Incidence of Ocular, Adnexal and Orbital Trauma at Different Tertiary Care Centers of Karachi.

Purpose:To assess the incidence of ocular trauma resulting from various inciting agents presenting at three large centers of Karachi, Pakistan.Method:Patients with ocular trauma were recruited at the three centers over a period of three months, in this study. Any other ocular disease was excluded. After informed consent, history and examination was done. A proforma was filled for every patient. The various inciting agents were identified and incidence of the different types of ocular damage found. Trauma scoring was also done according to the Ocular Trauma Score.Results:A total of 343 patients with trauma presenting at different tertiary centres including DIMC 38 (11%), JPMC 150 (44%) and IPIO 155 (45%). Male predominance was found overall. Patients presented with different forms of injuries at the three centers. Commonest presentation at IPIO was of keratitis, at JPMC of road traffic accidents and at DIMC of corneal and conjunctival foreign body impaction. Most of the patients fell at grade 5 of Ocular Trauma Score.Conclusion:This study showed that the type of inciting agents were different at the three centers respective to their location, surrounding workplaces and the authority of the hospital to attend to medicolegal cases.

Durian seed an uncommon foreign body impaction: a case report

<p class="abstract">Durian is known as the king of fruits. Its seed is an uncommon foreign body impaction on the larynx. A 23-year-old male alleged that durian seed stuck in the throat while eating. He was having difficulty breathing with bouts of coughing. He had a failed Heimlich manoeuvre and rushed to emergency department and subsequently the seed expelled after bouts of violent coughing. Flexible nasopharyngolaryngoscopy was done and showed the arytenoids was swollen, erythematous laryngeal surface of the epiglottis, inflamed inner surface of right anterior and left true chords, ventricles and the false chords. Close observation with intravenous dexamethasone and intravenous antibiotic is paramount in managing the patient. Durian seed impaction on the larynx is rare. This case report showed the function of the larynx as the protective or the watch dog for any foreign body. The endoscopic findings highly suggestive the lodgement of the foreign body on the laryngeal inlet and the appropriate treatment is important in managing such cases.</p>

Role of Intraoperative Endoscopy in the Management of Small Bowel Diseases

With the advances in the endoscopic technology, most of the small bowel diseases are being diagnosed by capsule endoscopy and device assisted enteroscopy. However, there are many clinical situations such as small bowel obstruction, foreign body impaction were these advanced endoscopic procedures cannot be performed. In such cases, intraoperative endoscopy plays a vital role in the management of these small bowel diseases. Intraoperative endoscopy is also very useful in identification of the site of obscure gastrointestinal bleeding in difficult cases. Moreover, capsule endoscopy and device assisted enteroscopy are expensive procedures and not readily available at all medical centers especially in low income countries. On the other hand, intraoperative endoscopy can be easily performed by conventional gastroscope and colonoscope. In this chapter, we have discussed the indications, techniques, outcomes and complications of intraoperative endoscopy in the current era of deep enteroscopy.

Foreign Body Nose: An Unusual Presentation

Introduction This is a very interesting case of retained homicidal foreign body in the nose in contrast to most of the foreign bodies which are accidental. Case Report A 27 year old male presented to ENT emergency with alleged history of assault over face with sharp object following which patient developed nasal bleed. On examination vertical laceration of approximately 8 cm in length was present along left naso-orbital groove extending superiorly from medial canthus of left eye and inferiorly to nasal alar cartilage. On anterior rhinoscopy a metallic foreign body was seen in both nasal cavities, which appeared to be crossing from left to right side piercing the nasal septum. Foreign body was removed via open approach. Discussion Penetrating maxillofacial injury with foreign body impaction are less common. High index of suspicion is required in diagnosing these cases. Radiological intervention should be done to get idea of exact location and extent of foreign body. Lateral rhinotomy is a useful approach in removing these foreign bodies.

Beware of chicken bones: An uncommon presentation of a foreign body in the palate

This paper describes a case of an intra-osseous foreign body impaction in the hard palate, a chicken bone fragment, in an adult male. The presentation mimicked that of an odontogenic lesion. Though palatal soft tissue foreign bodies in toddlers are well reported, the literature is sparse on cases involving adults. The location of the foreign body, and radiographic presentation, resulted in a diagnostic challenge to the attending clinician. This appears to be the first reported case of an animal bone presenting in this way in an adult. CPD/Clinical Relevance: The case highlights the importance of credible history reporting, 3D imaging and developing accurate differentials in the diagnostic pathway when faced with an atypical clinical presentation.

Chronic retained esophageal foreign body: a case report

Chronic esophageal foreign bodies (CEFB) are associated with a high incidence of morbidity and mortality in adults. However, the presentation, management and outcome of chronic esophageal foreign bodies in children are not well described. Seventy-six percent of patients presented with a primary complaint of respiratory symptoms, with respiratory distress being the most common followed by asthmatic symptoms and cough. Twenty-two percent of patients had primarily gastrointestinal symptoms including nausea, vomiting and dysphagia. We present a case report of 2year 6month old male with 3 months history of cough and vomiting later diagnosed to be a case of upper esophageal foreign body impaction.