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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A metallic density foreign body is observed in the posterior mediastinum&#44; adjacent to the esophagus&#46; The circled area indicates the foreign body&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ingestion of foreign bodies is a common occurrence across all age groups&#44; typically arising from accidental events or inquisitive behavior&#46; While many instances result in uneventful passage through the gastrointestinal tract&#44; certain cases may present therapeutic challenges&#44; especially when the foreign body becomes lodged or migrates to unexpected locations&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The migration of an ingested foreign body into the posterior mediastinum is a rare and challenging scenario&#44; requiring careful consideration and specialized intervention&#46; In this case presentation&#44; we aim to discuss the clinical nuances&#44; diagnostic challenges&#44; and the role of minimally invasive surgical techniques as well as the importance of a careful anamnesis in addressing such unique and intricate cases&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case Report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 45-year-old male applied to our department complaint with blood in sputum for 1 week&#46; Physical examination was normal&#46; There was no feature in his medical history other than 20 pack-years of smoking&#46; Chest X-ray and computed tomography &#40;CT&#41; scans revealed the opacity in the posterior mediastinum&#44; suggestive of a metallic foreign body &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">When the anamnesis was detailed due to these radiological findings&#44; it was seen that he had a history of getting a piece of dishwashing scourer in his mouth while eating soup approximately 2 weeks ago&#46; The patient&#39;s psychiatric history absence and the presence of eyewitnesses led to the realistic evaluation of this medical history&#46; In the light of these data&#44; surgery was planned with the preliminary diagnosis of a foreign body transesophageally migrated into the posterior mediastinum&#46; Preoperative fiberoptic bronchoscopy was performed&#44; revealing remnants of clots&#59; however&#44; no active hemorrhage was observed&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Surgical intervention was planned due to the likelihood of continued migration of the foreign body&#44; the history of hemoptysis in the patient&#44; and the potential for the foreign body to cause infection&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Right sided video-assisted thoracic surgery was performed&#46; Pleural adhesions were removed with blunt and sharp dissections&#46; The area between the azygos vein and the vertebral body was dissected&#46; The sympathetic chain was identified and preserved&#46; The foreign body&#44; consisting of a thinly curved metal material&#44; was completely removed &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46; The adjacent esophageal segment was dissected&#44; and air was administered through a nasogastric tube and an underwater leak test was performed&#46; No air leakage was observed in the esophagus&#46; Intraoperative X-ray radiography was performed due to the possibility of a residual foreign body&#46; No residual foreign body was observed&#46; The operation was completed without any complication&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The postoperative period was uneventful&#46; The thorax tube was terminated on the 3rd postoperative day and the patient was externalized&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">The presented case of transesophageal migration of an ingested foreign body into the posterior mediastinum sheds light on the intricate nature of such incidents and emphasizes the need for a comprehensive understanding of atypical migration patterns&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ingested foreign objects&#44; especially if these objects have pointed ends&#44; can migrate to neighboring areas along the digestive tract&#46; The cases of needles migrating to deep cervical tissues&#44; omentum&#44; and liver after ingestion are documented in the literature&#46; The common characteristic of these cases is that patient history&#44; potential complications&#44; and treatment approaches are generally well-defined&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3&#8211;5</span></a> A history of psychiatric illness or suicidal attempts is frequent and surgery&#44; often preferred as laparotomy or laparoscopy&#44; is commonly chosen due to intra-abdominal migration&#46; However&#44; the posterior mediastinum&#44; being an uncommon location for lodged foreign bodies&#44; demands heightened vigilance in diagnosis and treatment planning&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6&#44;7</span></a> Standard imaging modalities may not always capture the exact location or provide sufficient information for planning a surgical approach&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In our case&#44; there was also a history of hemoptysis as a confusing symptom&#46; We attributed this to the inflammation induced by the foreign body in the surrounding lung parenchyma&#46; The supporting evidence for this includes increased opacity in the relevant region of the lung parenchyma on CT and&#44; intraoperatively&#44; significant parenchymal adhesions formed in the posterior mediastinal region where the foreign body had lodged&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In our case&#44; the successful application of video-assisted thoracic surgery &#40;VATS&#41; exemplifies the adaptability of minimally invasive techniques in addressing such complexities&#46; VATS not only allows for precise visualization but also minimizes the invasiveness of the procedure&#44; contributing to a quicker recovery for the patient&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Collaborative efforts are crucial for accurate diagnosis&#44; risk assessment&#44; and the formulation of an effective treatment strategy&#46; Additionally&#44; ongoing advancements in imaging technologies and surgical methodologies play a pivotal role in enhancing our capabilities to manage such intricate cases&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Informed Consent</span><p id="par0065" class="elsevierStylePara elsevierViewall">A written informed consent was obtained from patient&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Authors&#8217; Contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Idea&#47;concept&#44; design&#44; writing the article and literature review&#58; G&#46;B&#46;&#59; data collection&#44; control&#47;supervision&#44; critical review&#58; S&#46;K&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors received no financial support for the research and&#47;or authorship of this article&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of Interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declared no conflicts of interest&#46;</p></span></span>"
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Case Report
Foreign Body in the Posterior Mediastinum: Successful Minimally Invasive Removal of a Transesophageally Migrated Piece of Dishwashing Scourer
Güntuğ Batıhana,
Corresponding author
gbatihan@hotmail.com

Corresponding author.
, Soner Kınab
a Kafkas University Medical Faculty, Department of Thoracic Surgery, Turkey
b Kafkas University Medical Faculty, Department of Anesthesiology, Turkey
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A metallic density foreign body is observed in the posterior mediastinum&#44; adjacent to the esophagus&#46; The circled area indicates the foreign body&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ingestion of foreign bodies is a common occurrence across all age groups&#44; typically arising from accidental events or inquisitive behavior&#46; While many instances result in uneventful passage through the gastrointestinal tract&#44; certain cases may present therapeutic challenges&#44; especially when the foreign body becomes lodged or migrates to unexpected locations&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The migration of an ingested foreign body into the posterior mediastinum is a rare and challenging scenario&#44; requiring careful consideration and specialized intervention&#46; In this case presentation&#44; we aim to discuss the clinical nuances&#44; diagnostic challenges&#44; and the role of minimally invasive surgical techniques as well as the importance of a careful anamnesis in addressing such unique and intricate cases&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case Report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 45-year-old male applied to our department complaint with blood in sputum for 1 week&#46; Physical examination was normal&#46; There was no feature in his medical history other than 20 pack-years of smoking&#46; Chest X-ray and computed tomography &#40;CT&#41; scans revealed the opacity in the posterior mediastinum&#44; suggestive of a metallic foreign body &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">When the anamnesis was detailed due to these radiological findings&#44; it was seen that he had a history of getting a piece of dishwashing scourer in his mouth while eating soup approximately 2 weeks ago&#46; The patient&#39;s psychiatric history absence and the presence of eyewitnesses led to the realistic evaluation of this medical history&#46; In the light of these data&#44; surgery was planned with the preliminary diagnosis of a foreign body transesophageally migrated into the posterior mediastinum&#46; Preoperative fiberoptic bronchoscopy was performed&#44; revealing remnants of clots&#59; however&#44; no active hemorrhage was observed&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Surgical intervention was planned due to the likelihood of continued migration of the foreign body&#44; the history of hemoptysis in the patient&#44; and the potential for the foreign body to cause infection&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Right sided video-assisted thoracic surgery was performed&#46; Pleural adhesions were removed with blunt and sharp dissections&#46; The area between the azygos vein and the vertebral body was dissected&#46; The sympathetic chain was identified and preserved&#46; The foreign body&#44; consisting of a thinly curved metal material&#44; was completely removed &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#46; The adjacent esophageal segment was dissected&#44; and air was administered through a nasogastric tube and an underwater leak test was performed&#46; No air leakage was observed in the esophagus&#46; Intraoperative X-ray radiography was performed due to the possibility of a residual foreign body&#46; No residual foreign body was observed&#46; The operation was completed without any complication&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The postoperative period was uneventful&#46; The thorax tube was terminated on the 3rd postoperative day and the patient was externalized&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">The presented case of transesophageal migration of an ingested foreign body into the posterior mediastinum sheds light on the intricate nature of such incidents and emphasizes the need for a comprehensive understanding of atypical migration patterns&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ingested foreign objects&#44; especially if these objects have pointed ends&#44; can migrate to neighboring areas along the digestive tract&#46; The cases of needles migrating to deep cervical tissues&#44; omentum&#44; and liver after ingestion are documented in the literature&#46; The common characteristic of these cases is that patient history&#44; potential complications&#44; and treatment approaches are generally well-defined&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3&#8211;5</span></a> A history of psychiatric illness or suicidal attempts is frequent and surgery&#44; often preferred as laparotomy or laparoscopy&#44; is commonly chosen due to intra-abdominal migration&#46; However&#44; the posterior mediastinum&#44; being an uncommon location for lodged foreign bodies&#44; demands heightened vigilance in diagnosis and treatment planning&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6&#44;7</span></a> Standard imaging modalities may not always capture the exact location or provide sufficient information for planning a surgical approach&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In our case&#44; there was also a history of hemoptysis as a confusing symptom&#46; We attributed this to the inflammation induced by the foreign body in the surrounding lung parenchyma&#46; The supporting evidence for this includes increased opacity in the relevant region of the lung parenchyma on CT and&#44; intraoperatively&#44; significant parenchymal adhesions formed in the posterior mediastinal region where the foreign body had lodged&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In our case&#44; the successful application of video-assisted thoracic surgery &#40;VATS&#41; exemplifies the adaptability of minimally invasive techniques in addressing such complexities&#46; VATS not only allows for precise visualization but also minimizes the invasiveness of the procedure&#44; contributing to a quicker recovery for the patient&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Collaborative efforts are crucial for accurate diagnosis&#44; risk assessment&#44; and the formulation of an effective treatment strategy&#46; Additionally&#44; ongoing advancements in imaging technologies and surgical methodologies play a pivotal role in enhancing our capabilities to manage such intricate cases&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Informed Consent</span><p id="par0065" class="elsevierStylePara elsevierViewall">A written informed consent was obtained from patient&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Authors&#8217; Contributions</span><p id="par0070" class="elsevierStylePara elsevierViewall">Idea&#47;concept&#44; design&#44; writing the article and literature review&#58; G&#46;B&#46;&#59; data collection&#44; control&#47;supervision&#44; critical review&#58; S&#46;K&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Funding</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors received no financial support for the research and&#47;or authorship of this article&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of Interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declared no conflicts of interest&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A metallic density foreign body is observed in the posterior mediastinum&#44; adjacent to the esophagus&#46; The circled area indicates the foreign body&#46;</p>"
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ISSN: 03002896
Original language: English
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