Tropical Doctor, January 1992

Fishing for a foreign body G A MacBride-Stewart MB ChB Kilu'ufi Hospital, Auki, Malaita Province, Solomon Islands TROPICAL DOCTOR,

1992, 22, 45

CASE REPORT

A l6-year-old female presented to Kilu'ufi Hospital, the district hospital for Malaita Province, in considerable pain and with epistaxis. Earlier in the day she had been spear fishing in a freshwater river in the East Kwa'arae region. She was using a modified umbrella rib as a spear to catch small fish. She impaled a small specimen of the type known locally as DADALI, this is well known for being extremely slippery. The usual practice after spearing the fish is to bite its head, this kills it immediately and prevents it escaping. As this young woman brought the fish towards her mouth it leapt off the spear and disappeared into her right nostril. Efforts to remove the fish were unsuccessful and the patient then endured a very painful and distressing 2 hours as the fish fluttered in its death throes inside her nose. She was seen in the hospital some 6 hours later. She was still in considerable discomfort with slight epistaxis. Examination of the right side of the nose found a silvery object quite posterior in the base of the nose. We do not routinely have intubational anaesthesia available and she was given premedication and then ketamine IV. Suction, laryngoscope and tracheostomy set were all to hand. A hook was fashioned from 23 gauge needle. The patient was placed in the recovery position with the neck extended and the table tilted down. An attempt was then made to hook the fish out of the nose. This proved to be very difficult because the fish scales were digging into the mucosa and also causing some bleeding. A different approach was then made. The fish was pushed backwards into the nose in small increments. The pharynx was checked after each increment. The fish eventually appeared in the pharynx and was hooked forward and safely landed. It was 8 em long and 1.3 cm in diameter. The smell of rotting fish was most marked, the hot humid nasal space having

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induced rapid decomposition. The fish was not weighed. The procedure caused moderate post-nasal haemorrhage but the patient was observed carefully and all drainage was through the right nostril. She was started on a short course of co-trimoxazole and discharged well the next day. On further enquiry it was found that these particular fish sometimes do jump off the spear into the face of the would-be biter. They usually enter the mouth and are swallowed immediately. It is rare for them to enter the nose. When they do so they are usually also swallowed. There are no anecdotal accounts of laryngeal obstruction from an inhaled fish.

More than 104 urinary bladder stones W Schweizer MD W Moll MD

P Stutz MD

St Francis Hospital, Ifakara, Tanzania TROPICAL DOCTOR,

1992, 22, 45-46

Whereas general surgeons have taken pride in reporting the removal of record numbers of gallstonesl--, urologists have favoured publications concerning the size of bladder stones! or historical vignettes about very old stones or famous patients with bladder stonest>. In recent studies only veterinary surgeons have reported multiple urinary calculi in dogs" and cats 7 • CASE REPORT

A l4-year-old boy was referred with a one year history of urinary tract infection. He had been treated on several occasions with co-trimoxazole, ampicillin and chloramphenicol without improvement. He had also been treated 4 years earlier for urinary schistosomiasis. On examination he was a tall otherwise healthy looking boy. His main

Correspondence to: W Schweizer MD, Clinic of Visceral and Transplantation Surgery, Inselspital, University of Berne, CH-3010 Berne, Switzerland

Fishing for a foreign body.

Tropical Doctor, January 1992 Fishing for a foreign body G A MacBride-Stewart MB ChB Kilu'ufi Hospital, Auki, Malaita Province, Solomon Islands TROPI...
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