Removal of Intrapleural Foreign Body by Medical Thoracoscopy

Narasimhan, R; Sehgal, Inderpaul Singh; Dhooria, Sahajal; Aggarwal, Ashutosh N.; Behera, Digambar; Agarwal, Ritesh

doi:10.1097/lbr.0000000000000275

Cited by 7 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Adhesions were only encountered in cases where there was a hematoma, infection, or repeated trauma 11,14,15,17,22,37 . In contrast, many nonglass foreign bodies reported in the literature caused strong pleural adhesions, necessitating open surgical access 3 …”

Section: Discussionmentioning

confidence: 99%

“…11,14,15,17,22,37 In contrast, many nonglass foreign bodies reported in the literature caused strong pleural adhesions, necessitating open surgical access. 3 The question lingers as to whether the asymptomatic pleural foreign body in our case should have been removed sooner. There is an ongoing debate about the timing of intrathoracic foreign body removal.…”

Section: Treatmentmentioning

confidence: 93%

“…There is an ongoing debate about the timing of intrathoracic foreign body removal. 2,3,27,[114][115][116][117][118] A retrospective study of 105 patients suggested that asymptomatic bullets and shrapnel should be left in place due to the risk of damage and complications during removal, with the belief that they become inert and harmless due to fibrotic reactions. 2 On the other hand, a review of Narasimhan et al 3 recommended early removal of foreign bodies from the pleural cavity to avoid potential complications such as migration 119 leading to hemothorax, pericardial tamponade, pericarditis, diaphragmatic injury, and bronchopleural and bronchoesophageal fistula.…”

Section: Treatmentmentioning

confidence: 99%

“…However, they can also be introduced accidentally during medical procedures or surgeries, become lodged after aspiration or ingestion, or migrate to/ from other parts of the body over time. [1][2][3] Pancreatic foreign bodies are typically the result of ingestion and settlement after a transesophageal, transgastric, or transenteric penetration. 4 In our presented case, there are relatively large glass splinters in the pleura and pancreas; the exact entry mechanism remains unknown.…”

mentioning

confidence: 99%

“…Within the thorax, most foreign bodies are typically the result of penetrating bullets, shrapnel, or impalement. However, they can also be introduced accidentally during medical procedures or surgeries, become lodged after aspiration or ingestion, or migrate to/from other parts of the body over time 1–3 . Pancreatic foreign bodies are typically the result of ingestion and settlement after a transesophageal, transgastric, or transenteric penetration 4 .…”

mentioning

confidence: 99%

See 4 more Smart Citations

Foreign Glass Bodies in Pleura and Pancreas: Systematic Review for Entry Hypotheses and Treatment Options in an Unresolved Case

Ehrsam,

Meier Adamenko,

Schlumpf

et al. 2024

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

Background: Foreign bodies within the pleura and pancreas are infrequent, and the approaches to their treatment still a subject of debate. There is limited knowledge particularly regarding glass foreign bodies. Methods: We present a case involving large glass splinters in the pleura and pancreas, with an unknown entry point. In addition, a systematic review was conducted to explore entry hypotheses and management options. Results: In addition to our case, our review uncovered eight incidents of intrapleural glass, and another eight cases of glass in other intrathoracic areas. The fragments entered the body through impalement (81%), migrated through the diaphragm after impalement (6%), or caused transesophageal perforation (19%) following ingestion. Eight instances of glass inside the abdominal cavity were documented, with seven resulting from impalement injuries and one from transintestinal migration. There were no recorded instances of glass being discovered within the pancreas. Among the 41 nonglass intrapancreatic foreign bodies found, sewing needles (34%) and fish bones (46%) were the most common; following ingestion, they had migrated through either a transgastric or transduodenal perforation. In all these cases, how the foreign bodies were introduced was often poorly recalled by the patient. Many nonglass foreign bodies tend to become encapsulated by fibrous tissue, rendering them inert, though this is less common with glass. Glass has been reported to migrate through various tissues and cavities, sometimes with a significant delay spanning even decades. There are cases of intrapleural migration of glass causing hemothorax, pneumothorax, and heart and major blood vessels injury. For intrapleural glass fragment management, thoracoscopy proved to be effective in 5 reported cases, in addition to our patient. Most intrapancreatic nonglass foreign bodies tend to trigger pancreatitis and abscess formation, necessitating management ranging from laparoscopic procedures to subtotal pancreatectomy. There have been only four documented cases of intrapancreatic needles that remained asymptomatic with conservative management. There is no direct guidance from the existing literature regarding management of intrapancreatic glass foreign bodies. Consequently, our patient is under observation with regular follow-ups and has remained asymptomatic for the past 2 years. Conclusions: Glass foreign bodies in the pleura are rare, and our report of an intrapancreatic glass fragment is the first of its kind. Impalement is the most likely method of introduction. As glass has significant migration and an ensuing complication potential, preventive removal of intrapleural loose glass should be considered. However, intrapancreatic glass fragment management remains uncertain.

show abstract

Section: Discussionmentioning

confidence: 99%