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Reports of intracranial self-mutilation by psychotic individuals are associated with severe mental disorders, criminality, or both. We describe a psychotically depressed male who drove a ballpoint pen through his right medial canthus and into his intracranial compartment. The patient developed a cavernous sinus syndrome and a traumatic dissection of the cavernous portion of the carotid artery. The pen was removed intraoperatively. Postoperatively, the patient was placed on a course of broad-spectrum antibiotics, antidepressants, and antipsychotic medications, and he has received long-term psychiatric follow-up. The literature related to these unusual cases is reviewed, and relevant surgical, medical, and psychiatric aspects of treatment are discussed.

A 19-year-old female presented four and onehalf months after an occupational injury from a punch-type machine. Exploration revealed a large fragment of her fingernail embedded in the fingerpad. Foreign bodies are commonly encountered in the practice of emergency medicine and failure to localize and remove them can result in significant morbidity. We present a case of a fingernail as a foreign body. Foreign bodies may be difficult to detect despite sophisticated imaging techniques. Although not visualized often, a radiolucent foreign body may be inferred from boney changes. A thorough history regarding mechanism of injury and resultant wound exploration are required. When an adequate wound examination using digital tourniquet control and proper precautions is performed, the majority of foreign bodies will be detected.

Losing a needle during laparoscopic surgery is an uncommon but potentially challenging scenario for the surgeon. The prolonged operative time to search for a small retained foreign body such as a needle can cause clinical and medicolegal complications. As a result, it is considered a ‘never event’. This report describes a case of a lost needle during a laparoscopic prostatectomy, when a meticulous and systematic search for the foreign body was initiated and completed with the use of x-rays, only to find it in an unusual place.

A case is discussed of an adolescent presenting with a rectovaginal fistula secondary to a sexual assault 2 years earlier. The fistula resulted from a retained foreign body (bottle cap) inserted into the vagina during the assault. The adolescent did not disclose the presence of the foreign body at the initial examination.

An 11-year-old girl was admitted to the emergency department (ED) having fallen through a glass door with a wound to her left buttock. She was haemodynamically normal, with no clinical evidence of distal neurovascular deficit. Wound exploration under local anaesthesia revealed no significant bleeding or obvious foreign body. The wound was cleaned and sutured. At 3 months post-injury, her general practitioner referred her for abdominal ultrasound as a result of recurrent infection, persistent …

Small-bore radiopaque drains can be used to drain pleural effusions. They offer reliable drainage of simple pleural effusions and provide a safe, less-invasive, more comfortable alternative to the standard tube thoracostomy. Importantly, removal of such drains does not require purse-string sutures and hence can be removed without assistance. We report here the cautionary tale of a retained foreign body related to drainage of a pleural effusion with a Pleurocath in a patient following cardiac surgery to raise awareness of this potential complication. Emphasized is the need for all staff to be familiar with the normal appearance of equipment being utilized in the ward and to report when incomplete removal of drain equipment is suspected. In addition, amendments to insertion techniques for such small-bore drains are proposed to avoid similar undue complications.

The scenario of a forgotten instrument or foreign body has plagued surgical procedures from the early days. It has been estimated that the incidence of retained foreign bodies is around one in every 1,000-1,500 intra-abdominal operations and can be expected to occur at least once per year in hospitals where 8,000-18,000 major surgeries are performed annually. We report a case of a forgotten asepto bulb in the vagina following a robot-assisted total laparoscopic hysterectomy.

Gossypiboma, an infrequent surgical complication, is a mass lesion due to a retained surgical sponge surrounded by foreign-body reaction. A 27-year-old lady presented with palpable abdominal mass five years after cesarean section. Retained foreign body was diagnosed radiologically and confirmed with operation. Retained foreign body should be in the differential diagnosis of any postoperative patient who presents with pain, infection, or palpable mass.

Background Attention has been placed on surgical and medical errors, though there is a lack of data on the frequency of some complications. Methods International Classification of Diseases , Ninth Revision , Clinical Modification , code 998.4 and E code 871.0 were used to search a database from the United States. Results In the Kids' Inpatient Database 2003, there were 103 reports of retained foreign bodies after surgery (incidence, 0.0031%) with a mean age of 11.5 years. There was a wide range between the 36 states sampled. Total charges for a patient with this complication are $56,683 (95% confidence interval, $41,327-$72,039); mean length of stay is 10.5 days. There is an increased charge of $42,077 in patients who have this complication ( P Conclusions On a national perspective in the United States, the rate of a retained foreign body is 0.0031% or approximately 1 in 32,672 cases and is associated with an increased charge of $42,077 for this complication. Comparative data demonstrate that pediatric surgery in the United States is exceptionally safe with regard to retained foreign bodies.

▪ Abstract: Spinal cord stimulation is increasingly utilized as a treatment to alleviate low back pain and lumbar radiculopathy, particularly in patients with failed back surgery syndrome. We present an illustrative case of early, rapidly progressive methicillin-resistant Staphylococcus aureus (MRSA) infection after a brief stimulator trial lead implantation. Operators should maintain a high level of suspicion for deep infection, including epidural abscess, even when only minor symptoms and signs are present. Because of the poor ability to clear infections in the presence of a retained foreign body, the device must be explanted immediately. Subsequent surgical intervention, however, may nevertheless still be needed. While a variety of bacteria may cause epidural abscess, methicillin sensitive Staphylococcus aureus, and increasingly, MRSA and community-associated MRSA, are the most likely etiologic organisms. ▪

We present the first reported case of peroneal tenosynovitis secondary to a retained blackthorn in a patient with a 4 months history of persistent pain and swelling around her lateral malleolus following a penetrating injury. Ultrasonography reported considerable subcutaneous fluid but no identifiable foreign body. Magnetic resonance imaging confirmed peroneal sheath synovitis with a possible retained foreign body posteriorly. Surgical exploration revealed marked synovitis and chronic inflammation of the peroneal sheath with the tip of a blackthorn deep to peroneus longus. This case illustrates the many ways in which penetrating blackthorn injuries may present. In particular it highlights the need for a high index of suspicion for retained foreign material and the need for further imaging and surgical exploration when symptoms do not resolve.

The authors present two cases in which intraorbital wooden foreign bodies remained undetected after initial ophthalmologic examination and radiologic investigation which included plain orbital x-rays, orbital computed tomography (CT) scans, and, in one case, orbital ultrasound. In each case, subsequent magnetic resonance imaging (MRI) showed a well-delineated low-intensity lesion suggestive of a retained foreign body. Investigation of a case of suspected wooden foreign body in the orbit should include an MRI scan if there is no contraindication, and no foreign body has been defined on CT scan, ultrasound, or plain orbital films.

We present a case of a retained toothpick causing pseudotumor of the first metatarsal in a young female who was referred as a case of painless swelling in the dorsolateral aspect of the right foot to exclude a malignant tumor. Plain radiograph did show an osteolytic lesion in the head and neck of the first metatarsal. Magnetic resonance imaging revealed a toothpick inside the first metatarsal head. Surgical exploration revealed a 4 cm toothpick embedded inside the bone surrounded by granulation tissue. We could find seven cases of retained foreign bodies causing osteolytic lesions in the metatarsals of the foot with one case of osteomylitis in an adult due to a retained small piece of toothpick. Retained foreign body should be considered in the differential diagnosis of an osteolytic lesion of the foot.

Development of cancer in association with metallic implants is well recognized yet poorly understood. We report a case of angiosarcoma at the site of a revision total hip arthroplasty. We found only 3 previous reports on angiosarcoma associated with hip arthroplasty in English literature. Association between malignant tumor and hip arthroplasty deserves attention because this surgical procedure is so common that possible risk of a neoplasm should be quantified. Sarcoma is rare, and its possible causation by retained foreign body material has been reported only as single cases.

Fig. 1. (A) A right anterior chest wall scar indicated the site of the penetrating inju deeper visceral involvement from that accident. The patient claimed that wound deb any further details of the injury or the management received. (B) Chest roentgeno hypodense center. Fibre-optic bronchoscopy demonstrated only a small amount of pur Computed tomography of the chest revealed a 7 cm long hollow tubular structure insi parenchyma.

Foreign body is among complications of surgery. But as a complication of varicose vein surgery it was reported extremely rarely and, to our knowledge, there is only one paper in the literature. A case with retained sponge which was detected five months after varicose vein surgery was presented.

Background. Penetrating non-missile orbito-cranial injuries are uncommon civilian injuries which have some special features. Only limited case-reports are available in the international literature. Method. We present a retrospective review of 18 such in presumed trivial orbital injury. Early identification and removal of retained foreign body fragments was achieved within 36 hours. Findings. Patients were operated on and followed up for at least of 3 years. The final clinical outcome was excellent: 16 had a Glasgow Outcome Scale (GOS) of 5 while in the remaining 2 it was 4. Conclusion. The present report indicates that good results, in managing such injuries, can be achieved by a high index of suspicion and early diagnosis of intracranial injury in presumed trivial wounds and by the removal of every possible retained foreign body.

guidewires but to our knowledge this is the first case of a fractured guidewire that ultimately lodged in the right ventricle with no clinical signs or complications for the patient. The lesson to be learned from this case is that fracture of the wire is possible, due to, for example, the manufacturing process. Therefore, during the procedure, the operator should avoid excessive folding of the wire, making sure to inspect the catheter guidewire after removal and carefully examining the X-ray results. However, this may not be enough to entirely avoid the problem as a guidewire that was easily inserted and normally shaped after removal can still be associated with fracture and embolism and X-rays may have a delay in demonstrating a retained foreign body.

Maternal mortality remains a battle to be won in India. Unsafe abortions contribute to 8.9 % of maternal mortality [1] and still prevail in India. Medical Termination of Pregnancy Act has been in existence since last four decades, yet remains unreachable to many.

Like other countries, the physicians accusation that might be right or wrong, have increased nowadays in Turkey. Even all precautions are taken in the operation theatre, there are still some cases in which foreign bodies are retained in the abdominal cavity. It is not likely for the cases of retained foreign bodies in the abdominal cavity to be considered as an acceptable complication. Therefore, the surgeon must keep in mind that in such situations they are going to be judged as faulty both in the civil courts and in the courts of first instance. In this study incidences, causes and legal outcomes of the foreign bodies that are left behind in the abdominal cavity in Turkey are discussed.

The term gossypiboma denotes a cotton foreign body retained inside the patient during surgery, a rare surgical complication. The symptoms following this entity are non-specific, such as pain, palpable mass and fever, which make clinical diagnosis difficult. The computerized tomography (CT) scan is the most useful method for diagnosis; however, sometimes the preoperative diagnosis remains uncertain even after the imaging exam. In that case, laparoscopy arises as a valuable diagnostic tool, as well as a prompt treatment option. However, when diagnosis is made years after the original surgery, the laparoscopic approach becomes harder. Our patient presented without clear symptoms, remaining asymptomatic for 34 years. The CT scan presumptive diagnosis was a gastrointestinal stromal tumour, and laparoscopy was performed providing an accurate diagnosis and treatment in the same surgical time.

Delayed rupture of a flexor tendon in the hand due to the presence of a retained foreign body is rare. We present the case of a late flexor pollicis longus rupture 30 years after traumatic implantation of a glass fragment. The foreign body had migrated distally a distance of 4.5 cm from the site of the original injury and eroded into the flexor tendon sheath. Thumb function was restored with a flexor digitorum superficialis tendon transfer from the ring finger with excellent results.

Retained foreign bodies can be a challenging diagnosis due to the wide array of presentations and greatly varied range of time to detection. Here we report a case of a retained surgical sponge detected 5 years postoperatively after an extensive workup for colon cancer. This case demonstrates the novel finding of a retained surgical sponge appearing as colon cancer and serves as a reminder that symptoms that cannot be explained by a standard workup, in any patient who has undergone previous surgery, must have retained surgical instruments as a differential diagnosis.

We report a 52-year-old woman presenting with stab wounds on her back and upper extremities. A knife retained in her chest wall was not discovered in the emergency department. This case reminds us that an obvious foreign body can be missed even after obtaining a detailed history, complete physical examination and plain film. Particularly, a retained foreign body increases the risk of infection and may cause further internal organ injury. We suggest that patients undergo computed tomography (CT) scanning whenever a penetrating wound cannot be explored adequately or the trauma surgeons are unable to perform detailed examinations on the injured patients. The CT images could delineate the course and severity of the penetrating injury, and decrease the risk of a retained foreign body.

Gossypiboma or textiloma is a rare avoidable surgical disaster having medicolegal repercussions. It is a mass lesion due to a retained surgical cotton sponge accompanied by foreign body reaction. The time of presentation may range from early postoperative period to several decades later. A correct diagnosis can be made only in one-third of cases. We report an unusual case of gossypiboma in a 56-year-old female which was mistaken for pelvic cystic lesion. The diagnosis of gossypiboma was confirmed only during surgical exploration. Retained foreign body should be one of the differential diagnosis of any postoperative patient presenting with pain, infection, or palpable mass.

Background The aim of this study was to analyze the effect of a surgical management protocol and other important clinical features on the prognosis of patients who had penetrating orbitocranial gunshot injuries. Methods Thirty-five patients (30 unilateral, 5 bilateral) who had penetrating orbitocranial gunshot injuries were analyzed. The wounds were mainly caused by shrapnel fragments or bullets. Craniotomy was the standard treatment in all patients. Investigated clinical features included Glasgow Coma Scale (GCS) score on admission, the mode and the extent of brain injury, and the presence of an intracranial retained foreign body. The prognostic importance of complications such as infection, intracranial hemorrhage, cerebrospinal fluid leak, and epileptic seizures was also investigated. The mechanism and the injury characteristics of the patients were evaluated by predicting the visual outcome of the victims according to a newer classification system as well as other variables pertinent to this specific clinical setting of severe eye trauma. Final visual acuities of the patients were also measured. Results The outcome of 35 penetrating orbitocranial gunshot injured patients was as follows: death in 3 patients, vegetative state in 1, severe disability in 2, moderate disability in 2, and good recovery in 27 cases. Localization and extent of the injury and GCS score on admission were the most important indicator for good neurological outcome. The predictors for good visual outcome were type B, grade 1, zone I, and relative afferent pupillary defect–negative injuries. The predictors for poor outcome were type A, grade 5, zone III, and relative afferent pupillary defect–positive injuries. Conclusion The prognosis of the injury depends on the course of the bullet or shrapnel fragment and the interdisciplinary care. An extensive preoperative evaluation of penetrating orbital trauma and a combined ophthalmic and neurosurgical approach are recommended to minimize the morbidity of the patients. However, complete removal of the foreign material in a deep or ventricular localization is not mandatory because careful debridement and tight closure of dura provides desired outcome. Evaluation of trauma mechanism and injury characteristics according to the Ocular Trauma Classification System seems to predict accurately the visual outcomes in this series.

Two cases of chronically retained foreign bodies are presented, demonstrating that a long delay may exist between a penetrating injury and the manisfestation of a severe symptom, such as haemoptysis or recurrent infection, referable to a retained foreign body. In only one of these cases was the diagnosis of retained foreign body considered the most likely pre-operatively. Some diagnostic and management problems arising in such situations are discussed.

We recently admitted a young immunocompetent man with cryptococcal meningitis. He presented alone, and a combination of language barrier and blunted cerebral function hampered history taking. He described 1 week of headache and fever, and gave a vague account of a penetrating head injury 6 months previously.

Ingestion of foreign bodies in children is a commonly occurring event worldwide. Swallowed foreign bodies usually pass successfully through the alimentary canal, from the mouth to the anus, but occasionally they may become lodged in the lumen of the oesophagus and cause complications. Accurate diagnosis of a retained foreign body is crucial in anticipating and preventing complications, but diagnostic delay can occur. We present a case of delayed diagnosis of a foreign body ingestion in an infant. Based on our experience, we emphasise the importance of accurate interpretation of X-rays with particular attention paid to the region of highest suspicion by the first touch physician.

The uncommon occurrence of acute retropharyngeal abscess in adults can be the result of a retained foreign body. A large piece of wood impacted in the neck in a road traffic accident and presenting as retropharyngeal and bilateral parapharyngeal abscesses is reported for its rarity and clinical interest.

TVT-Secur is a new "less" invasive derivative of the tension-free vaginal tape (TVT). We report an unusual case of dyspareunia for both the patient and her husband resulting from a retained finger pad from the TVT-Secur introducer. The sling was also explanted because of malposition.

The case of a 12-year-old patient with a wooden foreign body which had penetrated the superior orbital fissure is presented. Using a transethmoidal approach, only some splinters lying in the periorbital soft tissue were removed. The patient became febrile, indicating an infectious complication due to a retained foreign body. This was confirmed by CT scan and MRI demonstrating a main splinter in the superior orbital fissure. Total removal of the wood was achieved via a pterional extradural approach. The difficulties of identifying wooden foreign bodies as well as the topographical problems involved with the approach to the superior orbital fissure are discussed.

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

Purpose: To present an unusual case of a preretinal mass that simulated a retained metallic foreign body. Method: Case report. Results: A 30–year–old man presented with unilateral iridocyclitis and an ipsilateral preretinal mass with ultrasonographic and computed tomographic characteristics of a metallic foreign body. Histologic examination of the mass disclosed a central concentration of iron-containing hemoglobin breakdown products surrounded by a cocoon of fibrous tissue. Conclusion: Blood breakdown products surrounded by a fibrous capsule can present with the characteristics of an intraocular metallic foreign body.

Saccular bronchiectasis secondary to the presence of a long retained foreign body is considered irreversible and an indication for resection of the diseased segment or lobe. We describe a 3 1/2 year-old girl with a retained organic foreign body for 18 months, and who was treated conservatively after laser resection and extraction of the inflammatory mass from the bronchus intermedius followed by complete resolution of the bronchiectasis. We suggest that even severe bronchiectasis following prolonged retention of a foreign body may be reversible after removal of the obstruction and reestablishment of airway patency.

편측성 부비동 병변은 세균성 부비동염뿐만 아니라, 양성 및 악성 종양, 치성 병변, 진균성 부비동염 또는 이물질 등 다 양한 원인에 의해 발병할 수 있다. 또한, 이물질에 의해 이차 적으로 진균성 부비동염이 발병한 증례도 문헌에 소수 보고 된 바 있기 때문에, 자세한 병력청취 후 비내시경 검사를 포함 한 신체 검진과 영상의학적 검사를 면밀히 검토하여 편측성 부비동 병변을 술 전과 술 중에 감별 진단하는 것이 치료에 필수적이다. 이물질에 의해 이차적으로 발생한 진균구 증례들이 보고된 바 있으나, 대부분이 아말감, gutta-percha point 등의 치과용 재료에 의한 증례들로 진균의 성장에 영향을 주는 무기 요소 를 공급할 수 있는 이물질 삽입에 의한 것들이었다. 또한, 외 상으로 삽입된 볼펜의 스프링과 선단으로 인해 이차적으로 진 균구가 발생한 증례도 보고된 바 있으나, 부비동 내로의 장 기간 의인성 이물질 삽입에 의해 발병한 이차성 진균구는 아직 문헌에 보고된 바 없다. 최근 저자들은 장기간 의인성으로 부 비동에 삽입된 수술용 거즈에 의해 이차적으로 진균구가 발생 한 증례를 경험하여 문헌 고찰과 함께 보고하는 바이다.

We present the case of a 33-yr-old female patient who, along with members of her family, attempted to extort approximately $6000.00 from our institution and her insurance company. This attempted extortion was done under the guise of a missed retained foreign body. The patient initially presented to our emergency department with a laceration to her right forearm; X-ray studies obtained after the wound had been sutured revealed no foreign body. Several days later, the patient and family members approached our administrative staff demanding recompense for metal fragments discovered in the patient's wound at another facility. Comparison of radiographs revealed that the metallic fragments were placed in the wound after she was treated and released from our emergency department, and monetary compensation was denied.

A case is described of a 3-year-old boy who presented with a seemingly trivial injury to his soft palate, who went on to develop a parotid sinus as a result of a retained foreign body. This is a rare clinical problem and it highlights the difficulty in the clinical assessment of a palatal injury — especially in children. The child had the foreign body removed successfully 5 months after the initial injury and made an uneventful recovery.

Retained foreign bodies after surgery is a quite rare condition, which can have medico-legal consequences. Foreign bodies forgotten in the abdomen include towels, artery forceps, pieces of broken instruments or irrigation sets, and rubber tubes. The most common surgically retained foreign body is the laparotomy sponge. Such materials cause foreign body reaction in the surrounding tissue. The complications caused by these foreign bodies are well known, but cases are rarely published because of medico-legal implications. We report a case of 41-year-old female who was admitted with complaints of intestinal obstruction who had a previous history of hysterectomy performed 2 months back, at another hospital. Pathologists must be aware of this entity and its proper reporting, as the cases are liable to go to court. Surgeons must recognize the risk factors that lead to a gossypiboma and take measures to prevent it.

An uncommon complication of any surgery is iatrogenic retained foreign body. This condition is gossypibomas. In this case report, we present cases of middle-aged females who had undergone total abdominal hysterectomy and came to us with feature of intestinal obstruction. She was diagnosed radiologically, and later a review surgery was performed. A prompt diagnosis and treatment is necessary to reduce morbidity and mortality of this condition. It is to emphasize that any post-operative patient who present to us with complaints of pain or obstruction, the differential diagnosis must include retained foreign body (gossypibomas).