Presentation
Repeated ingestion of foreign objects presents a multidisciplinary endoscopic dilemma. [ncbi.nlm.nih.gov]
Medical records were reviewed, and information including age at presentation, type of foreign body, side of presentation, length of time in place, signs and symptoms at presentation, management practices, and outcomes was recorded. [doi.org]
Entire Body System
- Inflammation
Last year, she experienced signs of inflammation around the periumbilical area. The patient was treated with antibiotics and daily dressing at a local clinic. [ncbi.nlm.nih.gov]
For example, blackthorns contain an alkaloid that produces intense inflammation. The oils and resins in redwood and cedar splinters also cause considerable inflammation. [accessemergencymedicine.mhmedical.com]
If they irritate they will cause inflammation and scarring. They can bring infection into the body or acquire infectious agents and protect them from the body's immune defenses. [definitions.net]
- Asymptomatic
Presenting Symptoms Child may be asymptomatic Choking, dysphagia, discomfort, drooling and/or vomiting if the foreign body is compressing the larynx or trachea. [pedclerk.bsd.uchicago.edu]
However, the 12-month-old child was asymptomatic, which led to deliberation in regard to wait time for an appendectomy in younger children with asymptomatic appendiceal foreign body. He underwent prophylactic appendectomy after 2 months. [ncbi.nlm.nih.gov]
Foreign bodies that pass through the esophagus are mostly asymptomatic unless perforation or obstruction occurs. [msdmanuals.com]
- Foreign Body Aspiration
For these reasons, the true incidence and prevalence of foreign body aspiration is unknown. [web.archive.org]
The following is a case report of a child who presented in the ED with a carinal push-pin aspiration and a lack of respiratory symptoms; an extremely rare ED presentation of foreign body aspirations masquerading as a foreign body ingestion. [ncbi.nlm.nih.gov]
The most common aspirated foreign bodies in children are peanuts (6). [amj.amegroups.com]
- Unconsciousness
Continue alternating five back blows and five abdominal thrusts until successful or the patient becomes unconscious. In an unconscious patient: Lower the patient to the floor. Call an ambulance immediately. [patient.info]
If obstruction is total - rapidly progresses to unconsciousness and cardiorespiratory arrest. May be present in a child in cardiorespiratory arrest and who it is impossible to ventilate. [rch.org.au]
If the person who has swallowed an object becomes unconscious, lay the person on his or her back on the ground. If you can see an object in the mouth, reach a finger in and sweep the object out. Be careful not to push it deeper into the airway. [mayoclinic.org]
[…] body is still blocking an airway: Stridor (a high-pitched sound usually heard when the child breathes) Cough that gets worse Child unable to speak Pain in the throat area or chest Hoarse voice Blueness around the lips Not breathing The child becoming unconscious [urmc.rochester.edu]
[…] causing an airway obstruction: Stridor (a high-pitched sound usually heard when the child breathes) Cough that gets worse Child is unable to speak Pain in the throat area or chest Hoarse voice Blueness around the lips Not breathing The child may become unconscious [stanfordchildrens.org]
- Lymphadenopathy
[…] esophageal foreign body flat foreign bodies (e.g. coins) tend to lie in the coronal plane in the esophagus 4 lung hyperinflation 6 asthma - usually bilateral viral infection - usually bilateral mass causing bronchial compression e.g. bronchogenic cyst, lymphadenopathy [radiopaedia.org]
Respiratoric
- Aspiration
Foreign body aspirations are commonly seen in emergency departments (EDs) worldwide, presenting with cough, dyspnea, wheeze, and decreased air entry. Chest radiographs are commonly utilized diagnostic tools to confirm foreign object aspiration. [ncbi.nlm.nih.gov]
Most often, the aspirated object is food, but a broad spectrum of aspirated items has been documented over the years. [web.archive.org]
Take Away Points: Referral to ENT will be necessary if ED extraction fails, extraction causes uncontrolled epistaxis or if the foreign body is aspirated. [emdocs.net]
- Cough
Sudden onset of the classic triad (ie, coughing, wheezing, decreased breathing sounds) is frequently not observed. Presenting symptoms (other than cough) include fever, hemoptysis, dyspnea, and chest pain. [web.archive.org]
Foreign body aspirations are commonly seen in emergency departments (EDs) worldwide, presenting with cough, dyspnea, wheeze, and decreased air entry. Chest radiographs are commonly utilized diagnostic tools to confirm foreign object aspiration. [ncbi.nlm.nih.gov]
Children[3] If coughing effectively, just encourage the child to cough, and monitor continuously. If coughing is, or is becoming, ineffective, shout for help and assess the child's conscious level. [patient.info]
There may have been an episode of choking, coughing or wheezing while eating or playing but many episodes are unwitnessed. Symptoms may include persistent wheeze, cough, fever or dyspnoea not otherwise explained. [rch.org.au]
- Respiratory Distress
Respiratory distress. See Inhaled foreign bodies. Tender abdomen on palpation, signs of peritonitis or obstruction. [rch.org.au]
OF ENDOSCOPY Emergent (ASAP) Urgent (< 24 Hours) Non-Urgent (> 24 Hours) Esophageal Location BUTTON BATTERY – NO DELAY Obstructive symptoms Respiratory distress Significant pain Sharp pointed objects Multiple magnets Stomach Location Multiple magnets [chop.edu]
If a patient presents with stridor or respiratory distress, it is best to leave him or her in a position of comfort while getting airway equipment ready and gathering resources such as anesthesia and ENT, if available. [emdocs.net]
These patients may present with choking, refusal to eat, vomiting, drooling, wheezing, blood-stained saliva, or respiratory distress. Imaging studies also may be needed in these patients. [msdmanuals.com]
- Dyspnea
Foreign body aspirations are commonly seen in emergency departments (EDs) worldwide, presenting with cough, dyspnea, wheeze, and decreased air entry. Chest radiographs are commonly utilized diagnostic tools to confirm foreign object aspiration. [ncbi.nlm.nih.gov]
Choking with severe dyspnea, leading to respiratory or cardiac arrest while eating, might be initially misdiagnosed as myocardial ischemia. References [web.archive.org]
Children may otherwise present with cough, dyspnea, or irritability 2,6. Most (70-90%) foreign bodies are organic, most commonly seeds and nuts. Inorganic foreign bodies vary dramatically and can include teeth, coins, pins, pens/crayons, etc. [radiopaedia.org]
Hyperventilation resulting from anxiety and discomfort often gives the appearance of respiratory distress, but actual dyspnea or auscultatory findings of stridor or wheezing strongly suggest the foreign body is in the airway rather than the esophagus. [msdmanuals.com]
blunt foreign body such as coin from esophagus Indications (endoscopy is preferred over these methods) Single coin (or similar flat, blunt object) lodged less than 24 hours (some use 72 hours as cut-off) No prior foreign body, normal esophagus, no Dyspnea [fpnotebook.com]
Gastrointestinal
- Overeating
The tip of the knife was isolated into the cervical esophagoscope, and the salivary bypass tube advanced off the cervical esophagoscope over the knife, shielding the serrated edge during removal preventing laceration to the esophagus. [ncbi.nlm.nih.gov]
This results in a kind of fragmentation and incoherence of the body leading to questions over the coherence of the self in relation to the body. [antonycrossfield.com]
Just lean over the fountain, turn on the water, and keep the eye open. At a sink, stand over the sink, cup the hands, and put the face into the running water. Hold a glass of water to the eye and tip the head back. Do this multiple times. [emedicinehealth.com]
- Choking
Presenting Symptoms Child may be asymptomatic Choking, dysphagia, discomfort, drooling and/or vomiting if the foreign body is compressing the larynx or trachea. [pedclerk.bsd.uchicago.edu]
A history of a choking episode is not always obtained or may have initially been ignored or misdiagnosed. Most patients or parents can identify a specific episode of choking; however, presentation is often delayed by more than a week. [web.archive.org]
If the person is choking and cannot talk, cry or laugh forcefully, the Red Cross recommends a "five-and-five" approach to delivering first aid: Give 5 back blows. Stand to the side and just behind a choking adult. For a child, kneel down behind. [mayoclinic.org]
To prevent choking: Cut foods into small pieces Never let small children run, play, or lie down while eating Keep coins and small items out of reach of your children Read warning labels on toys Learn first aid for choking [urmc.rochester.edu]
Epidemiology Incidence Choking is a risk whenever food is consumed. [patient.info]
- Vomiting
Don't induce vomiting. Don't eat or drink until the x-ray shows the battery is beyond the esophagus. Watch for fever, abdominal pain, vomiting, or blood in the stools. Report these symptoms immediately. Check the stools until the battery has passed. [poison.org]
After admission to the hospital, these patients underwent surgery for the following reasons: (1) failure to spontaneously pass ingested foreign materials; (2) sudden-onset abdominal pain and vomiting during hospitalization; and (3) gastric perforation [ncbi.nlm.nih.gov]
Careful monitoring for persistent vomiting, depression, abdominal discomfort, and/or fever is critical. If vomiting persists, reevaluation is warranted. [merckvetmanual.com]
She has had vomiting and epigastric pain since then. The patient has a long history of similar behavior in the past. [web.archive.org]
Presenting Symptoms Child may be asymptomatic Choking, dysphagia, discomfort, drooling and/or vomiting if the foreign body is compressing the larynx or trachea. [pedclerk.bsd.uchicago.edu]
- Gagging
Often these bristles can be removed in the clinic; however, on occasion, the patient requires general anesthesia for retrieval because of the gag reflex and difficulty with access and visualization. [ncbi.nlm.nih.gov]
Choking / gagging episode as described by mother / caregiver 2. Followed by coughing spells 3. Wheezing 4. Diminished breath sounds When the foreign body moves distally in the airway, symptoms may become less apparent or may even subside. [sites.google.com]
REMOVAL OF FB UNDER GENERAL ANAESTHESIA: • Patient is anaesthetised with cuffed ET tube • Pharyngeal pack placed • If FB is placed posteriorly, patient positioned in rose position and mouth gag applied. • Palate is generally retracted with a catheter [slideshare.net]
Even with anesthesia and sedation, you may gag or experience pain. Your physician may need to adjust the levels of sedative and anesthetic. Ultrasound may be used to guide the foreign body removal procedure. [radiologyinfo.org]
- Nausea
The patient admitted to injecting a suspension of crushed ondansetron (Zofran) tablets into the antecubital area to control post-operative nausea. [ncbi.nlm.nih.gov]
If nausea occurs, an antiemetic is given. Symptoms of corneal abrasion or foreign body include foreign body sensation, tearing, and redness; visual acuity is typically unchanged. [msdmanuals.com]
For intraocular foreign bodies, give systemic and topical antibiotics, apply a shield, control pain and nausea, and consult an ophthalmologist for surgical removal. [merckmanuals.com]
Patients may be in significant discomfort and complain of nausea or vomiting if a live insect is in the ear canal. Patients may present with hearing loss or sense of fullness. Physical The physical examination is the main diagnostic tool. [emedicine.medscape.com]
Cardiovascular
- Palpitations
[…] of children with FB aspiration survive, several die, either due to obstruction of the airway (resulting in choking or reflexive cardiac arrest) or as a result of complications (pneumonia, severe haemoptysis).6,14 Deaths also occur due to blind finger palpitation [elsevier.es]
Jaw & Teeth
- Hypersalivation
The main presenting symptom is acute dysphagia; patients with complete obstruction of the esophagus hypersalivate and are unable to swallow oral secretions. [msdmanuals.com]
Pediatric and mentally handicapped patients may present immediate symptoms of foreign body ingestion, commonly including choking, refusal to eat, hypersalivation, wheezing, and respiratory distress [5]. [ajronline.org]
Skin
- Alopecia
To our knowledge, this is the first report in the English literature of alopecia as an adverse event associated with Radiesse injection. [ncbi.nlm.nih.gov]
Neurologic
- Irritability
Foreign bodies can be inert or irritating. If they irritate they will cause inflammation and scarring. They can bring infection into the body or acquire infectious agents and protect them from the body's immune defenses. [definitions.net]
In order to reduce the irritation of the airway during tracheobronchial foreign body (TFB) removal, tracheal surface anesthesia is usually performed using a laryngotracheal topical anesthesia (LTA) kit (LTA20, Highgreen Medical Technology Company, China [ncbi.nlm.nih.gov]
Clinical features: Symptoms: foreign body sensation, continuous irritation or ocular pain. [columbiaeye.org]
Pain, inflammation, and irritation: The skin in the ear canal and the eardrum is very sensitive. Any inflammation or injury is usually readily apparent due to pain or irritation. [medicinenet.com]
Poor perineal hygiene may cause irritation of the vulva or vagina. [webmd.com]
Workup
Further investigations/workup Radiological assessment is the key to further evaluation following a thorough history and clinical examination. [intechopen.com]
Diagnostic Imaging Diagnostic imaging is an essential component of the workup to determine the presence, location, material, size, and number of OrbFBs. [aao.org]
[…] from children spending more time indoors on rainy days, with greater opportunity to put a small toy in their ear or nose. [6] Differential Diagnosis Abrasions to ear canal Cerumen impaction Hematoma Otitis externa Tumor Tympanic membrane perforation Workup [emedicine.medscape.com]
Imaging exams are helpful, with routine radiography being the preferred imaging modality for the initial workup. However, several types of soft tissue foreign bodies are not radiopaque and therefore remain undetected. [scielo.br]
Treatment
Rectal Foreign Object Treatment 1. Go to a Hospital Emergency Room Do not try to remove foreign object. A hospital emergency room is most likely to have appropriate tools for removal. Delay in treatment could lead to serious injury or infection. 2. [web.archive.org]
MAIN LESSONS: An appendiceal foreign body is very rare in infant and there are currently no treatment guidelines. We report 2 cases of appendiceal foreign body including infant who gave us difficult decisions. [ncbi.nlm.nih.gov]
Prognosis
Open eye injury is one of the commonest ophthalmic emergencies, and when accompanied by intraorbital foreign bodies, the condition carries a poor prognosis. [ncbi.nlm.nih.gov]
With increased awareness and advanced surgical techniques, the outcome and the prognosis for these potentially devastating injuries have substantially improved. [web.archive.org]
Local environments have an important influence on the types of objects aspirated, location in the tracheobronchial tree, and prognosis. [emedicine.medscape.com]
Etiology
Heavy, prolonged menstrual bleeding is common in adolescents and results from a variety of etiologies. [ncbi.nlm.nih.gov]
Pathology Etiology There are many ways in which a foreign body can be introduced into various parts of the human body. [radiopaedia.org]
That patient belongs to gender and age group (20–39 years) most affected by facial trauma, and the etiology of the trauma that attacked him (interpersonal violence) fits as the most frequent [20]. [hindawi.com]
Given the shared traumatic etiology, a corneal foreign body injury may seem like a likely source for RCE to develop from. The reality, however, is that foreign bodies rarely cause this condition. [reviewofoptometry.com]
Etiology of esophageal food impactions in children. J Pediatr Gastroenterol Nutr. 2011 Jan. 52(1):43-6. [Medline]. Pavlidis TE, Marakis GN, Triantafyllou A, Psarras K, Kontoulis TM, Sakantamis AK. Management of ingested foreign bodies. [emedicine.medscape.com]
Epidemiology
This study aimed to analyze the current epidemiology of in-hospital or out of hospital treated foreign object injuries and suspected foreign body injuries in children. [ncbi.nlm.nih.gov]
Common removal methods include use of forceps, water irrigation, and suction catheter. [ 1 ] Epidemiology Foreign bodies of the ear are relatively common. [patient.info]
Epidemiology Most common in children, psychiatric patients and jail inmates IV. History Object swallowed How long ago was the ingestion V. [fpnotebook.com]
Pathophysiology
Because the respiratory tract does not participate in gas exchange, its total volume of the tidal volume is referred to as dead space. 5 Pathophysiological notes After the gastrointestinal tract, the respiratory tract has the highest germ count. [flexikon.doccheck.com]
Pathophysiology The final resting place of and damage caused by an IOFB depend on several factors, including the size, the shape, and the momentum of the object at the time of impact, as well as the site of ocular penetration. [web.archive.org]
Pathophysiology The final resting place of and damage caused by an IOFB depend on several factors, including the size, the shape, and the momentum of the object at the time of impact, as well as the site of ocular penetration. [1, 2] IOFBs transversing [emedicine.medscape.com]
Essential Treatment Considerations The pathophysiology and management of a foreign body wound is dependent upon the material that has punctured the foot, the location, depth and time of presentation, footwear and underlying medical conditions of the patient [podiatrytoday.com]
Prevention
Foreign bodies should be removed within 24 hours to prevent erosive changes. The majority of objects that have passed into the stomach will go through the GI tract. [pedclerk.bsd.uchicago.edu]
Anesthesia/Sedation: Lidocaine or phenylephrine spray can be used to prevent swelling and pain, but should be rarely used due to the risk of causing sneezing and associated aspiration or ingestion of the object. [emdocs.net]
In order to prevent such iatrogenic injuries, which could have fatal consequences, the hospital staff must give particular care in the handling of sharp FBs. [ncbi.nlm.nih.gov]