過去２０年間の気道異物症例の検討

A statistical study was made of 137 cases of esophageal and 10 cases of tracheobronchial foreign bodies treated in our clinic during the 11 years from 1983 to 1993. The results were as follows:1) Of the 137 cases of esophageal foreign bodies, 68 were males and 69 were females. There were no year-to-year changes in the incidences and sex distributions.2) Two peaks were observed in the age distribution of the esophageal foreign bodies, one in infants under 9 years old and the other in adults over 50. These were especially prominent in male infants and female adults.3) The foreign objects were PTPs (press through pack for medicine, 24%), coins (21%), fish bones (17%), artificial teeth (11%) and others. The most frequent object in the infants was coins; on the other hand, PTPs, fish bones, artificial teeth and pieces of meat were frequently observed in adults.4) The present results indicate that the incidence of the elderly people over 70 and the percent of PTP foreign bodies of our clinic were higher than reported elsewhere.5) Of the 10 cases of tracheobronchial foreign bodies, 7 were males and 3 were females. The annual incidence has not changed markedly.6) Eighty percent of the total tracheobronchial foreign body cases were under 2 years old, and 20 percent were over 70 years old.7) Beans were the most common tracheobronchial foreign bodies in infants, and false teeth were found in 2 cases of elderly people. Foreign bodies were more often seen in the right bronchus.8) In order to prevent esophageal and tracheobronchial foreign bodies, it is necessary to emphasize the dangerous features of PTP, fish bones and artificial teeth to elderly people and their families, in addition to the danger of coins and beans to the parents of infants.

Between 1977 and 1986, 15 cases of tracheobronchial foreign bodies in infants and children were treated. The ages ranged from 6 months to 2 years and 5 months. The most frequent foreign body was peanuts (8 cases). The location of foreign bodies was mostly in the right main bronchus (8 cases). The most common chief complaints were stridor and cough.For the management of respiration, ventilating bronchoscopy was used in 6 cases, tracheotomy in 3, high-frequency positive pressure breathing in 2 and spontaneous respiration in 9. Some of the methods overlapped. We recommend combined use of modified-neuroleptanesthesia and topical anesthesia under spontaneous respiration for removal of the tracheobronchial foreign body in infants and children.

Logistic regression analysis of risk factors for prolonged pulmonary recovery in children from aspirated foreign body

Foreign body in glottis especially in infants is rare. Retrieval of foreign body is a rather simple procedure but sharing of the airway with the anaesthetist and impeding complication makes it more challenging and dangerous. Making a diagnosis of foreign body is most challenging in delayed cases. Complete history and detailed physical examination along with high index of suspicion, in cases of persistent cough, fever, nonresolving respiratory infection, are needed to rule out airway especially laryngeal foreign body. This series of 4 cases is being reported because of the rarity of the glottis foreign body in infants.

Tracheobronchial Foreign Bodies in Children: Imaging Assessment

Foreign bodies in the kidneys are extremely rare, particularly in pediatric patients. We report a unique case of a nine-month-old male infant who was incidentally found to have a needle in his left kidney during evaluation for a lower respiratory tract infection. The foreign body was initially identified on chest X-ray and confirmed by a computed tomography scan. The infant had a history of transient swelling in the left lumbar region during the neonatal period, which resolved spontaneously, suggesting a possible entry point. Despite being asymptomatic, surgical intervention was deemed necessary due to the metallic nature of the foreign body and its potential for complications. A laparoscopic approach was successfully used to remove the 3 cm needle, which was identified as a broken hypodermic injection needle. The kidney was preserved, and no postoperative complications were observed. The infant's recovery was uneventful, with normal renal function and imaging during follow-up. This case highlights the rarity of renal foreign bodies in infants, the effectiveness of laparoscopic surgery for their removal, and the importance of early recognition and timely intervention to prevent long-term complications. The report also discusses potential risks associated with outdated practices, such as the broken needle technique, which involves intentionally breaking a hypodermic needle for collecting blood samples from neonates and infants, and emphasizes the need for improved safety protocols and awareness in pediatric procedures.

A statistical study was made of 69 cases of tracheo-bronchial foreign bodies treated at our clinic during the 16 years from 1978 to 1994. Fifty-five cases (80%) were under 3 years of age and 38 cases (55%) were one-year-old babies. The foreign bodies were found in the right bronchus in 24 patients, in the left bronchus in 32 patients, and in the trachea in 6 patients. Of the various kinds of foreign bodies removed, peanuts predominated (34 cases, 49.3%). The foreign bodies were removed by means of a ventilation bronchoscope under general anesthesia. Most of the cases were treated within a few days successfully. However, the longest period of lodgement was 87 days.

SummaryThe accidental ingestion of sharp foreign bodies into the upper‐gastrointestinal tract is not uncommon in children. Endoscopic extraction of these objects poses technical difficulties, and a number of dangerous complications can occur. We present two cases of successful retrieval of large, sharp gastroesophageal foreign bodies in small children using a new, commercially available endoscopic end protector hood that prevents exposure of the esophageal and pharyngeal wall to injuries and laceration by the foreign body. This device is simple to use, versatile, and effective and advances the safe endoscopic removal of a variety of gastroesophageal foreign bodies in pediatric patients.

Two infants inhaled eggshell fragments. The first aspirated a small fragment into the upper part of the trachea and resuscitation attempts resulted in descent of the foreign body to the right lower lobe bronchus. Two attempts at bronchoscopy were unsuccessful and spontaneous disintegration occurred. The second infant aspirated an eggshell fragment to the entrance of the larynx where it was removed by laryngoscopy. Laryngeal or tracheal foreign body in infants under 1 year of age are rare, and the diagnosis and removal are difficult.

AGREEMENT has not yet been reached regarding the treatment of foreign bodies of the airway in infants. 1-3 The smaller the child, the greater the technical difficulties and frequency of complications arising from removal of foreign bodies. The reduced tolerance of infants and their particular susceptibility to anoxia requires careful bronchoscopy with delicate manipulation of instruments. Our bronchological experience in childhood are based on more than 3,000 bronchoscopies and over 1,000 bronchographies in children ranging from under 1 year to 14 years of age during a ten-year period. Some 1,800 bronchoscopies have been performed with intravenous barbiturate narcosis and succinyl muscle relaxation, including about 200 infants, the youngest being 4 days of age. 4-6 Both the barbiturate narcosis and succinyl muscle relaxation were well tolerated by all the infants and the respiratory depressive action of the barbiturates was balanced by continuous oxidation. This method of anesthesia proved to be safe

2091543 Wooden Toothpick with Two Sharp Tips Pierced the Gallbladder: A Very Rare Clinical Case Report

Objective To analyze the clinical effects of endoscopic treatment of foreign bodies in the upper gastro intestinal tract. Methods A total of 168 patients, aged from 80 days to 100 years, with foreign bodies in the upper gastro- intestinal tract treated by endoscopy in the First Affiliated Hospital of Zhengzhou University from September 2017 to September 2018 were selected. The relationship between foreign body type, foreign body location and patient’s age was analyzed to explore the influencing factors of complications. Results One hundred and sixty-eight cases of foreign bodies in the upper gastro- intestinal tract were more common in elderly patients, accounting for 44.1% (74/168); 78.0% foreign bodies (131/168) were in esophagus; and 53 cases of foreign bodies were jujube pits.Foreign bodies in children were mainly distributed in the esophagus and stomach, accounting for 51.2% and 39.0% respectively. The foreign bodies in the middle and young age were mainly distributed in the esophagus and stomach, accounting for 77.4% and 18.9%, respectively. The foreign bodies in the elderly were mainly distributed in the esophagus, accounting for 93.2%. The main types of foreign bodies were different among children, middle and young persons and the elderly. The success rate of endoscopic foreign body removal was 98.2%(165/168), and 53.6% (90/168)of patients had local complications, and 94.4% of them (85/90) recovered after medical treatment. All complications were considered to be caused by the foreign body itself, and no complications occurred during the treatment of the foreign body. The incidence of complications was related to age, foreign body location and foreign body types. The proportion of elderly patients with associated digestive tract diseases was 33.8%, and other operations could be performed while removing foreign bodies under endoscopy. Conclusions Therapeutic endoscopy is the most significant method treating foreign bodies in the upper gastrointestinal tract, which has great safety and effectiveness. Meanwhile, it has great value in discovering invisible diseases and treating primary diseases or complications. Key words: Foreign bodies in the upper gastrointestinal tract; Endoscope; Child; Elderly

Background: Tracheobronchial foreign body aspiration is a common emergency case, particularly in children. It happens mostly in children, causing airway obstruction and accidental death. Bronchoscopy is the gold standard of both diagnostics and therapeutics, but despite rapid developments in anesthesia techniques and bronchoscopic instrumentation, airway foreign body extraction is not an easy procedure to perform. Purpose: To demonstrate various approaches that can be employed to extract difficult tracheobronchial foreign bodies. Case report: This case report presented four cases of difficult extraction of peanut foreign body in the tracheobronchial tract that utilized different approaches of extraction. In all four cases, the foreign body was extracted successfully. Clinical question: What are the options available for difficult extraction of tracheobronchial peanut foreign body? Method: Evidence-based literatures study about approaches of tracheobronchial foreign body extraction was performed through PubMed, Google Scholar database, and hand searching/e-book. Result: A total of 5 relevant articles in pertaining to difficult extraction of tracheobronchial foreign bodies were found. Conclusion: There were multiple approaches for extracting tracheobronchial foreign body that could be costumized to each case. Keywords: tracheobronchial foreign body, peanut foreign body, difficult extraction ABSTRAK Latar belakang: Benda asing traktus trakeobronkial adalah salah satu kasus benda asing tersering pada keadaan gawat darurat. Kondisi tersebut paling sering terjadi pada anak-anak, menyebabkan sumbatan jalan nafas dan kematian. Bronkoskopi merupakan baku emas diagnostik sekaligus terapeutik, , akan tetapi walau telah terjadi perkembangan pesat dalam teknik anestesi dan instrumentasi bronkoskopi, ekstraksi benda asing di jalan napas bukan suatu prosedur yang mudah untuk dilakukan. Tujuan: Memaparkan berbagai pendekatan ekstraksi yang dapat dilakukan pada kasus sulit benda asing trakeobronkial. Laporan kasus: Dipaparkan empat kasus ekstraksi sulit benda asing kacang tanah di saluran trakeobronkial yang menggunakan pendekatan ekstraksi yang berbeda. Pada semua kasus, benda asing berhasil diekstraksi. Pertanyaan klinis: Apa saja pilihan pendekatan yang tersedia pada kasus ekstraksi sulit benda asing kacang trakeobronkial? Metode: Studi literatur berbasis bukti mengenai pendekatan ekstraksi benda asing trakeobronkial dilakukan melalui PubMed, basis data Google Scholar, dan pencarian manual/e-book. Hasil: Didapatkan 5 artikel yang relevan mengenai ekstraksi benda asing trakeobronkial. Kesimpulan: Terdapat beberapa pendekatan yang dapat digunakan untuk mengekstraksi benda asing trakeobronkial, yang dapat disesuaikan dengan masing-masing kasus. Kata kunci: benda asing trakeobronkial, benda asing kacang, ekstraksi sulit

저자들은 기관지 내에 이물이 있음을 알고도 장기간 간과하여 이로 인해 대량객혈과, 폐쇄성 폐렴 등이 발생하였고 이물의 자발적인 제거로 임상 증상 및 방사선적인 호전을 보인 증례 1예를 경험하였기에 보고하는 바이다. 또한 증상이 없는 폐 이물질이 우연히 발견된 경우에도 향후 이물질로 인한 합병증 발생의 가능성을 생각해서 제거에 대한 필요성을 환자에게 적극적으로 알릴 필요가 있다는 점을 느낀 증례이다.

Although not common, cases of foreign bodies are important and interesting. Foreign bodies enter the body by trauma or iatrogenic injuries. Because of the thin nature of the bony orbital...