Anıl Murat ÖZTÜRK, Omar ALJASIM, Meltem TAŞBAKAN, Gamze ŞANLIDAĞ

Retrospective evaluation of 377 patients with penetrating foreign body injuries: a university hospital experience (a present case of missed sponge foreign body injury)

Background/aim: This study aimed to retrospectively analyse patients with foreign body (FB) injuries in our hospital and to present a patient with missed penetrating sponge FB injury. Materials and methods: This study lasted 12 years (2008–2020) and reviewed all patients with FB injuries who were admitted to the emergency department (ED) of our hospital. Along with our overall results, we present a case with missed penetrating sponge FB injury in detail. Results: A total of 377 patients were included in the study (age: 28.3 ± 18.3 years, m/f: 229/148). The foot (n = 148, 39.3%) and the hand (n = 143, 37.9%) were the most frequently injured body parts. Regarding FB types, sewing needles (n = 140, 37.1%), metal pieces (n = 91, 24.1%), and glass (n = 80, 21.2%) were the most frequently observed objects. Most of the patients were injured at home, often by needles or glass. The injury-admission mean time was 7.38 ± 2.5 days. FBs were frequently removed in the ED (n = 176, 46.7%). Plain radiography is the first line in identifying FBs. Soft tissue infection was the most common complication. MRIs were much useful than USGs in detecting the missed penetrating sponge injury of the single patient in the study. Conclusion: For diagnosis of FBs, besides recording the patient’s history, obtaining a two-sided radiogram is of great importance. For nonradiolucent or deeply located FBs, further clinical or radiological investigation must be considered to avoid complications. Although most of the FBs can be removed in the ED, patients may require hospitalisation and operation for FB removal, depending upon FB location and age.Key words: Foreign body, sponge, missed foreign body, complication, injury

PDF

___

1. Fitzgerald RH Jr, Cowan JD. Puncture wounds of the foot. The Orthopaedic Clinics of North America 1975; 6 (4): 965-972.
2. Capellan O, Hollander JE. Management of lacerations in the emergency department. Emergency Medicine Clinics of North America 2003; 21 (1): 205-231. doi: 10.1016/s0733- 8627(02)00087-1
3. King C, Henretig FM. Ovid Technologies Inc. Textbook of Pediatric Emergency Procedures. 2nd ed. Philadelphia, USA: Lippincott Williams & Wilkins; 2008.
4. Hunter TB, Taljanovic MS. Foreign bodies. Radiographics 2003; 23 (3): 731-757. doi: 10.1148/rg.233025137
5. Horton LK, Jacobson JA, Powell A, Fessell DP, Hayes CW. Sonography and radiography of soft-tissue foreign bodies. AJR American Journal of Roentgenology 2001; 176 (5): 1155-1159. doi: 10.2214/ajr.176.5.1761155
6. Graham Jr DD. Ultrasound in the emergency department: detection of wooden foreign bodies in the soft tissues. The Journal of Emergency Medicine 2002; 22 (1): 75-79. doi: 10.1016/s0736-4679(01)00440-1
7. Öztürk AM, Akyol D, Süer O, Erdem HA, Şimşir IY et al. Necrotising fasciitis: clinical evaluation and treatment results of 18 Patients. Mediterranean Journal of Infection, Microbes and Antimicrobials 2019; 8: 9. doi: 10.4274/mjima. galenos.2019.2019.9
8. Donaldson J. Radiographic imaging of foreign bodies in the hand. Hand Clinics 1991; 7 (1): 125–134.
9. Anderson MA, Newmeyer WL, Kilgore ES. Diagnosis and treatment of retained foreign bodies in the hand. American Journal of Surgery 1982; 144 (1): 63-67. doi: 10.1016/0002- 9610(82)90603-1
10. Peterson JJ, Bancroft LW, Kransdorf MJ. Wooden foreign bodies: imaging appearance. AJR American Journal of Roentgenology 2002; 178 (3): 557–562. doi: 10.2214/ajr.178.3.1780557
11. Javadrashid R, Fouladi DF, Golamian M, Hajalioghli P, Daghighi MH et al. Visibility of different foreign bodies in the maxillofacial region using plain radiography, CT, MRI and ultrasonography: an in vitro study. Dentomaxillofacial Radiology. 2015; 44 (4): 20140229. doi: 10.1259/dmfr.20140229
12. Crowford R, Matheson AB. Clinical value of ultrasonography in detection and removal of radiolucent foreign bodies. Injury 1989; 20 (6): 341-343. doi: 10.1016/0020-1383(89)90008-9
13. Little CM, Parker MG, Callowich MC, Sartori JC. The ultrasonic detection soft tissue foreign bodies. Investigative Radiology 1986; 21 (3): 275-277. doi: 10.1097/00004424- 198603000-00014
14. Conti RJ, Shinder M. Soft tissue calcification induced by local corticosteroid injection. The Journal of Foot Surgery 1991; 30 (1): 34-37.
15. Flom LL, Ellis GL. Radiologic evaluation of foreign bodies. Emergency Medicine Clinics of North America 1992; 10 (1): 163-176.
16. Sidharthan S, Mbako AN. Pitfalls in diagnosis and problems in extraction of retained wooden foreign bodies in the foot. Foot and Ankle Surgery 2010; 16 (2): e18-20. doi: 10.1016/j. fas.2009.04.006
17. Tantray MD, Rather A, Manaan Q, Andleeb I, Mohammad M et al. Role of ultrasound in detection of radiolucent foreign bodies in extremities. Strategies Trauma Limb Reconstruction 2018; 13 (2): 81-85. doi: 10.1007/s11751-018-0308-z
18. Salati SA, Rather A. Missed foreign bodies in the hand: an experience from a center in Kashmir. Libyan Journal of Medicine 2010; 12: 5. doi: 10.3402/ljm.v5i0.5083
19. Nagendran T. Management of foreign bodies in the emergency department. Hospital Physician 1999; 9: 27-40.
20. Tuhan K, Necdet S, Gursel S, Mehmet I, Fuat A. Tips and tricks in the diagnostic workup and the removal of foreign bodies in extremities. Acta Orthopaedica et Traumatologica Turcica 2013; 47 (6): 387-392. doi: 10.3944/aott.2013.2979
21. Choudhari KA, Muthu T, Tan MH. Progressive ulnar neuropathy caused by delayed migration of a foreign body. British Journal of Neurosurgery 2001; 15 (3): 263-265. doi: 10.1080/026886901750353728
22. Ozsunar Y, Tali ET, Kilic K. Unusual migration of a foreign body from the gut to a vertebral body. Neuroradiology 1998; 40 (10): 673-674. doi: 10.1007/s002340050663
23. Combalìa AA, Fuster OS. Migration of a Kirschner wire from the sternum to the right ventricle. a case report. The American Journal of Sports Medicine 1993; 21 (5): 763-764. doi: 10.1177/036354659302100530
24. Gschwind CR. The intravenous foreign body: a report of 2 cases. The Journal of Hand Surgery 2002; 27 (2): 350-354. doi: 10.1053/jhsu.2002.31148
25. Laor T, Barnewolt CE. Nonradiopaque penetrating foreign body: “a sticky situation”. Pediatric Radiology 1999; 29 (9): 702- 774. doi:10.1007/s002470050678
26. Timmers M, Snoek KG, Gregori D, Felix JF, van Dijk M et al. Foreign bodies in a pediatric emergency department in South Africa. Pediatric Emergency Care 2012; 28 (12): 1348-1352. doi: 10.1097/PEC.0b013e318276c20e
27. Potini VC, Francisco R, Shamian B, Tan V. Sequelae of foreign bodies in the wrist and hand. Hand (N Y) 2013; 8 (1): 77-81. doi: 10.1007/s11552-012-9481-6
28. Gulati D, Agarwal A. Wooden foreign body in the forearm-- presentation after eight years. Ulusal Travma ve Acil Cerrahi Dergisi 2010; 16 (4): 373-375.
29. Yanay O, Vaughan DJ, Diab M, Brownstein D, Brogan TV. Retained wooden foreign body in a child’s thigh complicated by severe necrotizing fasciitis: a case report and discussion of imaging modalities for early diagnosis. Pediatric Emergency Care 2001; 17 (5): 354-355. doi: 10.1097/00006565-200110000- 00009
30. Chandrashekara CM, George MA, Al-Marboi BS. Neglected foreign body, the cause of navicular osteomyelitis in a paediatric foot: a case report. Journal of Orthopaedic Case Report 2013; 3 (3): 26-29. doi: 10.13107/jocr.2250-0685.111
31. Das De S, McAllister TA. Pseudomonas osteomyelitis following puncture wounds of the foot in children. Injury 1981; 12 (4): 334-339. doi: 10.1016/0020-1383(81)90212-6
32. Roth S, Zaninovic M, Roth A. Sponge rubber revealed two years after penetrating injury: a case report. The Journal of Foot Ankle Surgery. 2017; 56 (4): 885-888. doi: 10.1053/j. jfas.2017.03.006
33. Laya BF, Restrepo R, Lee EY. Practical imaging evaluation of foreign bodies in children: an update. Radiologic Clinics of North America 2017; 55 (4): 845-867. doi: 10.1016/j. rcl.2017.02.012
34. Conners GP, Mohseni M. Pediatric Foreign Body Ingestion. Treasure Island (FL), USA: StatPearls Publishing LLC; 2019.
35. Ipaktchi K, Demars A, Park J, Ciarallo C, Livermore M et al. Retained palmar foreign body presenting as a late hand infection: proposed diagnostic algorithm to detect radiolucent objects. Patient Safety in Surgery 2013; 7 (1): 25. doi: 10.1186/1754-9493-7-25
36. Polat B, Atici Y, Gurpinat T, Polat AE, Karaguven D et al. Diagnosis and treatment of retained wooden foreign bodies in the extremities using ultarsound. Acta Ortopedica Brasileria 2018; 26 (3): 198-200. doi: 10.1590/1413-785220182603180345
37. Braig EM, Birnbacher L, Schaff F, Gromann L, Fingerle A et al. Simultaneous wood and metal particle detection on dark-field radiography. European Radiology Experimental 2018; 2 (1): 1. doi: 10.1186/s41747-017-0034-1
38. Erik A. Campbell; Christopher D. Wilbert. Foreign Body Imaging. Treasure Island (FL), USA: StatPearls Publishing LLC; 2020.
39. C Huttin, J J Hidalgo Diaz, P Verne, S Facca, Y Igeta et al. Relevance of intraoperative ultrasound imaging for detecting foreign bodies in the hand: a series of 19 cases. Hand Surgery & Rehabilitation 2018; 37 (6): 363-367. doi: 10.1016/j. hansur.2018.05.008
40. Hai-Dong Liang, Hong Li, Hao Feng, Zheng-Nan Zhao, WenJi Song et al. Application of intraoperative navigation and positioning system in the removal of deep foreign bodies in the limbs. Chinese Mediacal Journal 2019; 132 (11): 1375-1377. doi: 10.1097/CM9.0000000000000253