Penetrating head injury from angle grinder: A cautionary tale

Background. The goal is to demonstrate the possibilities of using various methods to stop bleeding from the liver due to a thoracoabdominal gunshot wound. Materials and methods. Male patient aged 25 years was wounded in the chest during mortar shelling. An hour after the wound, he was taken to the advanced surgical group in serious condition, and the right thoracocentesis, drainage of the pleural cavity according to Blau, and primary surgical treatment (PST) of the wounds were performed. After 2 hours, the patient was taken to the Military Medical Clinical Center of the Northern Region of the Military Medical Service of the Armed Forces of Ukraine, and hospitalized in the emergency department. The diagnosis was: combined gunshot shrapnel wound of the chest, abdomen, and extremities. Blind thoracoabdominal wound on the right with a comminuted fracture of the VIII rib, damage to the lower lobe of the right lung, right lobe of the liver, right kidney with the presence of a foreign body (metal fragment) in the retroperitoneal space. Right-sided hemopneumothorax, pneumonitis. Hemoperitoneum. Blind wound of the soft tissues of the right shoulder and the presence of a foreign body (metal fragment). Operations: thoracocentesis, drainage of the right pleural cavity according to Blau. PST of gunshot wounds. The patient was examined, laboratory tests were performed: general clinical blood, urine tests, biochemical blood test, blood coagulogram, blood group and Rh factor, thromboelastography, blood electrolytes, alkaline-base composition and blood gases, ultrasound examination of the chest and abdominal organs according to the FAST protocol, multislice computed tomography (MSCT) of the head, chest, abdominal organs and pelvis with and without contrast, radiographic examinations of the head, chest and abdominal organs, electrocardiography, angiographic diagnosis and final stoppage of bleeding, removal of a foreign body using a multifunctional magnetic instrument for the diagnosis and removal of metallic ferromagnetic foreign bodies. Hemostasis from the liver wound was achieved by suturing the liver wound, Pringle maneuver, tamponade with gauze, using a Bowa ARC 303 high-frequency electrosurgical device, an isolated output electrosurgical generator Valleylab™ LS10, and a Medtronic AEX™ generator Aquamantys. Surgical interventions were performed using the (DCS) technique. Results. Upon admission, chest and abdominal ultrasound using the FAST protocol was done: fluid in the right pleural cavity and abdominal cavity. MSCT of the head, chest, abdominal organs and pelvis was also performed, which revealed a gunshot fracture of the right VIII rib, post-traumatic pneumonitis of the lower lobe of the right lung, signs of damage to Sg6, Sg7, Sg8 of the liver, gauge in the liver, foreign body (metal fragment) in the area of the upper pole of the right kidney, pleural drainage in the pleural cavity, signs of small hemopneumothorax, signs of hemoperitoneum. On the first day, 3 hours after the injury, DCS I was performed. Laparotomy, revision of the abdominal organs and the right extraperitoneal space. Atypical resection of Sg6, Sg7, Sg8 of the liver. Suturing and hemostasis of the liver. Suturing of the right dome of the diaphragm. Removal of a foreign body (metal fragment) using a multifunctional magnetic instrument for the diagnosis and removal of metal ferromagnetic foreign bodies. “Sandwich” liver tamponade. Suturing of the upper pole of the right kidney. Sanitation and drainage of the abdominal cavity. Closed laparostomy. Revision of the abdominal organs, hemostasis and suturing of the liver, “sandwich” liver tamponade, sanitation and re-drainage of the abdominal cavity. Closed laparostomy. The diagnosis was established: combined gunshot shrapnel wound of the chest, abdomen, and extremities. Blind thoracoabdominal wound on the right with a comminuted fracture of the VIII rib, damage to the lower lobe of the right lung, right lobe of the liver (AAST IV), right kidney (AAST III) with the presence of a foreign body (metal fragment) in the retroperitoneal space. Right-sided hemopneumothorax, pneumonitis. Hemoperitoneum. Blind wound of the soft tissues of the right shoulder and the presence of a foreign body (metal fragment). Operation: thoracocentesis, drainage of the right pleural cavity according to Blau. PST of gunshot wounds. Signs of intra-abdominal bleeding appeared the next day with blood being removed from the abdominal cavity through drainage. MSCT of the head, chest, abdominal and pelvic organs with contrast was performed, signs of extravasation of contrast material into the abdominal cavity were detected. The next day, due to the presence of intra-abdominal bleeding from the liver, a re-look, revision of the abdominal organs, hemostasis and re-tamponade of the liver, sanitation, re-drainage of the abdominal cavity, and laparostomy were performed. Twelve hours after a re-look, intra-abdominal bleeding relapsed. The operation was performed: revision of the abdominal organs, hemostasis and re-tamponade of the liver, sanitation, re-drainage of the abdominal cavity, laparostomy. A day after the injury, endovascular embolization of the branches of the right hepatic artery was performed due to recurrence of intra-abdominal bleeding from the liver. Diagnostic angiography of the liver vessels was performed, during which the source of bleeding was identified as a pseudoaneurysm from one of the branches of the right hepatic artery. The right hepatic artery originates from the superior mesenteric artery. Superselective catheterization of the damaged branch of the right hepatic artery and its embolization were performed. Hemostasis was achieved. Two days after the injury, a re-look, revision of the abdominal organs, liver detamponade, sanitation, re-drainage of the abdominal cavity, and a closed laparostomy were performed. Four days after the injury, left re-thoracocentesis and drainage of the pleural cavity according to Blau were conducted due to an increase in the amount of fluid in the pleural cavity. On the fifth day after the injury, the patient was transferred to the next level of medical care. It is known that subsequently, on the 10th day, an atypical liver re-resection was performed with laparostomy closure, and the patient was discharged on the 21st day with presentation to the military medical commission and provision of sick leave for 30 calendar days. Conclusions. The presented clinical case of endovascular hemostasis in the comprehensive treatment of gunshot wounds of the liver complicated by abdominal bleeding using the damage control surgery against the background of anatomical features of the right hepatic artery origin showed its high effectiveness.

A relatively large foreign body (ham bone) was seen in the left upper lobe bronchus of a 25-year-old woman and was successfully extracted with the use of a standard fiberoptic bronchoscope. Although the removal of foreign bodies by the fiberoptic bronchoscope has serious technical limitations, the use of this instrument should be considered when the foreign body is not within range of the rigid bronchoscope.

Tracheobronchial foreign bodies in preterm neonates are extremely rare. They are usually iatrogenic and associated with dislodgement of medical devices. The narrow airways of neonates pose a challenge in removal of foreign bodies. The obstructing object or attempt of removal in itself may cause significant morbidity or mortality. We report a rare case of pulmonary hemorrhage secondary to a tracheobronchial foreign body in an extremely preterm infant and its successful removal. Literature reviews show atelectasis, pneumonia, and respiratory distress being the most common complications from a tracheobronchial foreign body. Removal of tracheobronchial foreign bodies in the narrow airways of neonates can be a grueling task with multiple risks. A high index of suspicion is needed for early detection of foreign body in the airways to avoid morbid complications.

Purpose: Numerous studies have focused on techniques for detecting foreign bodies in soft tissue in the hand, but removal remains a subject of interest. In this study, we describe the microscope-assisted removal of foreign bodies in the hand. Methods: We reviewed records of patients treated for foreign bodies in the hand at our department from July 2013 to May 2023. In 16 patients aged 23 to 55 years, the following variables were analyzed: the cause of trauma; the time interval from trauma to surgery; the location, type, size, and number of foreign bodies; patient complaints; imaging technique; and procedure type. Under local anesthesia, a slit incision was made at the suspected site. Foreign bodies were completely removed using micro-instruments under microscopic guidance. Results: Stab injuries were the most common (n=13), and there was one case each of abrasion, traffic accident, and bee sting. The middle finger (n=5) was the most affected, followed by the thumb (n=4), index (n=3), little finger (n=2), ring finger (n=1), and palm (n=1). Foreign bodies included glass (n=6), wood (n=4), seashell (n=2), fish bone, a pencil tip, a bee stinger, and metal. Their size ranged from 1 to 20 mm. Patient complaints included a foreign body sensation, localized pain, swelling, discoloration, and a skin lesion. X-ray examinations were performed in all cases, and ultrasonography was conducted in five cases. Conclusion: A microscopic approach allows precise, safe, and complete removal of foreign bodies without tissue damage, highlighting the efficacy of this technique in hand surgery.

Tracheobronchial foreign bodies (FBs) are frequently present in adults. This study reports our experience with the managements of FB and FB-related complications using flexible bronchoscopy. We retrospectively reviewed the adult patients with FBs treated between 2001 and 2011 in China. The demographic and endoscopic data were collected and analyzed. A total of 200 adult patients (136 men and 64 women) with an average age of 51 years were analyzed. The most common FBs included bones (51.0%), nut shells (15.0%), food boluses (7.0%), plastic toys or pen caps (6.5%). After FB aspiration occurred, only 11.0% were diagnosed within three days, while more than half of the patients (58.0%) delayed the diagnosis by more than one month. The incidence of FB-related complications was 79.5%, including granulation formation (76.5%), obstructive pneumonia (22.0%), hemorrhage (14.5%), atelectasis (10.0%) and endobronchial stenotic scarring (8.0%). In 96.5% of the patients, the FBs were successfully removed under flexible bronchoscopy. A total of 53 out of the 153 patients with granulation (34.6%) were managed by argon plasma coagulation (APC) or cryotherapy; two out of the sixteen patients with endobronchial stenotic scars were treated by balloon dilation under flexible bronchoscopy. A high incidence of FB-related complications occurs, likely as a result of the long delay between aspiration and diagnosis, a proportion of which require endoscopic intervention. The removal of FBs under flexible bronchoscopy has a high success rate and therefore should be recommended for adults.

An 88‐year‐old bedridden man with Alzheimer's disease developed fever and hypoxaemia. Chest radiography showed obstructive pneumonia caused by a foreign body in the airway. Examination using a flexible bronchoscope revealed a silver‐crowned molar, thought to have fallen out due to root caries, at the left lower lobe branch. Removal of the foreign body was unsuccessful with grasping or basket forceps, but successful with cryoadhesion using a cryoprobe. Removal of an airway foreign body by a cryoprobe depends on the nature of the foreign body, namely its water content. Therefore, cryoprobes are not inherently suitable for removing foreign bodies of aspirated teeth, but a tooth covered with mucus for a long time after aspiration can be cryoadhered with cryoprobes. Airway foreign bodies that remain in the airway for a long time should also be considered for removal by cryoprobe, regardless of the water content of the material.

To examine the diagnostic and therapeutic role of fiber-optic and rigid bronchoscopy in pediatric patients with foreign body inhalations. From January 1986 to December 2004, we observed 128 young patients with suspicion of foreign body aspiration. Patients were divided into 3 groups: group I, patients with negative chest X-ray; group II, patients with radiological direct signs; group III, patients with radiological indirect signs. Removal of the foreign body was effected in 105 patients by rigid bronchoscopy and in 13 patients by fiber-optic bronchoscopy. In 3 group II patients a thoracotomy with a bronchotomy was necessary. Fiber-optic bronchoscopy showed a diagnostic accuracy rate of 100 % but played a poor therapeutic role with a case resolution of 10.7 %. Rigid bronchoscopy was the main technique, permitting the removal of the tracheobronchial foreign body in 97.2 % of patients.

Removal of a foreign body by rigid bronchoscope after virtual reality-aided presurgical planning: A case report

Evaluation of pulmonary reexpansion in a porcine model of bronchial foreign body.

Orbitocranial penetrating injury should be considered a neurosurgical emergency in order to avoid potential infectious and neurologic sequelae. Incomplete removal of a foreign body may lead to complications that can be avoided. This is a case report of a 15-year-old male who sustained orbitocranial penetrating trauma with a tree branch. Management of orbitocranial penetrating injury with a foreign body is described. We discuss the importance of urgent diagnosis and foreign body removal in order to avoid infectious and neurologic complications and the utility of a skull base style of cranio-orbital exposure to facilitate the safe complete removal of the foreign body. Because of potential infectious and neurologic sequelae, appropriate neurodiagnostic studies and exploration with foreign body removal should be performed without undue delay in cases of orbitocranial penetrating injury. Appropriate antibiotic coverage should be initiated immediately. The operative approach should be tailored to the anatomic location of the foreign body penetration. In cases that involve the anterior and middle cranial compartments, it is necessary and beneficial to utilize a skull base style of neurosurgical exposure in order to completely extract the penetrating foreign bodies while avoiding further injury to adjacent neurovascular structures. A literature review is also presented.

Intracranial foreign bodies are typically removed via a craniotomy, which carries significant peri-operative risks. Nasal endoscopy for removal of intracranial foreign bodies is rare and has been attempted only a few times. Here, we describe a case in which nasal endoscopy was employed to successfully remove an air rifle pellet from the anterior cranial fossa, with subsequent repair of the associated cerebrospinal fistula. We thus advocate nasal endoscopy as an alternate line of management for the removal of foreign bodies from the anterior cranial fossa when possible, due to its significantly lower associated morbidity, provided adequate neurosurgical backup is available if required.

The removal of foreign bodies from the esophagus with a Foley catheter is a simple, safe, and highly successful procedure. This technique should be used initially when managing a blunt foreign body in the esophagus; it reduces the risk, time, and expense involved in endoscopic removal.

Transthoracic Removal of Pulmonary Artery Foreign Body by Percutaneous Balloon Occlusion

To describe the use of intraoperative fluoroscopy as an aid in the removal of radio-opaque orbital foreign bodies. A retrospective interventional case series of 12 patients with orbital foreign bodies that required removal for various indications. All patients underwent orbitotomy and removal of the foreign bodies with the aid of real-time intraoperative fluoroscopic localization. The orbital foreign body was successfully removed without complication in all 12 patients. One patient with ethmoid sinusitis preoperatively had resolution of the infection after surgery. Two patients with extraocular motility deficits preoperatively experienced significant improvement in motility after surgery. Three patients who required MRI studies for unrelated conditions were able to undergo scanning postoperatively without complications. Two patients were combat casualties treated by US medical personnel during Operation Iraqi Freedom. There were no cases of visual or ocular morbidity directly attributable to foreign body removal. Intraoperative fluoroscopy is a valuable tool that can aid in the removal of radio-opaque orbital foreign bodies.

Rigid bronchoscopy (RB) is still considered the gold standard approach for the removal of airway foreign bodies (FBs) in children; however, flexible bronchoscopy (FOB) has recently been proposed both as diagnostic and therapeutic means. Our purpose was to evaluate the outcomes of FOB, associated with the Dormia basket, for the removal of FBs. Retrospective data about 124 children who underwent bronchoscopy for the suspicion of a FB aspiration between January 2008 and January 2019 in our department were collected. In a total of 51 cases, FBs were removed through FOB or RB associated with forceps or Dormia basket. Male to female ratio was 1.8:1, mean age 30 ± 26.1months. Thirty-four (67%) FBs were directly removed through FOB, in most of the cases using Dormia basket and twelve (23%) patients underwent RB. The overall left-versus-right distribution was 57% vs. 43%. The mean retrieval procedural time was 36.29 ± 24.99min for FOB and 52.5 ± 29.74min for RB; the success rate of the procedures was 97% vs. 67%. FOB can be used not only as a diagnostic procedure, but also as the first method for the removal of airway FBs. The Dormia basket is a useful tool, especially to remove peripherally located FBs.