovery of the patient, showing a normal gait. To the author's knowledge, this is the first case report describing successful removal of an intramedullary foreign body penetrating cervical spinal cord by ventral approach in a cat.

ObjectiveThis case series, conducted during the coronavirus disease 2019 pandemic, investigates the impact of leaving aural foreign bodies in situ for a prolonged period of time, including the risk of complications and success rates of subsequent removal attempts.MethodA retrospective study of aural foreign body referrals over a six-month period was carried out.ResultsThirty-four patients with 35 foreign bodies were identified (6 organic and 29 inorganic). The duration of foreign bodies left in situ ranged from 1 to 78 days. Four patients suffered from traumatic removal upon initial attempts. First attempts made by non-ENT specialists (68.8 per cent) all failed and were associated with a high risk of trauma (36.4 per cent).ConclusionBecause of the coronavirus disease 2019 pandemic, this is the first case series to specifically investigate the relationship between the duration of aural foreign bodies left in situ and the risk of complications. Our data suggest that prolonged duration does not increase the incidence of complications.

Esophageal foreign body impaction is the most common cause of endoscopic emergency. However, there are limited available data on delayed endoscopic management of esophageal sharp-pointed food impaction.To investigate cases of esophageal sharp-pointed food impaction with endoscopic removal findings.This single-center retrospective study collected medical records to identify patients with esophageal sharp-pointed food impaction who underwent endoscopic removal between April 2018 and April 2020. The patients were divided into the early (endoscopic removal12 h) and delayed intervention (12 h) cohorts.Overall, 133 and 696 patients received early and delayed intervention, respectively. The success rate of endoscopic foreign body removal was 96.45%. The most common foreign body was fish bone (66.90%), and the most common shape was "I" (56.26%). Patients from the delayed intervention cohort received general anesthesia with a higher risk for perforation, and no foreign body was identified. The duration of endoscopy, distance between the foreign body/wound and the incisor, and longest diameter of the foreign body were not different between the groups. In multivariate analysis, male sex (odds ratio = 1.792 [1.159, 2.771]; P = 0.009), longer duration of impaction (odds ratio = 2.212 [1.121, 4.365]; P = 0.022) and endoscopy (odds ratio = 1.502 [1.253, 1.800]; P 0.001), and longest diameter of the foreign body (odds ratio = 1.632 [1.329, 2.003]; P 0.001) were associated with a higher incidence of perforation in patients with foreign body impaction.Endoscopic removal is a safe and effective treatment method for sharp-pointed food impaction. Delayed endoscopic removal can increase the risk of esophageal perforation.

Background: Rectal foreign bodies (RFB) are quite uncommon except in very busy hospitals. Because of their rarity, it is seldom that the treating physicians have a standard approach to the diagnosis, technique of extraction, and post-extraction evaluation. This can be further complicated by the rather extreme variability of size, shape, and texture of the foreign bodies, as well as the potential extent of trauma to the rectum or distal colon.Aim: The objectives of this study were to delineate the demographics, classification of cause, and injury patterns of RFB, and to present the results of the transanal surgical management of a large series of RFB.Methods: We retrospectively collected extensive data from the hospital medical records of the 291 patients who presented with RFB to the emergency department of Shenyang Proctological Hospital (Shenyang, China) from 2012 July to 2020 December. Specifically, demographics, origins and circumstance of the RFB, complications, injuries, anesthesia method and the results of the transanal surgical management were recorded and analyzed.Results: Of the 291 RFB cases, 225 (77.3%) were male and 66 (22.7%) were female, with a mean age of 53.8±15.5 years (range, 1～88 years). The circumstances of the RFB were categorized as swallowed, 199 cases (68.4%); self-inserted, 87 (29.9%); and iatrogenic, 5 (1.7%). The proportion of males in the self-inserted RFB group was significantly greater than the swallowed RFB group (t=31.114, p=0.000).In the swallowed RFB group, the most common anorectal injuries and pathological changes were the following: penetration into the mucosa (75 cases, 37.7%), perianal or submucosal abscess (27 cases, 13.6%) and penetration into the anal canal (18 cases, 9.0%). In the self-inserted RFB group, 64 (73.6%) of the 87 cases had an intact rectum, whereas 8 (9.2%) had rectal mucosal ulcers and bleeding, and 7 (8%) had rectal lacerations. In the iatrogenic RFB group, 3 cases (60%) had rectal mucosal ulcers and bleeding, and 2 cases (40%) had inflammation of the rectal mucosa.Regarding extraction procedures, in the swallowed group, 187(187/199; 94%) patients underwent a transanal surgical procedure, and all were successful. In the self-inserted group, 82 patients underwent the transanal surgical procedure, and 74 (74/82; 90.2%) were successful whereas it was unsuccessful in the remaining 8 patients (8/82, 9.8%). Three (3/4, 75%) patients with iatrogenic RFB were resolved by the transanal surgical procedure.Conclusion: Men were markedly more likely than women to have swallowed RFBs and self-inserted RFBs. No serious damage to the rectum and anus was found in cases of swallowed RFB. Moreover, most surgical operations to remove foreign bodies via the anus were successful in this category of RFB. In contrast, rectal injury was more severe in patients with self-inserted RFB, such as rectal laceration, rectal mucosal ulcer, and bleeding. Moreover, the transanal removal operation in patients with self-inserted RFB had a failure rate of nearly 10%. Thick, long, hard foreign bodies did present a great challenge to the operator. Therefore, if necessary, patients with foreign bodies may need to be promptly referred for transabdominal removal.

Background Body stuffing and body packing are two methods of concealing illicit drugs. Body stuffing is defined as the oral ingestion of illicit drugs, typically to avoid law enforcement detection or other consequences of possession, and may present a serious medical emergency in patients. Most commonly, body stuffers ingest possibly large or unknown quantities of illicit substances to avoid detection of the drugs during apprehension. This ingestion is typically hasty or impulsive, and therefore the substances ingested are rarely packaged in a way that would be considered safe for ingestion. Case presentation This case highlights a series of rare complications of impacted esophageal foreign body including esophageal edema, pericarditis, and hydro-pneumothorax for a 16-year-old Hispanic male who was booked into a county juvenile detention and rehabilitation facility. He complained of persistent intractable epigastric pain, along with pleuritic chest pain with multiple episodes of vomiting over the previous 4 days. He denied swallowing any foreign body. He underwent esophagogastroduodenoscopy, and a plastic bag with content suspicious for marijuana was discovered in the distal esophagus and removed. Conclusions Failure to consider body stuffing and foreign body impaction in individuals during medical evaluation in detention centers with complaints of chest pain, abdominal pain, dysphagia, and/or certain toxidromes can delay diagnosis and lead to a variety of medical complications.