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BACKGROUND: Naturally the ear produces soft wax from the sebaceous and ceruminous gland. This is what is referred to as earwax. This wax is important for protection of the ear by trapping dust and other foreign particles that could damage the eardrum. It also has some antibacterial properties. Jaw movements, like during chewing, moves the old earwax from inside the ear canal to the outside and finally flakes off. Build-up of this wax in the ear causes hearing loss, pain in the ear, irritation, dizziness and ringing in the ears. Self-ear cleaning refers to self-insertion of objects into the ear canal, with an attempt to remove the wax to get rid of these symptoms. It is a common practice amongst many individuals. Potentially, this rids the ear of its protective defences in addition to posing a risk of ear related injuries. This review paper aims to determine the prevalence of self-ear cleaning, the common methods used and the complications associated with this practice. METHODS: Electronic retrieval of articles for review was done from PubMed, Google and Google scholar with key-ward – self-ear cleaning, ear-wax, cerumen. Many articles were retrieved but only a few were about self-ear cleaning and only seven could be included in this review. The inclusion criteria included: article published in English language; study carried between 2005 and 2020 inclusive; article discussing materials used and complications associated with self-ear cleaning. Articles older than 15 years or published in languages other than English were excluded. RESULTS: On average the prevalence of self-ear cleaning amongst all studies was 76.6%. The commonest method used for ear cleaning was cotton buds with an average of 69.6%. Wax/dirt removal was the commonest reason for engaging in this practice. Several complications arising from this practice included perforation of eardrum, retained foreign body and otitis externa. CONCLUSION: In addition to ridding the ear of its natural protection, self-ear cleaning is associated with a risk of injury to the ear drum and retention of foreign bodies. Community education to avoid this practice is therefore of paramount importance. Trained health care providers should be consulted whenever someone has a problem related to hearing or any other symptoms.

Background Medical errors such as retained foreign bodies (RFB) during surgery are not well studied. To define risk factors associated with this type of error, we performed retrospective study. Methods We reviewed medical records for unintentional foreign object remaining in the body during surgery such as gender, age, surgery ward, and incident reports referred to several forensic medicine administrations as well as adverse effects of retained foreign bodies and methods for detection of them over a 3-years period from January 2008 through May 2011. Results Thirty eight patients were involved in the study to have retained foreign bodies (73% sponges and 27% other instruments including 7 (18.42%) cases of other bandages, 2 cases (5.26%) of scissor and 1 case (2.63%) of forceps). The general surgery ward was most commonly involved (47%) followed by the gynecology surgery ward (34%). Men (58%) were more involved with RFB than women (42%). Conclusion Considering the most frequent type of retained foreign bodies and also more frequent involved surgery wards besides detection methods for RFB, a mixed of preventing protocols such as regular counting of devices, post-operative X-ray with radiopaque markers and exact evaluation of surgery site should be employed to reduce the occurrence of retained foreign bodies and its complications.

Background: There are rare reports of broken surgical blades occurring during lumbar discectomy, and even fewer that discuss their retrieval. Case Description: While a 54-year-old male was undergoing a lumbar discectomy, the knife blade was broken. As it was difficult to retrieve the fragment through the original incision, the patient was closed, and a postoperative angio-computerized tomography (CT) was obtained. When the CT angiogram (CTA) documented the retained fragment had become lodged near the iliac vein within the psoas muscle, a second operation for blade retrieval, consisting of a paravertebral, lateral transpsoas approach, was successfully performed. Conclusion: In some cases, it is difficult to retrieve a broken scalpel blade during the index surgery. When this occurs, we would recommend closing the patient, and obtaining a CTA to better document the location of the retained foreign body. Based upon these findings, a safer second stage procedure may be performed (e.g., as in this case using a paravertebral lateral transpsoas approach) to avoid undue sequelae/morbidity.

Endobronchial ultrasound-guided transbronchial needle aspiration has a low complication rate and is a cost-effective procedure for mediastinal staging and diagnosis when compared with the more invasive mediastinoscopy. There are increasing case reports of unexpected complications including equipment failures with and without significant medical consequences. Knowledge of complications, including those that are rare, is essential for the physician performing this minimally invasive procedure. We report a case of a retained foreign body from the unexpected separation of a distal spring/coil mechanism from the Olympus ViziShot Aspiration needle following early needle deployment within the working channel of the bronchoscope.

The ability to re-establish pneumoperitoneum at the termination of a laparoscopic colon resection allows a surgeon to look for bleeding, confirm the satisfactory performance of an anastomosis, and evaluate for the presence of a retained foreign body after an instrument or sponge count suggests an error, without enlarging an incision or converting to an open incision operation. Techniques described in this chapter permit the ready recreation of pneumoperitoneum without an incision being enlarged.

Introduction. A liver abscess caused by fishbone ingestion is extremely rare in the Emergency Department.Case Report. We report a case of a middle-aged female who presented to the Emergency Department with nonspecific symptoms. Computed tomography showed a liver abscess that had formed secondary to a fishbone. The patient was treated conservatively initially and subsequently with percutaneous drainage and finally with open drainage. Her condition improved and she was discharged from the hospital with the foreign body still in-situ.Conclusion. This case is one of six cases in literature where the patient has been discharged successfully from the hospital with a retained fishbone. It also demonstrates the difficulty of diagnosing a foreign body causing a liver abscess and the multiple treatment modalities used to treat a liver abscess caused by fishbone.

The post caesarean fistula and sinus can take place due to tuberculosis , Crohn’s disease , deep pelvic infections or non absorbable sutures and even gauzes. A thirty year old woman ( P1 ,L1 ) who presented with multiple discharging sinuses at left lower abdomen since five months . She underwent lower segment caesarean section 10 months ago. On local examination , there were three linear scars two cm below the previous horizontal scar . The Ultrasound of local site revealed irregular loculated collections of size 3 × 2 cm in subcutaneous plane. We excised the sinus tracts ,but after two month came with reccurence . We did re- exploration and the sinus tract of size 9 cm was excised. Sinuses reccur even without retained foreign body or chronic disease. The management does not differ with the size of sinus.

Rationale: Retention of foreign objects in spinal canal usually results from penetrating spinal trauma or failed internal instruments. However, entrapment of a foreign body in cervical spinal canal during surgery is rare, and whether such an object may cause neurological complications remains unknown in literature. Patient concerns: A 50-year-old man underwent C5 corpectomy and instrumentation surgery due to cervical myelopathy. During the surgery, the cutting edge of a Kerrison rongeur was broken and the metal tip was retained behind C4 vertebra. Diagnosis: Retention of foreign body in the cervical spinal canal. Interventions: To remove the metal object, multiple strategies were tried but all failed. As such a metal object was thought to be dangerous to the spinal cord, a remedy C4 corpectomy was performed to remove it. Accidentally, however, the metal fragment further migrated to C2/3 canal. At last, the metal fragment had to be retained in the cervical spinal canal. Outcomes: At 2-year follow-up, the metal fragment remained in situ and no delayed complications occurred. Lessons: We reported a rare case of metal object retention in cervical spinal canal due to rongeur fatigue fractures. Under certain circumstances, retention of a small foreign object in spinal canal may not lead to neurological complications. If failed to remove an entrapped foreign body, it may be safe to leave it in the spinal canal for further observation.

Highlights • Gossypiboma consist in retained surgical sponges are more usual than the reported. • A young patient nine years after cesarean section with abdominal pain and fever. • An abscess was diagnosed in the lower abdomen by CT. • During laparotomy, a sponge was extracted from a large abscess. • She had a normal post-operative course., Introduction Retained surgical sponge or other items in patients’ bodies happens more frequently than is reported. Healthcare personnel can forget to remove textile material or instruments during complicated, extended, or emergency surgery. In addition, changes in the operating team can influence the occurrence of such errors. Presentation of case We present a case with a symptomatic gossypiboma nine years after a previous cesarean section. A 34-year-old woman was admitted to the emergency room having experienced abdominal pain and fever for the previous month. An abdominal computed tomography revealed an abscess in the lower abdomen. A laparotomy was performed, and a resection and block were carried out. A surgical sponge was extracted from an omental abscess. Discussion Surgical sponges are the most common foreign materials retained (70%) in the abdominal cavity because of their frequent usage and small size. Moreover, a blood-soaked sponge in a hemorrhagic abdomen can be difficult to distinguish from blood. Conclusion Whenever the accounting for material depends on humans, mistakes will continue to be committed. A falsely correct sponge count was reported in 71.42% of cases [14]; therefore, a new count system must be developed for post-surgical situations.

Penetrating spinal injuries by wood are infrequently reported. They are particularly rare in children. Only 6 cases of wooden fragments causing penetrating intradural spinal injury have been reported. The authors report a case of a 3-year-old girl who suffered a penetrating wound on her lower back after sliding on a wood floor. A portion of the extraspinal part of the wooden splinter was removed prior to presentation; however, a high suspicion for retained foreign body was maintained. Findings on CT were equivocal, but the diagnosis was confirmed on MRI. An incomplete cauda equina syndrome was noted on examination. She was taken to the operating room for removal of the wooden foreign body, repair of a durotomy, and repair of a CSF leak. At 8 months after surgery, the patient had fully recovered without sequelae. The roles of imaging modalities, prophylactic antibiotics, and surgery are discussed.

A 24-year-old woman presented with a Zone I open globe injury of the left eye from a shattered glass door. During surgical repair of the open globe injury, retained small foreign bodies were identified and removed intraoperatively. The pre-operative and post-operative course was uncomplicated, resulting in excellent visual acuity. This case demonstrates the potential for excellent visual outcomes in cases of Zone I injury, as well as the importance of careful intraoperative exploration for potentially retained foreign body material.

Retained foreign bodies inside the soft tissue following penetrating injuries are common. Late onset of symptoms and complications are possible in these cases. In the present report, we present a case of late flexor digitorum profundus irritation and pseudotumour formation caused by a retained glass piece 10 years after the injury. Pseudotumour is formed by reaction to the retained material as an enlarged portion of tissue that resembles a tumour. The complaints were completely improved soon after removal of the foreign material. Retained soft tissue foreign bodies should be suspected in differential diagnosis of soft tissue masses. History of a penetrating trauma should be questioned persistently. The authors recommend the removal of retained foreign bodies with sharp edges to avoid further injury to the surrounding anatomical structures.

Two cases of chronic foreign body aspiration were treated in our hospital. Management of the foreign body aspiration was challenging in them as the symptoms were discrete and persisted for as long as 20 years and in one of the cases there was failure of retrieving the foreign body elsewhere. We share our experience in using flexible fibreoptic bronchoscope for removal of retained foreign body. This further emphasizes that flexible bronchoscopy is a successful therapeutic option if carried out using appropriate instruments by extremely skilled personnel in an adequate hospital setup and in selected cases.

Case: A fifteen-year-old boy sustained an archery injury when a carbon-fiber arrow shaft embedded in the volar aspect of his left forearm. The shaft was removed, but at a follow-up visit he still felt the sensation of a retained foreign body in the tissue. Although radiographs were negative, ultrasound examination found three foreign bodies of various lengths still located in the soft tissue. Further surgery removed the objects without difficulty. Conclusion: Ultrasound examination can be a valuable diagnostic tool when radiographs yield inconclusive results after penetrating wounds due to radiolucent foreign bodies.

Laparoscopic adjustable gastric band (LAGB) has weight loss and associated obesity-related disease benefits. Well-recognised LABG complications lead to a higher re-operation rate when compared to other obesity surgeries and therefore potential for retained foreign body. By way of a case series, we have evaluated retained foreign body after the intended complete removal of a gastric band. Analysis focused on circumstances and similarities leading to retained foreign body. From the series, the most commonly retained band component is band tubing. Difficult surgery or surgery associated with intra-operative complications may lead to increased chances of retained gastric band. Strategies to prevent this complication should be implemented. Specifically, removal technique, equipment familiarisation and post removal inspection all play a role.

Background Despite over a decade of efforts to reduce the adverse event rate in healthcare, the rate has remained relatively unchanged. Root cause analysis (RCA) is a process used by hospitals in an attempt to reduce adverse event rates; however, the outputs of this process have not been well studied in healthcare. This study aimed to examine the types of solutions proposed in RCAs over an 8-year period at a major academic medical institution. Methods All state-reportable adverse events were gathered, and those for which an RCA was performed were analysed. A consensus rating process was used to determine a severity rating for each case. A qualitative approach was used to categorise the types of solutions proposed by the RCA team in each case and descriptive statistics were calculated. Results 302 RCAs were reviewed. The most common event types involved a procedure complication, followed by cardiopulmonary arrest, neurological deficit and retained foreign body. In 106 RCAs, solutions were proposed. A large proportion (38.7%) of RCAs with solutions proposed involved a patient death. Of the 731 proposed solutions, the most common solution types were training (20%), process change (19.6%) and policy reinforcement (15.2%). We found that multiple event types were repeated in the study period, despite repeated RCAs. Conclusions This study found that the most commonly proposed solutions were weaker actions, which were less likely to decrease event recurrence. These findings support recent attempts to improve the RCA process and to develop guidance for the creation of effective and sustainable solutions to be used by RCA teams.

On 30 June 1559, Henry II, King of France, was mortally wounded in the head by a lance during a jousting match. Despite the best efforts of his physicians, Ambroise Paré and Andreas Vesalius, King Henry died 11 days later. This article, based on previously unpublished evidence, aims at examining the historical account of his death against modern medical practice to establish the probable cause of the king's death. We also discuss what treatments the doctors in the sixteenth century may have had to offer. Historical accounts of the joust provide details of the incident including the position of the visor of the king's helmet. Descriptions of the wood fragments removed from the right orbit by Italian observers and a new translation of the autopsy by Andreas Vesalius allow an accurate description of the actual injury. Our research counters previous theories and concludes that Henry II was the victim of craniofacial trauma involving the right eye and that he died from periorbital cellulitis caused by a retained foreign body in the wound, complicated by a left interhemispheric empyema preceded by a traumatic interhemispheric haematoma. It would appear that the royal court doctors advocated a wait-and-see strategy, with little actual input from Ambroise Paré or Andreas Vesalius, with a clearly regrettable outcome.

Introduction: Foreign bodies have been reported in the maxillary sinus. It has been suggested that asymptomatic foreign bodies do not require removal. The effect of such retained foreign bodies on sinus-elevation procedures is unknown.Case Presentation: This case report documents the management of an asymptomatic foreign body embedded in the Schneiderian membrane. The foreign body was left in situ while elevating the membrane for a sinus-augmentation procedure. A staged approach with delayed implant placement was used. Leaving the foreign body in situ did not seem to adversely affect the healing or clinical success of the augmentation procedure.Conclusions: From this short-term follow-up case, a retained foreign body in the maxillary sinus consistent with periapical endodontic filling material could be left in place in conjunction with maxillary sinus grafting based on a lack of symptoms. Long-term clinical success has yet to be confirmed.

Non- missile penetrating spinal injury (NMPSI) is a rare entity in North America and as a result there is no clear treatment paradigm. According to the literature, NMPSI causes serious acute neurological deficits and can also lead to devastating delayed complications in cases of untreated retained foreign bodies (RFB). In this report we present an acute case of NMPSI to the thoracic spine resulting in RFB treated by operative removal using minimally invasive fluoroscopic technique. While in prior published cases of NMPSI operative intervention was accomplished through laminectomy, our case presents an alternative, less invasive approach which may results in shorter recovery time. We also review the literature on NMPSI, including reports on both acute cases and chronic presentation due to RFBs. Based on this review, we conclude that NMPSI associated with RFB should be managed with operative intervention.

In the United States, approximately 2000 stingray injuries occur annually. The majority of reports on stingray injuries to the foot and ankle reflect acute injuries. Delayed presentation after stingray injury to the foot and ankle has not been reported. We present a case of a 29-year-old female who sustained a stingray injury to the left plantar medial hindfoot 14 months prior to presenting to our clinic with new-onset posteromedial ankle redness and swelling along the tarsal tunnel. Magnetic resonance imaging (MRI) revealed multiple linear foreign bodies at the quadratus plantae and tarsal tunnel. The patient underwent operative exploration with removal of multiple retained stingray spines. At her most recent follow-up at 3 months, she was able to resume her usual activities. Level of Evidence: Level V, case report.

Highlights • Retained foreign objects describes a mass composed of a central cotton core surrounded by foreign body reaction. • It represents an unfortunate event for the patient and the surgeon with severe implications. • This case highlights the important clinical history features for diagnosing this surgical error. • Need for implementing definite strategies to avoid retained foreign objects in surgical practice., Introduction Gossypiboma, also referred to as a textiloma, gauzoma or muslinoma describe a mass in the body composed of a central cotton core surrounded by a foreign body reaction. It has an estimated incidence of 1/1000–1/10000 surgeries, occurring in the abdomen (56%), pelvis (18%) and least commonly the thorax (11%) and represents an unfortunate event for both the patient and the operating surgeon with severe liability implications. Presentation of case We report a case of a 49-year-old male with Marfan Syndrome who was admitted to the cardiology department with a four day history of shortness of breath and associated dull, non-radiating chest pain. Past history included a previous Bentall procedure for a type-A aortic dissection and coronary artery bypass grafting involving a saphenous vein graft to the right coronary artery. A computed tomography (CT) scan showed a round, heterogeneous mass measuring 14 × 9 cm with lobulated contours, situated adjacent to the left ventricle along the left posterior region of the aorta. The mass was resected and further dissection revealed a plastic band harboured from the core of the mass. Discussion The majority of cases of intrathoracic gossypiboma present as intractable cough or an incidental finding on radiological evaluation. Dyspnoea alone is relatively underreported as a presenting symptom of this condition Conclusion This case highlights the important clinical history features for diagnosing this surgical error, including persistent respiratory symptoms and a history of cardio-thoracic surgery. It also emphasizes on the need for implementing definite strategies to prevent the occurrence of gossypiboma in surgical practice.

Lumbar discectomy is done in increasing frequency worldwide. A rare event associated with this procedure is breaking of the disc forceps blade during discectomy. In majority the broken part of the disc forceps can be removed during the initial surgery. But, rarely, the surgeon’s attempts might be unsuccessful, resulting in intradiscal retained foreign body. Literature regarding this issueis scarce, although there might be cases that have been never reported because of the medico legal consequences. Furthermore, until recently, there have been no guidelines to address this complication. Herein, a middle age woman in whom the blade of disc forceps was broken during L5-S1 discectomy is presented. Her surgeon could not remove the broken blade, so it was retained. .Once the patient and her family became aware about this event, began to seek medical advice .In our institute, retrieval of the broken blade of the disc forceps became possible via transforaminal corridor. Thereafter, posterior screw rod fixation and L5-S1 interbody fusion was done. To our knowledge, the reports about the broken surgical instruments being retained in the disc space are extremely rare complication of lumbar discectomy. Moreover, xtraforaminal or transforaminal corridor might an appropriate alternative option instead of anterior or anterolateral approaches.

In this paper, a 63-year-old woman was reported with recurrent abdominal pain after cholecystectomy. A retained surgical towel was seen by CT-scan in the peritoneal cavity, where it migrated across duodenum wall toward pre-pyloric region of the stomach. Endoscopic removal of the large retained gauze in size of 40 cm x 40 cm was successfully performed without laparotomy and with no complication. In the last years, the main method for removal of retained foreign objects has been open laparotomy or laparoscopy. We claimed that removal of large retained surgical long gauze is actually possible using upper GI endoscopy by expert endoscopists, and, therefore, there is no need for anesthesia or surgery as well as no occurrence of complication and laceration.

Rhinolith is a stone that form in the nose. It is an uncommon disease that may present asymptomatically. It is usually occur secondary to retained foreign bodies. Sometimes, it can be cause by fungal infection. It can be seen on radiographs as a radiopaque object in the nasal fossa and may be confused with several pathologic entities that will call for more invasive surgical procedures. Here we present a case of giant rhinolith possibly arising from retained foreign body, and discuss its clinical and radiologic features.

Video-assisted thoracic surgery (VATS) is widely adopted in acute management of patient with thoracic trauma, but its use in penetrating thoracic injuries with retained foreign bodies were rarely reported. We described three of such cases using VATS as the first line approach. Identification of injuries, control of bleeders, clot evacuation, resection of damaged lung parenchyma and safe retrieval of foreign bodies were all performed via complete VATS within short operative time. Patient were uneventfully discharged during early post-operative period. We suggest that, for haemodynamically stable patients, VATS offers a safe and minimally-invasive alternative to conventional thoracotomy for penetrating thoracic injury with retained foreign bodies.

Preventable medical errors in the operating room are most often caused by ineffective communication and suboptimal team dynamics. TeamSTEPPS is a government-funded, evidence-based program that provides tools and education to improve teamwork in medicine. The study hospital implemented TeamSTEPPS in the operating room and merged the program with a surgical safety checklist. Audits were performed to collect both quantitative and qualitative information on time out (brief) and debrief conversations, using a standardized audit tool. A total of 1610 audits over 6 months were performed by live auditors. Performance was sustained at desired levels or improved for all qualitative metrics using χ2 and linear regression analyses. Additionally, the absolute number of wrong site/side/person surgery and unintentionally retained foreign body counts decreased after TeamSTEPPS implementation.

Introduction & Objective: Gossypiboma is a term used to describe a mass within the body that comprises a surrounded by foreign body reaction and is occurred following surgical procedures. Herein we reported a patient with presentation of retained three surgical sponge in abdominal cavity. Case Report: A 25-years old female patient was referred to ED in 2011 for complaints of abdominal pain. This patient had history of hospitalization 60 days before this admission because of multiple trauma and penetrating trauma to left flank. In recent admission, abdominal x-rays and CT scan revealed a cystic mass with dimension of 8×4cm. Laparatomy was done for this patient. Then she discharged after 3 days and her abdominal pain resolved after operation. Conclusion: Retained foreign bodies should be considered in differential diagnosis of post operation in all patients with unusual complaints after surgery.