FOREIGN BODIES

FOREIGN BODIES are alien to the body, embedded in its tissues, organs or cavities through damaged integuments or through natural openings. Most often foreign bodies penetrate into the tissues of the body when the covers are damaged. Usually these are needles, pieces of wood, glass and metal fragments; With gunshot and stab wounds - bullets, shot, clothing particles, earth. Foreign bodies can get into tissues and with some medical manipulations. For example, if the technique of parenteral drug administration is broken, a fracture of the injection needle is possible, as a result of which its fragment becomes a foreign body. Natural holes penetrate through the natural holes accidentally (for example, accidental ingestion of fish or meat bones during the meal), but sometimes they are intentionally introduced.

Entered into the tissues of the body foreign bodies are usually encapsulated - around them a dense connective tissue develops. In this case, they can lie for a long time motionless and do not cause clinical manifestations. However, in a number of cases, foreign bodies can move, for example, with muscle contraction.

Infected foreign bodies cause suppuration. Supporting the inflammatory process, they prevent healing of the wound. The pressure of a foreign body on a blood vessel can lead to the formation of a decubitus of the vessel wall and bleeding.

In the recognition of foreign bodies, a carefully collected history, as well as the results of an X-ray study, give an idea not only about the localization of the radiopaque body, but also about its relationship with surrounding organs. The presence of a foreign body can indicate a painful compaction near the wound, bruising, skin detachment.

In the initial surgical treatment, wounds tend to remove all foreign bodies. Deeply stuck in the tissues of the body is removed only if they cause significant functional impairment, put pressure on the vessels and nerves.

Foreign bodies of the eye can penetrate into the outer shell of the eye (conjunctiva, cornea, sclera) and into its cavity. The presence of a foreign body in the conjunctiva of the eyelids is accompanied by lacrimation, pain. Detect a foreign body, pulling the lower eyelid or twisting the upper eyelid. Remove the foreign bodies of the conjunctiva with a tightly twisted cotton tow harnessed with a solution of furacilin 1: 5000.

The presence of a foreign body in the cornea is usually accompanied by pain, lacrimation, hyperemia of the conjunctiva of the eye. Foreign bodies of the cornea can be complicated by the development of the inflammatory process and the formation of the corneal ulcer (see Keratitis); They are subject to emergency removal under local anesthesia with 0.5-1% solution of dicaine. In some cases, they can be removed in the same way as the foreign bodies of the conjunctiva. Inserted into the tissue of the cornea, the body is carefully removed with a special lance-shaped tool. After that, 30% solution of sulfacyl-sodium or 0.25% solution of levomycetin is injected into the conjunctival sac, tetracycline, erythromycin or sulfacyl-sodium ointment is placed behind the eyelids.

The wounding of the eye with the introduction of foreign bodies deep into the tissue of the eyeball refers to severe damage to the organ of vision. With a penetrating wound of the eye in the wound of the cornea, the iris can fall out or be trapped in it. Damage to the lens is usually accompanied by its turbidity (the lens acquires a grayish-milk color).

Fragments of metal not only mechanically damage the eye, but also affect it chemically. The toxic effect of metal bodies on the eye tissue leads to the development of eye metallosis, which can manifest itself as toxic iridocyclitis, uveitis, cataract, secondary glaucoma, retinal dystrophy, leading to loss of vision or complete loss of vision. When the copper and brass fragments are in the eye for a long time, chalcosis of the eye develops, and iron fragments - the siderosis of the eye. Non-oxidizing small foreign bodies (glass, stone) can remain in the eye for many years without causing irritation. The most formidable complication in the introduction of a foreign body into the cavity of the eye is due to its infection, which can lead to the development of a purulent process in the shells of the eye.

With a penetrating eye injury or suspicion of it, it is necessary to impose a sterile bandage on the eye and urgently send it to the ophthalmologist. Victims with a penetrating eye injury and the presence of foreign bodies in the cavity of the eyeball require urgent hospitalization in the eye department.

With penetrating wounds of the eyes, the affected person is injected with tetanus antitetanus, prescribing antibiotics, including locally. In the eye instilled solutions of antiseptic.

Foreign bodies of the external auditory canal are more often found in children who introduce themselves into the ear canal various small objects (fruit bones, peas, seeds, beads, etc.). In adults, pieces of cotton wool, fragments of matches, etc. can be found. Other insects (bugs, cockroaches, flies, etc.) - the so-called living foreign bodies - can enter the ear.

Small foreign bodies with a smooth surface, pieces of cotton wool, matches in the absence of trauma to the walls of the ear canal do not cause complaints in patients. Foreign bodies with sharp edges and especially living foreign bodies cause unpleasant sensations, cause pain and noise in the ears.

Be sure to inspect the external ear canal (otoscopy) to detect a foreign body and establish its nature. Insects are usually sacrificed by instilling 2 to 3 drops of liquid sterile oil or 2% boron alcohol into the ear, then removing with tweezers or rinsing the external ear canal with warm water using a Janet syringe. Just remove and other foreign bodies. Do not remove the tweezers round objects, such as beads, as this can lead to their pushing into the deeper parts of the ear canal. Swelling foreign bodies of plant origin (peas, beans) are dehydrated before being removed by repeated infusion into the ear of alcohol. Although ear washing is the safest method, it is contraindicated in the presence of a perforation of the tympanic membrane (to avoid purulent otitis). When foreign bodies completely obturating the bone section of the auditory canal, a jet of water pushes them even deeper. Foreign body under vision control is removed with a small crochet. This procedure requires great care. The hook is held flat for the foreign body and pulled to itself. Inept removal of a foreign body, especially from the deep sections of the external auditory canal, can lead to serious complications.

Foreign bodies of the nasal cavity are most often located in the lower or middle nasal passages. A characteristic feature is a one-sided obstruction of nasal breathing, and then the appearance of purulent discharge from the same half of the nose. After inspection and detection of a foreign body, an anesthetic of the nasal mucosa is made and the foreign body is removed with a blunt crochet.

Foreign bodies of the gastrointestinal tract. In the throat with hasty food can get pieces of uneaten food, which closes the entrance to the larynx and lead to asphyxiation. Symptoms are pain and difficulty swallowing. They identify them with the help of examination of the pharynx, sometimes applying a palpation.

Foreign bodies of the esophagus are more often located in the upper third of the esophagus. It is noted difficulty swallowing, dull pain and a feeling of heaviness in the chest or along the spine. Acute foreign bodies can cause perforation of the esophageal wall, which leads to the development of phlegmonous esophagitis or mediastinitis. The diagnosis is established based on the history of the patient, the results of radiological and endoscopic examination of the esophagus. Remove the foreign bodies of the esophagus with an esophagoscope and special long forceps.

Patients with foreign bodies of the gastrointestinal tract are subject to observation in the hospital. It is strictly forbidden to prescribe laxatives for them. To facilitate the progress of foreign bodies recommend a diet with a high content of vegetable fiber. The passage of metallic foreign bodies is monitored by repeated survey X-ray studies of the abdominal cavity.

Operative removal of foreign bodies from the stomach is undertaken in cases where their size and shape exclude the possibility of removal by means of an endoscope or movement along the gastrointestinal tract (knife, spoon, fork, etc.). When there are signs of peritonitis or intestinal obstruction, an emergency laparotomy is indicated.

Foreign bodies of the respiratory tract. Foreign bodies of young children, as well as adults, who have a habit of keeping pins, nails, etc. (tailors, shoemakers) while they work in the mouth, are most often aspirated by foreign bodies. Foreign bodies can be dentures and fragments of broken dental crowns. Aspiration is promoted by hasty food and a state of intoxication. The main symptom arising in this case is a sudden, painful cough that does not bring relief, excitement, cyanosis of the skin. In this situation, immediate assistance is required. Since even with complete closure of the upper respiratory tract and asphyxia, a person loses consciousness no earlier than 1.5 to 2 minutes, he should try after a reflex but not effective cough to produce 3 to 4 arbitrary cough movements, while trying not to take a deep breath . If this does not lead to the removal of a foreign body, the victim must rest his fist of one hand in the upper half of the abdomen and with the palm of the second hand, press sharply on the fist 3-4 times in the direction from front to back and from below upward. The increased pressure created in this abdomen in the abdominal cavity is transmitted through the diaphragm to the chest and simulates a cough . To the same effect can lead and a quick torso forward with the abdominal upper abdomen on the back of the chair.

If self-help for any reason is impossible or does not give the desired effect, the victim must be assisted by another person by consistently conducting two receptions. The assisted person must approach the victim from behind and apply a 3-4 sharp blow to the spine at the level of the upper edge of the shoulder blades. In the absence of the effect, the assisting person, hugging the victim from behind with both hands, presses his fist onto his epigastric region and produces 3 to 4 jerky thrusts from front to back and from bottom to top.

In case of unconsciousness and absence of respiratory movements, artificial respiration should be started immediately from mouth to mouth. In the absence of effect, it should be assumed that respiratory arrest is caused by a foreign body. Then, keeping the victim in the lying position on his side, apply 3-4 hammering strokes between the shoulder blades, and then, turning the injured person on his back, with both hands, press 3-4 times on the epigastric region in front to back and from the bottom up, after which the victim is opened Mouth and finger extract foreign body from the respiratory tract. Further they continue to carry out artificial respiration from mouth to mouth until independent respiratory movements appear.

In a medical institution, a foreign body stuck in the region of the glottis and caused asphyxia in the affected person can be recovered by direct laryngoscopy with a forceps, clamp or tweezers. An emergency tracheotomy or a conicotomy is performed according to the indications.

Small foreign bodies, which usually do not cause closure of the larynx and trachea lumen, often fall into one of the main bronchi (up to 80% of the cases in the right bronchus) or its branching. Metallic foreign bodies are clearly visible on radiographs, and non-contrasts are diagnosed by indirect signs - the presence of emphysema or lung atelectasis. The presence of a foreign body in the respiratory tract is confirmed by bronchoscopy.

The terrible complication of foreign bodies of the trachea is asphyxia , which can cause the death of the victim. The most common complication of foreign bodies of the bronchus is festering, developing in the atelectasized area of ​​the lung, with an outcome in abscessed pneumonia and empyema of the pleura. Typical complications with prolonged finding of a foreign body in the bronchus are hemoptysis and pulmonary hemorrhage.

Foreign bodies of the trachea and bronchi are subject to emergency removal, usually performed with the help of a bronchoscope. In complicated cases, surgical intervention is indicated.

Foreign bodies of the uterus, the vagina. In the vagina, foreign bodies are more likely to get into masturbation, less often after medical manipulation. II of the uterine cavity may be foreign bodies, introduced for the purpose of causing an abortion or preventing pregnancy.

Foreign bodies irritate the mucous membrane, cause an inflammatory reaction, accompanied by whites, bloody discharge, bleeding. The infected foreign body of the vagina determines the development of vulvovaginitis (discharge with putrefactive odor and sometimes with a trace of blood). If the foreign body is found in the uterus or vagina for a long time, there may be bedsores followed by stenosis of the vagina and the formation of urogenital fistula.

Foreign bodies of the vagina are recognized by vaginal examination (see Gynecological examination), examination using a mirror. In girls and girls, rectal examination is necessary, vaginoscopy is mandatory. Foreign bodies of the uterus are detected using ultrasound or hysterography.

Remove the foreign body from the vagina with a finger or tweezers. With stenosis of the vagina, it is necessary to dissect scars that prevent the removal of a foreign body. Removal of foreign bodies in girls and girls sometimes presents considerable difficulties and is conducted under general anesthesia. From the uterine cavity, foreign bodies are removed after the dilatation of the cervical canal.

Foreign bodies of the bladder and urethra. In the bladder, they can penetrate the urethra or through the wall of the bladder from the surrounding tissues. On the urethra, foreign bodies are most often found during masturbation. These can be medical thermometers, rubber tubes, glass sticks, tips for enemas, mouthpieces, etc. Mental patients, children, and women can also inject similar items into the bladder when trying to cause abortion . Less often pieces of cotton wool, catheter heads may remain in the urinary tract after surgery or medical diagnostic procedures.

Entered into the bladder or urethra, foreign bodies are encrusted with salts contained in urine, injure the mucous membrane, cause cystitis , violate urination. Patients have pains above the pony joint, in the perineum or urethra, worse with movement, rapid and painful urination. The urine contains leukocytes and fresh non-alkaline erythrocytes. A patient with suspicion of a foreign body of the urinary tract should be sent to a medical institution. Diagnosis is established based on anamnesis, urine test results, radiography and cystoscopy. It should be borne in mind that patients can hide the fact of introducing a foreign body into the urinary tract. Foreign bodies of the bladder and urinary tract are removed with the help of an operation cystoscope or in an operative way.