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Friday, May 24, 2013

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Scientific Papers


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PARTICIPANTS
Presenter
Adam	Young	BS
Abstract Co-Author
William	Shiels	DO
James	Murakami	MD
Brian	Coley	MD
Mark	Hogan	MD

SUBSPECIALTY CONTENT
	Pediatric Radiology

	CODE: SSQ17-07
	SESSION: Pediatric (Interventional)
	Self-Mutilation in Adolescents: Radiological Management of Self-inflicted Soft Tissue Foreign Bodies


	DATE:	Thursday, December 04 2008
	START TIME:	11:30 AM
	END TIME:	11:40 AM
	LOCATION:	N229

	DISCLOSURES
	A.Y.	- Nothing to disclose.
	W.S.	- Nothing to disclose.
	J.M.	- Nothing to disclose.
	B.C.	- Consultant, Koninklijke Philips Electronics NV, Bothell, WA Advisory Board, Siemens AG, Mountain View, CA Consultant, ZONARE Medical Systems, Inc, Mountain View, CA
	M.H.	- Nothing to disclose.

	PURPOSE
	To evaluate the efficacy and clinical impact of image-guided foreign body removal (IGFBR) for treatment of self-inflicted soft tissue foreign bodies (STFBs).
	METHOD AND MATERIALS
	Four hundred patients underwent IGFBR with sonographic and/or fluoroscopic guidance. Self-mutilation was seen in 5 adolescent female patients (1.2%), representing 7 patient care encounters; 2 patients presented with self-inflicted STFBs on 2 separate occasions. Mean age 16.8 yr; (range 15-17 yr). Foreign body number, location, type and size as well as incision size, intraoperative imaging modality, type of surrounding reaction, and success or failure of removal were documented prospectively.

	RESULTS
	Twenty-five foreign bodies were inserted into the forearm or upper arm of the five patients. Referring services included Pediatric Surgery, Emergency Department, and Psychiatry. Number of STFBs per case ranged from 1-9; median=2. Foreign body types included metal (13), wood (5), graphite (3), plastic (2), crayon (1), and stone (1). STFB measurement (greatest dimension) ranged from 4.5-160 mm; mean=22.06 mm. During sonographic removal, hypoechoic halos representing purulent material surrounding the STFBs were defined in 2 cases. Mean incision = 4.67 mm; STFBs were removed with sonographic guidance in 3 cases, fluoroscopic guidance in 3 cases, and a combination of the two modalities in 1 case. IGFBR was successful in all 7 cases without fragmentation or complications.
	CONCLUSION
	Percutaneous radiological treatment of self-inflicted STFBs is safe, precise, and effective for radiopaque and non-radiopaque foreign bodies, including foreign bodies at risk for fragmentation during traditional operative removal techniques.

	CLINICAL RELEVANCE/APPLICATION
	Percutaneous IGFBR with sonography and/or fluoroscopy offers surgeons and emergency physicians a safe and effective alternative to operative foreign body removal in this unique high-risk population.

	QUESTIONS ABOUT THIS EVENT EMAIL:
	william.shiels@nationwidechildrens.org