Foreign Bodies

September 8, 2010

A 9-year-old boy was brought to the emergency department (ED) by his mother after he managed to lodge 2 magnets in his nose. He had been playing with connecting magnets from 2 body lights and wanted to see what would happen if he placed one of the magnets in his nose and the opposing magnet on the outside. By moving the outside magnet, he was able to move the inside magnet up and down in his right nostril.

“Body Light” Magnets in the Nose
A 9-year-old boy was brought to the emergency department (ED) by his mother after he managed to lodge 2 magnets in his nose. He had been playing with connecting magnets from 2 body lights (see below) and wanted to see what would happen if he placed one of the magnets in his nose and the opposing magnet on the outside. By moving the outside magnet, he was able to move the inside magnet up and down in his right nostril. He then tried the same experiment in his left nostril and was enjoying moving the magnets around in both sides of his nose simultaneously. When he suddenly pulled both of his hands away from his nose, the 2 interior magnets attracted each other and squeezed against his nasal septum.

In the ED, initial attempts to remove the magnets by magnetic force (with body light magnets and a pacemaker magnet) were unsuccessful, write Charles S. Ross, DO, of Roseburg, Ore, and Karen E. Ross, MD, of Minneapolis. Attempts to remove them with bayonet forceps were too uncomfortable for the patient. After anesthetizing his nose, one of the magnets was grasped with forceps and successfully pulled away from the septum (A, B). The second magnet was then easily removed with the forceps. There was no bleeding and the septum was intact. The patient was discharged home.

In 2 similar cases, magnets were also removed from the nose of a 10-year-old boy and a 12-year-old girl. These were removed with a 5-inch curved hemostat after the nasal mucosa was anesthetized with 2% lidocaine gel.

A body light is essentially a magnet “sandwich” (C); when worn on the ear, the earlobe is the “meat” and the magnets are the “bread.” The magnets in these lights are so powerful that they can be attached to an earlobe or to clothing, name tags, posters, etc. These lights come in different colors and often flash or blink. They have a number of names, including “flashing lights” and “blinkeys,” and can be purchased for under a dollar. Drs Ross and Ross write that as these inexpensive ornaments become more widely available, it seems likely that there will be a resulting increase in the number of cases of nasal foreign bodies among preteens.
 

Ingested Spring
Don’t jump to conclusions when you see a child who presents with wheezing and asthma. Not all wheezing is asthma, and not all vomiting is gastroenteritis, writes Michael Dinerman, MD, of Emory University School of Medicine in Atlanta.
 
Ingestion of a foreign body-a spring in this patient’s case-may cause increased drooling, dysphagia of solids and liquids, cough, and vomiting. This patient presented with hematemesis and decreased breath sounds. The major complications of foreign-body ingestions include perforation, aortoesophageal fistula, tracheoesophageal fistula, mediastinitis, and abscess formation.1 The latency period between the ingestion and manifestation of a fistula may range from 1 to 3weeks but can occur even years later.2 There were no complications in this patient, who went to surgery.

Radiographs identify most true foreign objects, steak bones, and free mediastinal or peritoneal air. However, fish or chicken bones, wood, plastic, most glass, and thin metal objects are not always seen.3

REFERENCES:1. Brady P. Esophageal foreign bodies. Gastroenterol Clin North Am. 1991;20: 691-701.
2. Takano H, Okada A, Monden Y, et al. Unusual case of acquired benign tracheoesophageal fistula caused by an esophageal foreign body. J Thorac Cardiovasc Surg. 1990;99:755-756.
3. Cheng W, Tam PK. Foreign-body ingestion in children: experience with 1,265 cases. J Pediatr Surg.1999;34:1472-1476
 

Lodged Spaghetti Strand
 This picture shows an unusual linear white object positioned vertically at the center of the posterior pharynx of a 5-year-old girl’s throat. The child had eaten spaghetti the night before and somehow managed to get a piece of it stuck as shown. She was entirely uncooperative during attempts to remove the strand, writes Robert P. Blereau, MD, of Morgan City, La, who suggested that she be given something bulky to swallow, such as bread or meat, in the hopes that the spaghetti would be swallowed along with it. This approach worked: the following morning, the mother called to report that the spaghetti was gone.