foreign body case this is the case of foreign body extraction leech

1. PRESENTATION
CASUALTY REPORT
Monday, 27th November 2023
Doctors on duty :
Wulan,MD/Aris,MD–Jer,MD-Kresna,MD–Anov,MD /Timo,MD-Nadira, MD
Consultant on Duty:
Elvie Zulka, MD, ORL-HNS, PhD
Rhinology Consultant on Duty:
Nina Irawati, MD, ORL-HNS, PhD

2. female, 4 years old
Chief Complaint:
Recurring nosebleeds
from the right nostril
since 1 week prior to
admission
IDENTITY & CHIEF COMPLAINT

3. MEDICAL HISTORY
3 weeks prior to admission
● Played in the swamp
● No complaint
● Repeated nosebleeds from the right nostril
● The nosebleed are bright red, dripping,
amounting to about 2 pieces of tissue.
● Nose picking (-) sneezing(-)
1 week prior to admission

4. MEDICAL HISTORY
3 days prior to admission
● Local hospital  inflamed nose  antibiotics, anti-allergies,
painkillers and nasal irrigation
● Advised to have a follow up evaluation after 1 week
● Playing on the beach and washing up  leech
coming out from the right nostril.
● No attempt to remove the leech by the parents.
1 day prior to admission

5. MEDICAL HISTORY
12 hours prior to admission
● Taken to the local hospital
● An attempt was made to remove the leech by baiting with
tap water → not successful
● Advised for further treatment at Cipto Mangunkusumo
National General Hospital
● Last nosebleed around 4 hours prior to admission,
stop spontaneously
● Pain (-), shortness of breath (-)
● History of foreign objects in the ears, nose or mouth(-)
On The day of admission

6. Mildly ill
E4M6V5
dyspnea (-), stridor (-),
retraction (-)
Eye: anemic
conjunctiva (-)
HR : 80x/min
RR : 22x/min
T : 36.5 Celcius
SaO2: 99% on room air
General Condition Vital Sign
PHYSICAL EXAMINATION
Consciousness

7. ENT EXAMINATION
Nose
Throat
Right nasal cavity: wide nasal cavity, a blackish foreign
object appears in the anterior 1/3 of the nasal cavity
Left nasal cavity: wide nasal cavity, inferior turbinate
eutrophy, no discharge, no septal deviation
Pharyngeal arch was symmetric, uvula in the middle,
tonsil grade 1, posterior pharyngeal wall not hyperemic
Ear Right and left ear: wide ear canal, no discharge,
no cerumen, intact tympanic membrane

8. Nasal right-left (27/11/2023)

9. WORKING DIAGNOSIS
Foreign body (leech) in the right nostril
1.

10. ● Extraction of foreign body (leeches) in the right nostril:
○ Placing clean water in the nierbeken in front of the nasal cavity → patient
uncooperative
○ Local anesthesia was performed with xylocain spray
○ Nasal irrigation was performed with NaCl 0.9% in the contralateral nose →
observation
○ Visible foreign body leech came out of the right nasal cavity, then
extracted with forceps successfully
MANAGEMENT

11. extraction process

12. foreign object

13. foreign object

14. nasolaryngoscopy evaluation

15. management
Report to Nina Irawati, MD, ORL-HNS, PhD:
- Nasal irrigation with NaCl 0.9% 2x30 ml right and left nostril
- Advise: Do not swim in swamps, do not manipulate and pick nose, do
not insert foreign objects into ears, nose and mouth
- Follow up to ENT Rhinology Outpatient Clinic

16. THANK YOU