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A 7 yr old castrated male domestic shorthair presented for assessment of a chronic left head tilt, losses of balance, and positional nystagmus. A computed tomographic scan of the head revealed several fragments of a metallic foreign body in the left tympanic cavity. The foreign material was removed under endoscopic assistance through a minimally invasive ventral bulla osteotomy. No complications were noted during the immediate postoperative period. Follow-up 5 mo after surgery revealed complete resolution of the neurological signs with no evidence of recurrence. Foreign bodies associated with middle ear infection have not been previously reported in the cat. They should now be included in the differential diagnosis of vestibular disease. Endoscopic-assisted foreign body removal in the middle ear seems to be a safe and efficient way to retrieve small foreign bodies in bullae in cats.

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CASE: Bean bag projectiles (BBPs) are less lethal munition composed of a cloth bag filled with lead pellets and marking powder housed in a plastic casing fired from a 12-gauge shot gun. Two patients sustained penetrating BBP injuries that resulted in open fractures and retained BBP. Patient clothing and all BBP components were found deep in the wounds with marking powder surrounding fracture edges. Both patients healed without infection. CONCLUSION: Surgical exploration of penetrating BBP injuries is recommended to remove marking powder, fabric, plastic, and potentially other forms of contamination. Fracture stabilization should adhere to existing guidelines pertaining to open contaminated wound conditions.

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BACKGROUND: There are many types of foreign bodies in the bladder and urethra. The most common way is to insert foreign bodies through the external urethra by oneself or by others. It is often seen in situations such as masturbation, mental disorder, curiosity, etc. This article discusses the clinical diagnosis and treatment methods and preventive measures for foreign bodies in the bladder and urethra caused by sexual fetishes. CASE PRESENTATION: This article introduces a rare case. The patient was a 54-year-old male who inserted a thermometer into his urethra during masturbation and could not remove it. During the operation, we tried various methods to remove the thermometer many times, but due to the angle of the thermometer embedded in the bladder and urethra and the smooth tip of the thermometer, it could not be removed with foreign body forceps. Finally, a homemade negative pressure aspirator (consisting of a section of infusion tube and a 50 ml syringe) was used to completely remove the thermometer from the bladder and urethra. The Written informed consent was obtained from patient did not experience complications such as mercury leakage and bladder and urethral perforation. A telephone follow-up 4 months later showed that the patient urinated smoothly without discomfort such as frequent urination and urgency. DISCUSSION: There are many types of vesicourethral foreign bodies. When treating vesicourethral foreign bodies clinically, these can be removed through endoscopy, laparoscopy or open surgery according to the size, type and nature of the foreign bodies. At the same time, in order to effectively prevent the occurrence of bladder and urethra foreign bodies, sex education should be vigorously promoted.

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INTRODUCTION: Flexible bronchoscopy under anesthesia is a mainstay diagnostic tool for evaluating respiratory disorders in pediatric patients. While flexible bronchoscopy is generally regarded as a safe procedure with low risk for major complications, it does entail additional risks associated with the use of general anesthesia. The use of diagnostic awake flexible bronchoscopy in children is not well documented in current literature. OBJECTIVES: The objective of this case series is to investigate the feasibility and potential utility of awake flexible bronchoscopy in pediatric patients and to highlight important precautions and complications. METHODS: This was a consecutive case series of patients who underwent an awake flexible bronchoscopy over a two year period at a tertiary children's hospital. Data collection included demographics, indications, number of attempts, scope findings, and complications. Successful attempts of flexible bronchoscopy were defined by visualization of the trachea and mainstem bronchi while failed attempts include if the scope entered the esophagus or if cough, vocal fold adduction, or movement prevented the scope from entering the trachea. RESULTS: 11 patients were involved in this study (mean age 20 months, age range 0d to 5y 1m, 72 % male). Common indications for bronchoscopy were suspicion of foreign body (5, 45.4 %), chronic cough (4, 36.4 %), and stridor (4, 36.4 %). The mean number of attempts until successful was 1.72 (range 1-3). One patient experienced a 30-s episode of gagging with mucinous emesis. There were no other complications. One patient ultimately underwent another flexible bronchoscopy under general anesthesia to confirm the findings and to evaluate the tertiary bronchioles and another patient underwent a surgical resection of an oral mass under general anesthesia after awake flexible bronchoscopy. DISCUSSION: Awake flexible bronchoscopy was well tolerated in this study and could serve as a useful diagnostic tool without necessitating anesthetic. However, further study is needed to compare awake flexible bronchoscopy with flexible bronchoscopy under general anesthesia. Additionally, the patients selected for this study were limited to those with minimal risk, such as patients without cardiac disease. Limitations of this technique include suboptimal visualization of subglottic region and limited diagnostic utility for sleep related airway pathologies and cases where therapeutic intervention is needed.

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ABSTRACT: Vaginal discharge is a common gynaecologic complaint in pre-menarchal girls. However, an intravaginal foreign body (FB) must be suspected when it is persistent. We report the case of a referred 4-year-old girl with a 5-month history of persistent foul-smelling vaginal discharge. Clinical examination confirmed purulent vaginal discharge, along with a vaginal granuloma. A hard, intravaginal object was felt through the anterior rectal wall on digital rectal examination. A plain pelvic X-ray revealed a radiopaque object whose intravaginal position was confirmed by ultrasonography. The patient underwent granuloma excision plus FB removal and antibiotic treatment. The 12-month follow-up was unremarkable.

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PURPOSE: Button battery nasal impactions pose serious risks due to complications and the need for prompt removal, yet research on interventions remains limited due to its rare occurrence. To delineate the clinical manifestations of nasal foreign bodies associated with button batteries and to explore treatment approaches focused on minimizing the reliance on general anesthesia and surgical interventions. METHODS: This study focuses on 176 cases of children who received treatment for nasal cavity button battery impactions. It encompasses various factors including age, gender, battery location, impaction duration, methods of extraction, and associated complications. RESULTS: The incidence of nasal button battery cases among nasal foreign body instances was 1.16%, with a majority being males (60.23%) aged 1-5 years (98.29%). Utilizing a specially designed nasal foreign body hook and following established treatment protocols enabled the successful outpatient management of the majority of cases. Only 12 cases (6.82%) necessitated removal under general anesthesia due to management challenges in an outpatient setting. Furthermore, our findings indicated no linear correlation between the duration of battery retention and the risk of nasal septal perforation, which was observed in 31 cases (17.61%). CONCLUSION: Nasal foreign bodies caused by button batteries in children demand urgent attention due to their potentially grave outcomes. Our research is directed towards enhancing diagnostic and therapeutic strategies to bolster the success rates of outpatient removal, curtail the duration of foreign body retention, and diminish the reliance on general anesthesia.

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RATIONALE: Gossypiboma is a term that refers to the condition of accidentally retained surgical gauze after surgeries. While many manifestations and complications are possible in this case, the migration of the retained gauze into the gastric cavity is one of the rarest. In this paper, we report the largest migrated surgical towel to the gastric cavity in the literature, measuring 90 cm × 90 cm. PATIENT CONCERNS: A 33-year-old woman with recurrent epigastric pain unresponsive to treatment was referred to our hospital. She had undergone an open surgery cholecystectomy 11 years before admission during wartime in Syria. DIAGNOSES: Abdominal computed tomography with contrast showed a large mass in the stomach, indicating malignancy. However, upper gastrointestinal endoscopy revealed a gray-black foreign body occupying the entire gastric lumen, which indicated the presence of bezoar. Upon surgery, the final diagnosis of gastric gossypiboma was made; which was a retained surgical towel from the previous cholecystectomy that had fully migrated to the stomach and resembled both malignancy and bezoar upon investigation. INTERVENTIONS: The patient underwent open surgery to excise the foreign body. OUTCOMES: The gossypiboma was successfully removed, and the patient was discharged 5 days after the operation without complications. LESSONS: Retained surgical items, such as gossypiboma, can lead to significant medical complications. The migration of gossypiboma to the stomach, though rare, poses challenges in diagnosis and management, often requiring open surgical removal to prevent adverse outcomes. Early detection and intervention are crucial to avoiding associated morbidity and mortality. It is important to consider gossypiboma in patients with unexplained abdominal pain following surgery and to emphasize meticulous sponge counting to prevent this complication.

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The present report aims to describe the case of a duodenal obstruction ileus in a dairy cow that was caused by a cage magnet. The 4.7-year-old German Fleckvieh cow was hospitalized because of symptoms of intestinal obstruction such as anorexia, noticeable drop in milk yield, reduced defecation, dehydration and positive percussion and swinging auscultation in a circumscribed area cranial of the right flank over the last 2 ribs. Six months as well as 3 days prior to hospitalization the cow had already been treated for signs of hardware disease, which included administration of a cage magnet.After the initial clinical diagnostic procedure on hospital admission, a diagnostic laparotomy in the right paralumbar fossa was performed to identify the cause of the ileus. The cranial part of the duodenum was markedly dilated, and a solid foreign body was found obstructing the intestine immediately aboral to the duodenal sigmoid flexure. This was identified as a cage magnet, which was massaged in retrograde direction into the pyloric antrum and removed via abomasotomy. The cow recovered from surgical intervention and was discharged from the hospital 6 days later.The present report describes an unusual complication of cage magnet administration, which is a standard veterinary procedure and generally considered a safe treatment option in cows with clinical signs of acute traumatic reticuloperitonitis.

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Double-J (DJ) stents are most commonly used urological tools these days. Serious complications may occur when stents are left in place for longer duration. We present a case of a woman in her 40s with a forgotten DJ stent for 4 years, leading to complications such as encrustations, bladder and renal stone formation. The patient underwent a comprehensive endourological approach, including endoscopic cystolithotomy and left-sided percutaneous nephrolithotomy. The case highlights the importance of timely stent removal to prevent complications such as encrustations and stone formation. Patient education and counselling are crucial to avoid poor compliance and the associated risks of forgotten stents. This case underscores the significance of a multidisciplinary approach and emphasises the need for proactive measures to prevent such complications, including the implementation of a stent placement registry.

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Hardware breakage in the form of guide wire or drill bit is a devastating complication particularly if occurs around hip joint during cephalo-medullary nailing. It should be removed on urgent basis as it can migrate to the pelvic cavity and damages adjacent neuro-vascular bundle and visceral organ immediately as well joint arthritis later on. There are very few cases report available in the literature with retrieval techniques by using disc forceps, pituitary forceps, oversized reamers, arthrotomy with joint dislocation and through ilioinguinal approaches occasionally. We are presenting an interesting and rare case of broken guide wire inside hip joint protruding into the pelvic cavity which got retrieved through lower midline open laparotomy approach.

RésuméLa rupture du matériel sous forme de fil de guidage ou de foret est une complication dévastatrice, en particulier si elle se produit autour de l'articulation de la hanche lors du clouage céphalo-médullaire. Il doit être retiré de toute urgence car il peut migrer vers la cavité pelvienne et endommager immédiatement le faisceau neuro-vasculaire et l'organe viscéral adjacents, ainsi que l'arthrite articulaire plus tard. Il existe très peu de cas rapportés dans la littérature avec des techniques de récupération utilisant des pinces discales, des pinces hypophysaires, des alésoirs surdimensionnés, des arthrotomies avec luxation articulaire et occasionnellement par des approches ilio-inguinales. Nous présentons un cas intéressant et rare de fil guide cassé à l'intérieur de l'articulation de la hanche faisant saillie dans la cavité pelvienne, qui a été récupéré par une approche de laparotomie ouverte sur la ligne médiane inférieure.

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Following an ileal conduit (IC) urinary diversion for intractable urinary incontinence, a woman in her 50s presented with deteriorating renal function during a routine follow-up. This decline prompted further investigation with an ultrasound scan (USS), which demonstrated bilateral hydroureteronephrosis and an atrophic left kidney. Although the mercaptoacetyltriglycine (MAG-3) renogram was inconclusive in revealing urinary obstruction, a subsequent computed tomography (CT) scan uncovered a calcified tube-like structure within the IC and hydroureteronephrosis extending to this level.To address the obstructive uropathy, a right nephrostomy was inserted, which resulted in improved renal function. A looposcopy was then performed, revealing an encrusted urethral catheter within the IC. Using techniques adapted from percutaneous nephrolithotomy, we were able to endoscopically fragment the encrustation on the catheter and remove it intact through the IC.

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Lung abscesses are uncommon in the paediatric population, often manifesting with cough, shortness of breath, chest pain and fever. A high index of suspicion is imperative to prevent delays in treatment. This is a case report of a previously healthy child in early childhood with a 5-month history of recurrent left upper lobe (LUL) pneumonia. A foreign body was identified in the LUL and removed via flexible bronchoscopy. Following the foreign body removal, the patient developed a 9 cm lung abscess. A high index of suspicion for a lung abscess post-foreign body removal is important for early diagnosis and ensuring appropriate antibiotic coverage in patients with persistent fever. Intravenous antibiotics are essential in the management of lung abscesses. Consideration should be given to percutaneous drainage in situations where there is minimal improvement after 72 hours of suitable antimicrobial therapy or when the abscess exceeds 6 cm in size.

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Ballistic embolism represents an unusual complication of vascular by a flying object injury. Because embolus is remote from injury site, the occurrence of missile embolus may be overlooked and lead to delay in diagnosis of significant ischemia or embolism. We herein report a successful surgical removal of a rare missile embolus from the upper arm in the right ventricle. A 44-year-old man visited our hospital because of pulsatile bleeding from the left upper arm due to injury by a flying metal fragment of a hammerhead. Chest roentgenogram and computed tomography (CT) scan 9 days after the injury demonstrated a missile embolus in the right ventricle, which was thought to be ballistic embolism of the metal fragment. We underwent surgical removal of the retained object under cardiopulmonary bypass uneventfully, and discharged home ten days later.

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It is unusual to see complications with the preparation of ear mold in order to get hearing aids for children who are in need. However, we came across 2 cases who had a foreign body retained in the middle ear after a long period of time from taking silicon mold impression for hearing aid fitting. One patient presented after 2 years, and the other patient presented after 10 years of hearing aid fitting. We are reporting 2 cases with silicon impression material left in the middle ear for a long period of time after taking an impression for hearing aid fitting and found unexpectedly during exploratory tympanotomy. These reported cases are among the few cases reported worldwide without clear known incidence. This necessitates proper examination by otolaryngologists and the audiologists who are responsible for taking the impression to prevent such complications.

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Pancreatitis caused by a fish bone penetrating the posterior wall of the stomach and entering the pancreas is rare. We herein report a case involving a woman in her late 30s with an approximately 1-month history of recurrent upper abdominal pain. Initial evaluation at another hospital failed to identify the cause but raised suspicion of pancreatic cancer. Computed tomography, magnetic resonance imaging, and a detailed consultation led us to suspect that the patient's pain had been caused by inadvertent ingestion of a fish bone. We used three-dimensional visualization technology to determine the location of the fish bone and informed the patient of the lesion and surgical plan through a simulated surgical demonstration. During surgery, we applied augmented reality navigation technology to remove the fish bone by a minimally invasive approach. The patient was discharged on postoperative day 3. She was followed up by telephone 24 hours after discharge. Outpatient follow-up was performed 1 week after discharge and on day 30. The patient recovered well and developed no complications. This case shows that digital medical technology can be applied in patients undergoing surgical removal of a pancreatic foreign body. Such technology assists with preoperative evaluation, patient education, and intraoperative trauma reduction.

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BACKGROUND: Ingestion of foreign bodies may be seen unconsciously or intentionally in patients with mental health problems. Most cases pass through the esophagus slowly; however, in some cases, the tumor may be located in narrower areas of the digestive tract that require endoscopic or surgical intervention. This study describes a rare case of successful removal of more than 450 pieces of metal objects from the stomach of a 36-year-old man via ingestion of foreign bodies at Imam Khomeini Hospital in Ahvaz. CASE PRESENTATION: A 36-year-old male patient (Aryan race) presented with complaints of chronic abdominal pain, frequent vomiting, and intolerance to liquids and food. The patient's companions mentioned a history of gradual ingestion of small metal objects 3 months prior. The patient was conscious and had stable vital signs. In the patient's X-ray and endoscopy, multiple metal objects inside the patient's stomach were observed, causing gastric outlet obstruction. The patient underwent gastrostomy surgery, and 452 screws, nuts, keys, stones, and other metal parts weighing 2900 g were removed from the stomach. Five days after the operation, the patient was transferred to the psychiatric service in good general condition and was diagnosed with psychosis, and her condition returned to normal at follow-up. CONCLUSION: Successful removal of this foreign body is rare. In chronic abdominal pain, especially in the context of psychiatric disorders, attention should be given to the ingestion of foreign bodies. In swallowing large amounts of sharp and metallic foreign objects, surgical intervention is necessary, especially in cases of obstruction, and saves the patient's life.

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BACKGROUND: Fish bone ingestion is commonly encountered in emergency department. It poses a diagnostic and therapeutic challenge particularly when it migrates extraluminally, necessitating a comprehensive and multidisciplinary approach for successful management. CASE PRESENTATION: Here we reported four cases of extraluminal fish bone. The first patient was a 68-year-old Chinese man who had odynophagia shortly after a meal involving fish. The second was a 50-year-old Iban man who reported a sharp throat pain after consuming fish 1 day prior. The third patient was a 55-year-old Malay woman who developed throat pain and odynophagia after consuming fish 1 day earlier. The fourth patient, a 70 year-old Iban man, presented late with odynophagia, neck pain, swelling, and fever 1 week after fish bone ingestion. These unintentional fish bone ingestions faced challenges and required repeat computed tomography scans using multiplanar reconstruction in guiding the surgical removal of the fish bone. CONCLUSION: We underscore the significance of multiplanar reconstruction in pinpointing the fish bone's location, demonstrating the migratory route, and devising an accurate surgical plan.

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INTRODUCTION: Lost objects and equipment malfunctions during robotic and laparoscopic cases can lead to an increase in operating time and potential risk to the patient. The literature on the management of foreign bodies during pediatric robotic-assisted surgery is limited. The purpose of the video is to review proper instrument handling to prevent loss of an object and to propose our technique for retrieving lost objects through two pediatric case examples. MATERIALS AND METHODS: The first case is a robotic-assisted laparoscopic left pyeloplasty in a 6-week-old male with congenital uteropelvic junction obstruction during which a needle was lost. In the video, we describe our techniques for safe needle passage, proper suturing technique, and recovering a lost needle. The second case is a robotic-assisted right upper pole heminephrectomy in a 14-month-old female with a duplicated renal collecting system and hydroureteronephrosis. We present the management of a rare case during which a harmonic scalpel jaw malfunctioned leading to a lost foreign body. We describe our technique for retrieving the lost fragment. RESULTS: All objects were safely removed, and patients were discharged post-op day one without complication. CONCLUSION: Our video presents two case examples of foreign bodies lost during pediatric robotic surgeries and approaches to manage each of these incidents.

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