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inspiredbymusic
03-23-2013, 06:28 PM
Follow-up question in post #9 Thanks!

Would this be plausible?

A person is seriously wounded in a car accident. After treatment, instead of healing properly as expected, the person suffers continuous bouts of infection to the point that it is life-threatening. Many weeks later it is discovered that several glass fragments, which were previously undetected, remain embedded near the wound site, and are the cause of the continuing infection. Once they are removed, the person recovers.

Is this possible? Believable? If not, is there some material other than glass which would be more likely to evade detection and cause ongoing problems?

Is there a particular type of infection that would make sense in this scenario?

James D. Macdonald
03-23-2013, 06:31 PM
I can see encysted infection nodules.

Glass, or wood, would work. Though glass might not continuously reinfect. I once put my arm (accidentally) through a glass door. It was all fixed up at the hospital, but, for years afterward, little flecks of glass kept working their way to the surface.

Corussa
03-23-2013, 06:57 PM
I don't know if this will be any help whatsoever - maybe not - but to illustrate that things can be left unchecked in the body after an injury, here's this BBC article from just yesterday:

Knife taken from Billy McNeely's back after three years (http://www.bbc.co.uk/news/world-us-canada-21891177)

:)

Maryn
03-23-2013, 07:02 PM
I had something very similar to James' experience with small bits of glass reaching the surface for a couple of years after the injury involving broken glass. There also seems to be a small encapsulated bit which has moved from a pressure point to a nearby no-pressure point.

I've had cactus spines do the same thing--in at the hip, out a year or more later and near the belly. (Ow...)

I would think--and I'm talking through my hat here--that an organic material like wood would be more likely to cause infection or other adverse reactions as the body breaks it down, which it can't do with glass.

Maryn, much better about wearing shoes and staying farther from cacti

mirandashell
03-23-2013, 07:04 PM
A friend of my father was in one of the bars involved in the Birmingham Pub Bombings back in the 70s. He had hundreds of tiny pieces of glass in his back. Took years before they all came out.

But I do agree with Maryn. Something organic like wood would be broken down and could cause ongoing problems with infection.

boron
03-23-2013, 07:34 PM
Is there a particular type of infection that would make sense in this scenario?

One thing is an acute infection that could develop within hours/days after the accident. Sharp pieces can force normally-present staphylococci (bacteria) from the skin surface to the inside and cause anything from a localized boil to sepsis. You may want to search for "foreign body infections" or so.

The other possibility is a development of a chronic granuloma around the foreign material. Immune cells enclose the material and try to destroy it; the consequence is "a foreign body granuloma." Organic materials, like wood, thorns, soil, parts of insects, but also talc or surgical sutures can trigger granuloma growth more likely than inert materials. Here's one example (http://www.hindawi.com/crim/orthopedics/2012/439836/).

debirlfan
03-26-2013, 01:22 AM
Does it have to be matter from the accident? If he had surgery, maybe they left a sponge or the like in him when they sewed him up. It happens - and is probably more likely to cause an infection than glass bits.

(Also consider clothing bits/dirt/gravel being carried into the wound in the accident. Maybe there was bird poop or road grime on that broken window?)

jackierandom
03-26-2013, 03:48 AM
my thoughts were in the direction of boron's
i was thinking of MRSA (http://www.mrsasurvivors.org/about) or cellulitis (http://www.merckmanuals.com/home/skin_disorders/bacterial_skin_infections/necrotizing_skin_infections.html) that went to a terrible extreme. MRSA is becoming more and more prevalent nowadays. Hospitals frequently do nasal swabs to detect it and to know whether to put a patient in isolation or to cohort with a like patient to keep it from spreading. HTH

inspiredbymusic
03-26-2013, 05:57 PM
Thank you all so much for the very helpful information, examples, and suggestions!

Additional question: I understand that it is definitely possible for a foreign body to remain undetected for a lengthy period of time. However, if the patient were experiencing severe infection, it seems likely that extensive testing would be done (X-ray, MRI, ultrasound ?), so would it still be plausible that the foreign body would remain undetected under these circumstances? Would it be possible that this type of testing wouldn't be done? Or that it wouldn't detect the foreign body?

Thanks!

boron
03-26-2013, 06:23 PM
A foreign body can push bacteria under the skin and the foreign body itself can fall off immediately. Bacteria can then slowly grow in a "pocket" under the skin and when they multiplicate enough, the symptoms of an infection can develop. So, you don't need a foreign body to be present at the time of the start of the infection at all.

Examples of infections where foreign bodies can be involved:
Osteomyelitis (http://www.mayoclinic.com/health/osteomyelitis/DS00759)
Cellulitis (http://www.mayoclinic.com/health/cellulitis/DS00450)
Tetanus (http://www.mayoclinic.com/health/tetanus/DS00227)
Sepsis (http://www.mayoclinic.com/health/sepsis/DS01004)

Pyekett
03-26-2013, 07:13 PM
You can see glass on X-ray, though it is more difficult to find. See, e.g., the wikiradiography article on foreign bodies (http://www.wikiradiography.com/page/Foreign+Body+Radiography) Case 4 for details.

Wood is yet more difficult to find on X-ray than glass, at least as small fragments. Ultrasound is the better choice.

Depending on size of the item and whether or not contrast is used, wood or glass can be seen on MRI and CT fairly easily--but you need to know where to look. If you aren't concentrating on the right area, small pieces can be missed this way, too.

If there is severe recurring infection and the source is hard to find, I would hope that someone would think of doing a technetium-labelled white blood cell study (http://jnm.snmjournals.org/content/38/6/987.full.pdf) to light up the site of ongoing inflammation. The technology has been around for well over twenty years, and it is both cost-effective and better medical care than random imaging while chasing an unknown site of infection.

Added: Given your scenario, you probably want pieces of dirt, fabric, or other extraneous elements driven into the tissue along with, say, very small shards of glass.

Drachen Jager
03-26-2013, 07:45 PM
Granted this is China, but maybe this story will help.

In 2007 Li Fuyan was stabbed in the head by a robber. The robber ran off and Li got medical treatment, went home, back to life as usual. He started suffering massive migraines, bad breath, other symptoms, but it took four years for doctors to figure out that he had a four inch fragment of the knife blade still imbedded in his head.

http://www.nydailynews.com/news/world/chinese-man-knife-blade-stuck-head-years-knowing-doctors-article-1.137179

I would think most western medicine would have caught the problem earlier, but something smaller? Mistakes happen all the time.

inspiredbymusic
03-31-2013, 05:06 PM
Thanks again to everyone for the responses. They are so very helpful! Thanks for taking the time and sharing your expertise.
:)