Ingested Magnets: A health hazard and the Role of laparoscopy

Ingestion of magnets is becoming a common problem among children and teens and are known to be associated with serious complications that result from pressure necrosis and bowel perforation. We report a series of eight children with multiple magnets ingestion that resulted in complications including small bowel perforation and intestinal obstruction necessitating an emergency laparotomy and intestinal resection. The aim of this report is to raise awareness of the complications associated with magnet ingestion in children. The literature on the subject is also reviewed and early surgical intervention is recommended for multiple swallowed magnets. The role of laparoscopy in this regard is also stressed.

Nonfreezing Cold Injury (Trench Foot)

Nonfreezing cold injury (NFCI) is a modern term for trench foot or immersion foot. Moisture is required to produce a NFCI. NFCI seldom, if ever, results in loss of tissue unless there is also pressure necrosis or infection. Much of the published material regarding management of NFCIs has been erroneously borrowed from the literature on warm water immersion injuries. NFCI is a clinical diagnosis. Most patients with NFCI have a history of losing feeling for at least 30 min and having pain or abnormal sensation on rewarming. Limbs with NFCI usually pass through four ‘stages.’ cold exposure, post-exposure (prehyperaemic), hyperaemic, and posthyperaemic. Limbs with NFCI should be cooled gradually and kept cool. Amitriptyline is likely the most effective medication for pain relief. If prolonged exposure to wet, cold conditions cannot be avoided, the most effective measures to prevent NFCI are to stay active, wear adequate clothing, stay well-nourished, and change into dry socks at least daily.

Unexpected extrusion of the implantable pulse generator of the spinal cord stimulator - A case report -

Background: Despite significant technological advances in the implantable pulse generator (IPG), complications can still occur. We report a case that unexpected extrusion of the IPG of spinal cord stimulation (SCS) was promptly identified and successfully removed without any complications. Case: After a car accident 4 years ago, a 55-year-old man who was diagnosed with complex local pain syndrome in his right leg. The SCS was inserted with 2 leads, with the IPG being implanted in the right lower abdomen region. Four years later, he developed extrusion of the IPG from his abdominal region. This unexpected extrusion may have been related to pressure necrosis caused by continued compression of pocket site where a belt was frequently tied. The IPG and the leads were successfully removed without infection occurring. Conclusions: To prevent unexpected extrusion of IPG, it is necessary to consider in advance whether the pocket site is pressed against the belt.

A massive phylloides tumor in the breast: case report and literature review

Phylloides tumor (PT) is a rare fibro epithelial neoplasm comprising <1% of all breast tumors. Clinical spectrum ranges from benign (B), borderline (BL), and locally recurrent to malignant (M) and metastatic type. Phylloides tumors originate from the connective tissue of the breast, so the malignant phylloides are histologically sarcomas. We are reporting a massive phylloides tumor in a 45 years old female. She presented with a huge breast mass occupying almost the whole of the right breast with two areas of pressure necrosis, on the overlying skin. She noticed a small lump 7 months ago in the right breast, which slowly grew to the current dimensions and areas of pressure necrosis appeared recently. FNAC was reported as a complex fibroadenoma; however due to strong suspicion, a core needle biopsy was done. The report came as a phylloides tumor. Simple mastectomy was done. The tumor specimen measured exactly 20×15×10 cm in size; the histopathology report came as benign phylloides tumor.

Accidental multiple magnet ingestion by an adult: a case report

Accidental multiple magnetic foreign body ingestion although common in children is rare in adults. Multiple magnetic foreign body ingestion possess a definitive risk of causing intestinal perforation, volvulus or fistulas and requires early surgical intervention even in apparently asymptomatic individuals to prevent catastrophic complications. We report a case of an 18 year old male with a history of accidental simultaneous ingestion of two semi-circular shaped magnets along with a nail. The peculiarity of the case being that despite the magnets being simultaneously ingested, one was in the stomach and the other in the jejunum adhered to each other through the transverse colon mesentery causing pressure necrosis of the adjoining wall with the patient being asymptomatic.

A fistulating incarcerated incisional hernia: a case report

An incisional hernia is usually a defect in the scar of an abdominal surgery. The natural history is intestinal obstruction with the risk of strangulation. We report a case of a long-term conservative management of an incisional hernia with an abdominal corset. This resulted in fistulation from pressure necrosis that required an en-bloc excision of the incarcerated fistulating bowel with the hernia sac. The defect was managed using the Jenkin’s ‘mass closure’ technique with no recurrence of the hernia.

Magnetic Apposition across the Epiglottis: Radiographic and Operative Correlation of a Rare Hypopharyngeal Foreign Body

Background and Aim. Rare-earth magnet ingestions are a subset of foreign body ingestions and can result in significant morbidity secondary to pressure necrosis. These magnets are best visualized radiographically, typically located in the gastrointestinal tract. However, unusual locations of magnetic adherence may include the hypopharynx along the epiglottis, where only 2 previous cases have been reported. Clinicians should be aware of the potential dangers of rare-earth magnet ingestion and consider atypical locations of attachment in the appropriate clinical setting. Case Presentation. We present an interesting case of a fourteen-year-old female patient who presents with witnessed ingestion of multiple rare-earth magnets. Soft-tissue neck radiographs demonstrate two adjacent rounded radiopaque densities in the hypopharynx. Intraoperative images confirmed the radiographic findings and identified two magnetic balls stuck along the dorsal and ventral aspect of the epiglottis without evidence of pressure necrosis. Conclusion. This is the first published case of magnetic foreign body adherence to the epiglottis in the Radiology literature. Awareness and recognition of the unique radiographic findings of this rare entity can help clinicians streamline timely management.