Challenges in treating patients with foreign bodies in hypopharynx and esophagus: our experience in a tertiary care hospital

Background: Foreign bodies (FBs) of the hypopharynx and esophagus are among the common otolaryngologic emergencies. Every new case poses a clinical challenge with need for optimal treatment strategy. The objective of our study is to highlight a few of the challenges faced while treating these patients.Methods: A prospective study was done on all patients who reported to the ENT casualty, Government Medical College Kozhikode with history or suspicion of foreign body throat from January 2020 to January 2021. A total of 160 patients reported of which 48 (30%) patients required further evaluation with rigid endoscopy and foreign body removal in the operative room. A few challenges like migration of foreign bodies, dilemma in diagnosis with FB mimicking ossified cartilages on X-ray, FB removal in mentally challenged patients and treatment of esophageal perforation post rigid endoscopy are discussed.Results: Only 48 (30%) patients of the total 160 patients required rigid endoscopy and foreign body removal in the operating room. The foreign body was obtained in 42 (87.5%) patients while 6 (12.5%) patients improved post rigid endoscopy though foreign body was not obtained. One patient with denture in the esophagus developed esophageal perforation requiring prolonged hospital stay.Conclusions: A high index of suspicion among patients presenting with dysphagia, neck pain and sudden decrease in food intake is warranted. Early diagnosis with appropriate imaging modalities is essential for confirmation of diagnosis. Dentures are among FBs that necessitate more caution. Esophageal perforation, a rare but life-threatening complication must be diagnosed timely with appropriate surgical intervention.

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Tracheo-bronchial foreign bodies: our experience at a tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20161848 ◽

2016 ◽

Author(s):

Shashidhar S. Suligavi ◽

Mallikarjun N. Patil ◽

S. S. Doddamani ◽

Chandrashekarayya S. Hiremath ◽

Afshan Fathima

Keyword(s):

Foreign Body ◽

Early Diagnosis ◽

Foreign Bodies ◽

Tertiary Care ◽

Case Series ◽

Team Work ◽

Care Hospital ◽

Retrospective Case ◽

Presenting Symptoms ◽

Case Series Study

Background:Tracheo- bronchial foreign bodies have always posed a challenge to the ENT surgeon as they present with varied symptomatology ranging from a simple cough and fever to more grave respiratory distress. It requires a strong suspicion, early diagnosis and timely intervention to reduce the overall morbidity and mortality .This study was undertaken to highlight our experiences in handling cases of tracheo- bronchial foreign bodies (FB) at our setup.Methods:It is a retrospective case series study conducted in S. Nijalingappa Medical College between January 2011 and January 2015. Results:Most commonly affected were children between 1year to 3years of age. Chronic cough and wheeze were the commonest presenting symptoms. Vegetative foreign body was found to be the commonest variety of foreign body. The mortality rate in our study was 4.7% (n=3).Conclusions:A good clinical acumen, team work, early diagnosis and timely intervention are all needed to reduce the overall mortality and morbidity associated with tracheo- bronchial foreign bodies.

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An Unusually Large Object Removed From the Upper Esophagus in a Patient With Self Harm Syndrome

Ear Nose & Throat Journal ◽

10.1177/0145561320953707 ◽

2020 ◽

pp. 014556132095370

Author(s):

Michael J. Lai ◽

Jace Morganstein ◽

Nathan Deckard ◽

Yekaterina Koshkareva

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Tertiary Care ◽

Trauma Surgery ◽

Care Hospital ◽

Upper Aerodigestive Tract ◽

Large Object ◽

Toilet Paper ◽

History Of ◽

Self Harm

A 32-year-old female with a history of bipolar disorder and schizophrenia was transported to our tertiary-care hospital after swallowing a large toilet paper holder bracket. Removal of the large foreign body required coordination between anesthesiology, otolaryngology, and trauma surgery. A tracheostomy airway was established, and the object was removed transorally. The object was found to be a toilet paper holder bracket measuring 7.5 cm × 5.4 cm × 5.4 cm with a 2.6 cm screw protruding from the end. A review of articles describing the removal of foreign bodies from the upper aerodigestive tract found our object to be the largest foreign body ingestion described in literature. One report suggested that 18% of adult patients with foreign body ingestions had primary neuropsychiatric disorders. Our patient’s psychiatric disorder was a major underlying factor leading to the ingestion, with our patient reporting hallucinations instructing her to ingest household objects.

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Capsular dissection technique for reducing recurrent laryngeal neuropraxia and temporary hypoparathyroidism after thyroidectomy: a single center experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212445 ◽

2021 ◽

Vol 7 (7) ◽

pp. 1111

Author(s):

Dimple Sahni ◽

Rajwant Kaur ◽

Gagandeep Kaur ◽

Sangeeta Aggarwal ◽

Sanjeev Bhagat

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Single Center ◽

Single Center Experience ◽

Clinical Presentations ◽

Life Threatening ◽

High Index Of Suspicion ◽

A Prospective Study ◽

Dissection Technique ◽

Nose And Throat

Background: Foreign bodies in aerodigestive tract is common, frequent, and sometime life threatening emergency for otorhinolaryngologists mainly in the paediatric group. The aims of the present study was to find the incidence of foreign bodies, in relation to demographic factors, type and sites of foreign bodies its clinical presentations and its management.Methods: A prospective study was conducted on 100 cases coming to the ear, nose and throat (ENT) emergency and outpatient department (OPD). After thorough history, clinical examination, routine blood and urine investigations and urine done. Radiological examination was done to visualize the radio-opaque foreign body, and if the foreign body was not radio-opaque then computed tomography (CT) scan was done. Results: Incidence of foreign was 67% in male than 33% in female. Mostly foreign bodies were in nose (49%), followed by oesophageal (31%), abdominal (14%), and bronchus (6%) respectively. 33% were totally asymptomatic, 25% with mucupurulent discharge from nose, dysphagia (16%), nasal obstruction (15%), and odynophagia (11%) respectively. Most of the foreign bodies were inorganic in nature, coin (42%), pearls (8.16%), and battery (6.45%). Among organic foreign bodies peanut was most common (33.33%), grains (10%). All foreign bodies were removed successfully with minimal morbidity and zero mortality.Conclusions: Present study suggested incidence was very common among male children, in rural background, with common asymptomatic presentation. With high index of suspicion, and proper and timely intervention all 100 cases were managed successfully. But still educating the parents about keeping such things away from kids prevent these incident.

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Clinical and etiological profile of neonatal sepsis in children admitted to tertiary care hospital

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20203163 ◽

2020 ◽

Vol 7 (8) ◽

pp. 1714

Author(s):

Jawad Nazir Wani ◽

Vivek Pandita ◽

Saleem Yousuf ◽

Nusrat Yousuf

Keyword(s):

Blood Culture ◽

Neonatal Sepsis ◽

Clinical Presentation ◽

Tertiary Care ◽

Abdominal Distension ◽

Causative Organism ◽

Care Hospital ◽

Suspected Sepsis ◽

High Index Of Suspicion ◽

A Prospective Study

Background: Neonatal sepsis is leading cause of mortality in children. The clinical presentation of neonatal sepsis is non-specific and variable. This study was undertaken to study clinical and etiological profile of neonatal sepsis.Methods: This was a prospective study conducted over a period of one year from March 2018 to March 2019. The patients with clinically suspected sepsis were included in this study. Detailed history and examination was done in all patients. In addition to baseline investigations, C-reactive protein and blood culture was done in all patients. Blood culture was done prior to administration of antibiotics.Results: In this study there were total of 102 patients out of which 54 were male and 48 were female. Among 102 patients, 69 patients were premature born before 37 weeks of gestation. Prematurity emerged to be the most common risk factor. In this study 62% patients had EOS (<72 hours of life) and 38% had LOS (>72 hours of life). The most common presenting feature were refusal of feeds, lethargy, respiratory distress and hypothermia. Other features were seizures, abdominal distension, apnea and sclerema. Blood culture was positive in 41% patients. The most common organism isolated on culture was Kleibsella followed by E. coli.Conclusions: Neonatal sepsis is leading cause of mortality in children. Early diagnosis and treatment is of paramount importance to prevent mortality. The clinical presentation of neonatal sepsis is non-specific and variable. So, high index of suspicion is required to detect sepsis at earliest. Gram negative organism like Kleibsella and E. coli are the common causative organism in neonatal sepsis.

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A152 FOREIGN BODY INGESTIONS AT A TERTIARY CARE CENTRE - A QUALITY ASSURANCE STUDY

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.151 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 16-17

Author(s):

T Mullen ◽

G Williams

Keyword(s):

Quality Assurance ◽

Foreign Body ◽

Foreign Bodies ◽

Tertiary Care ◽

Therapeutic Interventions ◽

Care Hospital ◽

Food Bolus ◽

Tertiary Care Centre ◽

Endoscopic Techniques ◽

Endoscopic Method

Abstract Background Foreign body ingestion and esophageal food bolus impaction are common emergencies encountered by gastroenterologists. If not treated in a timely fashion these can result in significant morbidity, or even mortality. The mainstay of diagnosis and therapy is endoscopy. Guidelines regarding timing of endoscopy have been published by both the American and European Societies of Gastrointestinal Endoscopy, and both suggest emergent endoscopy, meaning within 2 to 6 hours, for complete esophageal obstructions. There is relatively sparse data regarding the endoscopic techniques used in real world practice. Aims This is a quality assurance study looking at the endoscopic practices at an adult tertiary care hospital in Halifax, Nova Scotia with respect to foreign body and food impaction management. Methods The hospital records of all patients presenting with ingested foreign bodies or esophageal food bolus impactions between May 2018 and July 2019 were included. Patients were identified by searching the call-back forms used by our department which documents all on-call endoscopy cases. This was then cross-referenced by endoscopy nursing charting which documents every endoscopy performed. Information such as demographics, obstruction type, endoscopic method of removal, complications, time between consultation and endoscopy, underlying pathology, and others were analyzed. Results 70 cases were identified. Average patient age was 51.3 years old (range 16–96). 18 (25.7%) were female and 52 (74.3%) were male. 64 cases (91.4%) were esophageal food impactions and 6 (8.57%) were foreign body ingestions. Of the food impactions, 39 cases (60.9%) were cleared by the push/slide-by technique only and 10 (16.7%) were relieved using instruments such as snares, forceps, or nets. 15 (23.4%) passed spontaneously prior to scope, of which 7 received glucagon. An overtube was used in 1 case (0.16%). Complications occurred in 5 (7.8%) cases and included 3 mucosal tears, 2 of which required therapeutic interventions, and 2 episodes of oxygen desaturation in which the procedure was aborted. Complete obstructions occurred in 42 (65.6%) cases with average time of consultation to endoscopy of 2.4 hours. However, 3 (7.1%) cases exceeded 6 hours. The most common pathology was eosinophilic esophagitis with 20 cases (31.3%). Ingested foreign bodies included 2 long objects, 3 sharp objects, and a cylindrical battery, and all but one were in the stomach. 5 (83.3%) cases used an overtube. No complications occurred. Conclusions At our institution 67/70 (95.7%) cases were performed within the timelines recommended by society guidelines. No complications occurred in the cases not performed within those time limits. An overtube was used in only one case in which a food bolus was retrieved out of the esophagus. Overall this study suggests that our centre is meeting recommended targets, however there is room for improvement. Funding Agencies None

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Study on prevalence of foreign bodies in ENT

Integrative Journal of Medical Sciences ◽

10.15342/ijms.7.219 ◽

2020 ◽

Vol 7 ◽

Author(s):

Shilpi Agrawal ◽

Haritosh K. Velankar

Keyword(s):

Foreign Body ◽

Emergency Room ◽

General Anaesthesia ◽

Foreign Bodies ◽

Tertiary Care ◽

Age Groups ◽

Care Hospital ◽

Cross Sectional ◽

Common Location ◽

Nose And Throat

Introduction- Foreign body is a substance that doesn’t belong to a location where it is found. Ear,nose and throat are common location for occurence of foreign bodies. It is a common problem encountered in both adults and children. Objective- 1) To analyse the different kinds of foreign bodies in ear ,nose and throat and their prevalence in different age groups. 2) To analyse the most prevalent site of foreign body among ear, nose and throat.Methods- A cross-sectional study was performed in our tertiary care hospital in Navi-mumbai. The study period was from august 2017 to august 2019. The study population were the patients who came to the out patient department and emergency room of this hospital.Result- A total of 100 patients as sample size with foreign bodies in ear, nose or throat were taken on first come basis. 62 were males and 38 were females. Of the 100 patients, 36 had foreign body in ear, 47 in nose and 17 in the throat. The foreign body was removed under local anaesthesia in 4% patients, with general anaesthesia in 30 % and with no anaesthesia at all in 66% patients. The most common age group affected was less than 10 years among both male and female patients.Conclusion- The most frequent site of foreign body occurrence was found to be nose. The most common site requiring general anaesthesia for foreign body removal was throat. Although most of the foreign bodies could be removed without any anaesthesia in the emergency room or outpatient department.

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Endoscopic removal of foreign bodies from the upper aerodigestive tract: a retrospective study from a tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20192712 ◽

2019 ◽

Vol 5 (4) ◽

pp. 960

Author(s):

Sreeja Raj Vellamparambil ◽

Arjun Gopinath Menon ◽

Ariyamparambil Rajagopalan Vinayakumar

Keyword(s):

Retrospective Study ◽

Foreign Body ◽

Digestive Tract ◽

Clinical Examination ◽

Foreign Bodies ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Aerodigestive Tract ◽

Care Hospital ◽

Upper Aerodigestive Tract

Background: Foreign bodies (FB) in the upper aero-digestive tract pose major challenges to the otorhinolaryngologist in both diagnosis and management. Aspirated and ingested foreign bodies are often emergencies, leading to inadequate study, poor preparation and improper attempts at removal. A retrospective analysis was done on cases which were managed for the upper aero-digestive tract FBs in a tertiary care hospital in South India and the result is presented in this article.Methods: Retrospective study was done on 100 patients diagnosed as cases of foreign body in upper aerodigestive tract on the basis of detailed history, clinical examination and radiological investigation. They underwent per oral endoscopy under general anaesthesia for retrieval of foreign body. Results: Age group more prone for foreign body ingestion or aspiration was <10 years and >50 years. Most common site of impaction in oesophagus is cricopharynx and in airway is right bronchus. Most common type of FB is chicken bone. Most common symptom in FB ingestion is FB sensation and in case of FB aspiration it is cough. Most (82%) of the FBs were radio opaque.Conclusions: Accurate history and clinical examination were the keystones in diagnosis and prevention of complications of FB lodgement in aerodigestive tract. Negative history and or normal imaging do not rule out a foreign body.

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Surgical Procedure among Patients with Foreign Body Obstruction in Food Passage in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.5704 ◽

2021 ◽

Vol 59 (237) ◽

Author(s):

Krishna Chandra Rijal ◽

Krishna Prasad Koirala ◽

Ashish Khadgi

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Care Center ◽

Tertiary Care ◽

Neck Surgery ◽

Cross Sectional Study ◽

Care Hospital ◽

Food Passage ◽

Cross Sectional ◽

Foreign Body Obstruction

Introduction: Foreign body is any object in a region it is not meant to be, where it can cause harm if immediate medical attention is not sought. Its removal by surgical procedure is one of the commonest surgeries done. The objective is to find out prevalence of the patients who underwent operation for foreign bodies obstruction in food passage in the Department of Otorhinolaryngology-Head and Neck Surgery in a tertiary care centre. Methods: A descriptive cross-sectional study conducted among patients operated in the Department of Otorhinolaryngology and Head and Neck Surgery of a tertiary care center from August 2014 to May 2017. Ethical approval was received from the Institutional Review Committee of the Institute. Convenience sampling method was used. Statistical Package for the Social Sciences was used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of total 700 patients having operation in department, 115 (16.42%) (95% Confidence Interval = 13.67–19.16) had operation for foreign body obstruction in the food passage. Among 115 patients, 62 (53.90%) were males and 53 (46.10%) were females. Most common foreign bodies ingested in children was coin 17 (14.78%) and bone chips 40 (34.78%) in adults. Cricopharynx 90 (78.26%) is the commonest site for foreign body lodgement. Conclusions: Prevalence of the patients who underwent operation for foreign bodies obstruction in food passage in a tertiary care hospital is high. Their removal by rigid oesophagoscopy is one of the commonest surgical procedures done in tertiary care center.

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165 Impact of COVID-19 on management of Foreign Bodies in Otolaryngology

British Journal of Surgery ◽

10.1093/bjs/znab259.443 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

S Mahmood ◽

M Mair ◽

M Hussain ◽

P Conboy

Keyword(s):

Foreign Body ◽

Health Care Professionals ◽

Foreign Bodies ◽

Age Group ◽

Foreign Body Removal ◽

Foreign Body Extraction ◽

Paediatric Age ◽

Potential Risks ◽

A Prospective Study ◽

Nose And Throat

Abstract Aim The primary aim was to assess safety of Ear, nose and throat foreign body extraction during the coronavirus pandemic as this procedure is considered a potential aerosol generating procedure. The secondary aim was to evaluate the potential risks to patients if foreign body removal was delayed. Method A prospective study of 50 patients presenting to our unit with foreign bodies between March 2020 and August 2020 during the COVID-19 pandemic was performed. All patients were seen within 1 week of referral. The sites and types of foreign bodies were studied and correlated with complications where present. We assessed the circumstances under which foreign body removal was performed and its effect on health care professionals. Results The most common age group was the paediatric age group (52%). The most frequent sites of foreign bodies were the Ears at 78%(39 patients), followed by the nose at 12% (26 patients). Non-organic foreign bodies (52%) were more prevalent than organic foreign bodies (48%). Removal was performed in 31 (62%) patients either in clinic or in theatre. However, 19 patients (38%) were managed conservatively adhering to the British Association for Paediatric Otolaryngology guidance. Only 2 patients developed complications secondary to retained non-organic aural foreign bodies. None of the patients with organic foreign bodies developed complications. No infection rates among medical staff managing these patients were identified. Conclusions Contrary to normal practice, it is safe to manage selective ENT foreign bodies in a semi-urgent manner allowing time to implement ample precautions to reduce infection risks.

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Malrotation of gut presenting in adolescents and adults at a tertiary care hospital: a prospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20192361 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2032

Author(s):

Shabir Ahmad Mir ◽

Mohd Riyaz Lattoo ◽

Waseem Ahmad Dar ◽

Mumtazdin Wani

Keyword(s):

Prospective Study ◽

Tertiary Care ◽

High Index ◽

Care Hospital ◽

Age Group ◽

Diagnostic Challenge ◽

Adult Age ◽

Adolescents And Adults ◽

High Index Of Suspicion ◽

A Prospective Study

Background: Although malrotation of gut presenting in adolescents and adults is rare, but exists. Also its presentation is nonspecific. Hence its diagnosis needs high index of suspicion.Methods: This prospective study was done in the department of surgery at SMHS hospital (GMC Srinagar) over a period of 5.5 years from July 2012 to December 2017. The patients included all the adolescent and adult patients who proved to be the cases of malrotation of gut on intraoperative visualisation.Results: During the study period, 14 patients with malrotation of gut (belonging to adolescent and adult age group) were recorded. Age of the patients ranged from 16 to 54 years with an average of 26.21±11.15years. Majority of the patients belonged to adolescent age group. Preoperatively CT (computed tomography) scan was done only in 4 patients, thereby making the diagnosis of malrotation preoperatively in these 4 patients. In all other patients, the diagnosis was made only after laparotomy (for acute abdomen) and intraoperative visualisation. Ladd´s procedure was done successfully in majority of patients with two patients requiring resection of gangrenous small bowl and stoma formation.Conclusions: Malrotation of gut presenting in adolescents and adults is a rare phenomenon and also the symptoms are similar to several other abdominal pathologies, hence it represents a diagnostic challenge. Hence a high index of suspicion is needed to diagnose this rare entity early without undue delay. Threshold for CT scan should be kept a little low in suspicious cases so as to diagnose and intervene in time.

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