Conservative management of coin ingestion in a toddler using serial plain radiography in Zambia: An imaging case report

Foreign body ingestion in children is a medical emergency, with severe cases posing life-threatening risks. Swallowing blades is an extremely rare and critical emergency requiring immediate medical intervention. The blades may cause perforation or bleeding in the gastrointestinal tract at any time, threatening the patient's life. This case report aims to provide treatment process and experience for dealing with this condition. A 14-year-old girl was hospitalized for swallowing 6 blades. Upon hospital admission, an emergency esophagogastroduodenoscopy was immediately performed. One blade was removed under emergency esophagogastroduodenoscopy, and the other 5 blades had entered the intestine and could not be removed endoscopically. After conservative medical treatment, the rest blades remarkably and naturally passed without surgical intervention. And the patient was discharged from the hospital without obvious discomfort. Ingesting blades might lead to serious or fatal complications that require urgent surgical treatment. Strict medical management and timely assessment of the condition are very important for passage of ingested blades, which may avoid surgical procedures. This report provides valuable insights and guidance for clinicians in the management of patients with swallowing blades.

Foreign body (FB) ingestion is a common home accident during childhood; a timely management by the specialists may help prevent complications in the short and long term. To describe the characteristics and complications of FB ingestion located in the gastrointestinal tract in the pediatric population. Two phases, retrospective, and prospective study. Patients diagnosed with FB ingestion between January 1971 and December 2016 were included. The general characteristics of patients, FB type, removal method, and complications were registered. A descriptive analysis was performed. Over 45 years, 2637 FBs were removed from the pharynx (n= 118), the esophagus (n= 2410), the stomach (n= 103), and the intestines (n= 6). Male patients predominated (50.9%); 74% were younger than 5 years. Besides, 57% arrived within the first 24 hours; ptyalism, dysphagia, and vomiting were the main symptoms; 16% of patients had no symptoms. It was possible to locate the FB using an X-ray in 93% of cases; the most common FBs were coins (78%); the most frequent location was the upper third of the esophagus (79%); 86% of FBs were removed using a rigid endoscope, and complications were observed in 7.8% of patients. FB ingestion predominated among children younger than 5 years; metal objects were the most common ones. A plain X-ray is the test of choice for diagnosis; removal is usually done with a rigid or flexible endoscope, depending on the endoscopist's experience.

Digestive Foreign Bodies in Children: Old Problems, New Complexities.

Perforation of the Ascending Duodenum secondary to a tree branch ingestion in a child.

Evaluation of results of the group of paediatric patients treated for swallowed foreign bodies in the digestive tract. Retrospective analysis of patients treated for foreign bodies in the digestive tract, managed at the University Hospital of Hradec Králové between 2011-2018. 365 patients (182 boys, 183 girls) with aforeign body in the digestive tract have been evaluated. The mean age was 2.4 years. Most of the children were treated as outpatients (280 children, 76.7%) and only 85 children (23.3%) were hospitalized. The most commonly swallowed frequent bodies included coins (26%) and batteries (14.5%); sharp objects occurred in 5.2%. Unusual foreign bodies were noticed, too. We can mention for example apen or aplant nutrition product. In 302 cases (82.7%) the foreign bodies passed easily per vias naturales. Endoscopy was necessary in 63 cases (17.2%) - in 51 children the object had to be removed from the oesophagus and in 12 children the object had to be removed from the stomach. None of the swallowed bodies caused complications such as digestive tract perforation or bowel obstruction. No patient in the group was indicated for laparotomy to remove the foreign body. Foreign bodies entrapped in the oesophagus have to be removed endoscopically. In most cases, foreign bodies in the stomach require only observation in the outpatient setting because they leave the stomach easily, without complications, per vias naturales. If abattery remains at the same place of the digestive tract for more than 24 hours, endoscopic removal is indicated at our department. In addition, endoscopy is done in cases of swallowed multiple magnets or bodies that are too large and remain in stomach for several weeks or months. Surgical removal of foreign bodies should be reserved only for complicated cases.

PurposeForeign body (FB) ingestion is a common health problem that affects children. It requires endoscopic removal in up to 20% of cases. In this study, we reviewed all our pediatric cases of FB ingestion requiring endoscopy and compared their management to the published guidelines.MethodsRetrospective study of children (aged 0–16 years) who were admitted to the emergency pediatric service department and underwent endoscopy for FB ingestion from January 2007 to December 2022. All statistical analyses were performed using STATA software version 17.0 (StataCorp LP).ResultsOf a total of 962 children diagnosed with FB ingestion, 62 of them (median age 4 years; interquartile range 2–8 years) underwent endoscopies and were included in this study. Of these, 39 (62.9%) were symptomatic and 23 (37.1%) were asymptomatic. The most common symptoms were vomiting (24.2%), pain (24.2%), sialorrhea (22.6%). In most patients, FBs were located in the esophagus (56.2%), with coins being the most common type (42.0%). The occurrence of at least one symptom was found to be associated with the FBs located in the upper-middle esophagus (compared to all other anatomical regions) (p<0.001). NASPGHAN and ESPGHAN guidelines were met in 68.8% of patients, while SIGENP guidelines were met in 72.9%.ConclusionFB ingestion is common in children. Coins are the most frequently encountered objects, typically located in the esophagus or stomach. An association was observed between the presence of at least one symptom and FBs located in the upper-middle esophagus. Performing endoscopies within 2 hours of FB ingestion is challenging in some cases.

The study aimed to assess the awareness level of parents about the substances which could be ingested by the children. A survey has been conducted among the willing participants from Arar - Saudi Arabia. The first part of the questionnaire contains questions about age, gender, number of children, and level of education. The second part contains statements focusing on parental knowledge regarding foreign body ingestion in children. The third part assesses the parental practices toward foreign bod

Foreign body ingestion in children: adult gastroenterologist's experience

Metallic Foreign Body Ingestion in Children

Magnetic foreign bodies ingestion is a special cause for attending emergency department. Here, we aim to analyze the characteristics and treatments of children who ingested magnetic foreign bodies (Buckyballs). Data were collected from children who ingested Buckyballs between February 2017 and October 2019. A retrospective analysis was performed to summarize the experiences of conservative treatment, gastroscopy and surgery when dealing with Buckyballs ingestion.A total of 49 patients with buckyballs ingestion were identified, of whom 11 underwent conservative treatments, 6 underwent gastroscopy, and 32 underwent surgery. Among such individuals, eight patients (72.7%) had a successful conservative treatment (number of Buckyballs [NB]: 3.5[IQR: 2.0–4.0]); four patients (66.7%) had Buckyballs successfully removed by gastroscopy (NB: 3.5[IQR: 3.0–5.5]); 16 asymptomatic (50%) patients (NB: 4.0[IQR: 3.0–8.0]) and 16 symptomatic (50%) patients (NB: 8.5 [IQR: 6.25–11.75]) received emergency surgery. Compared to patients who received conservative treatment, the number of ingested Buckyballs was significantly higher in patients who received surgery or gastroscopy (7.0 [IQR: 3.0–10.75] vs 3.5 [IQR: 2.0–4.0], P < .05). The risk of intestinal perforation was significantly higher in symptomatic patients (P < .05) compared to asymptomatic patients.Gastroscopy is recommended when Buckyballs are in the stomach or esophagus. In asymptomatic patients, conservative treatment can be considered for 4 to 6 days. Patients failing conservative treatment, or those who are symptomatic should undergo emergency surgery.

Spontaneous passage of coins lodged in the upper esophagus

Acute kidney disease (AKD) contributes significantly to morbidity and mortality, particularly in low-resource settings where limited diagnostic capacity often leads to delayed recognition and suboptimal management. We aimed to evaluate the impact of implementing a comprehensive patient-specific clinical laboratory support on clinical outcomes in AKD and to identify factors associated with mortality. We conducted a mixed-method hybrid type 3 implementation study at Livingstone University Teaching Hospital in Zambia. The study compared a retrospective non-intervention cohort (NIC; n = 39) with a prospective intervention cohort (IC; n = 39) matched for age and sex. The intervention included providing full laboratory diagnostic support for AKD management and additional patient-specific tests. The primary outcome was death within 30 days after admission regardless of whether the patient was discharged before or after the thirty-day period elapsed. Data were analyzed using logistic regression and survival analysis. The median age of the NIC (43 years, IQR 31–53) was comparable to the IC (41 years, IQR 34–53), p = 0.996. Overall, 51.3% (n = 40/78) were males. Mortality rate was significantly lower in the intervention group, with deaths occurring in 5.1% of the IC compared to 28.2% in the NIC (p = 0.012). Logistic regression confirmed the intervention as a strong independent predictor of survival (adjusted odds ratio 0.07, p = 0.009). Diagnostic accuracy improved, with fewer cases of misdiagnosis or delayed diagnosis in the IC (7.7% vs 30.8%, p = 0.019). Re-hospitalization was significantly lower in the IC (38.6% vs 61.4%, p = 0.022). ESRD was more frequently recorded in the IC due to better diagnostics, follow-up and survival. The median time-to-ESRD was substantially longer in the IC compared to NIC (140 vs 21 days, p < 0.0001). Implementation of a comprehensive patient-specific clinical laboratory support for AKD/CKD management significantly improved diagnostic precision and survival and reduced re-hospitalization. These findings highlight the value of strengthening laboratory diagnostic capacity to improve AKD outcomes in low-resource settings.

Background: Ectopic pregnancy (EP) remains a major cause of early pregnancy-related morbidity and mortality, particularly in low-resource settings where late presentation and limited diagnostic capacity prevail. Despite being a preventable cause of maternal death, local data on its burden and clinical characteristics in Zambia remain limited. Objective: To determine the prevalence, socio-demographic patterns, clinical characteristics, and outcomes of ectopic pregnancy at Ndola Teaching Hospital (NTH), Zambia. Methods: A prospective, descriptive, hospital-based study was conducted among 94 women with surgically confirmed ectopic pregnancies between June 2024 and April 2025. Participants were recruited through purposive sampling. Data were collected using structured questionnaires and review of medical records, then analyzed using IBM SPSS version 27. Descriptive statistics were computed, and associations between categorical variables were tested using the Chi-square test at a significance level of p Results: Out of 9402 pregnant women managed during the study period, 94 were diagnosed with ectopic pregnancy, yielding a prevalence of 0.99%. The mean age was 28.3 ± 5.8 years, with most participants residing in low-income areas (79.8%) and being married (84%). A prior history of pelvic inflammatory disease (PID) was reported in 57.4%, while 35.1% had used emergency contraception. The most frequent presenting symptoms were lower abdominal pain (96.8%), amenorrhea (74.5%), and vaginal bleeding (62.8%). At surgery, 88.3% of cases were ruptured, and 41.5% presented in haemorrhagic shock. Abdominal pain showed a statistically significant association with ruptured ectopic pregnancy (p p = 0.015). The case fatality rate was 1.1%. Conclusion: Ectopic pregnancy at NTH remains a significant reproductive health challenge, characterized by late presentation, high rupture rates, and severe complications. The findings highlight the need for strengthened early diagnostic capacity, improved access to emergency care, and enhanced reproductive health education, particularly targeting women in low-income communities.

BackgroundEnterprise Risk Management (ERM) in healthcare is a method used to identify, assess and reduce risk to patients and the hospital organization. The objective of this study is to identify clinical and organizational challenges and risks in healthcare management caused by COVID-19, and its impact on patients and healthcare workers, in a low-resource obstetric setting.MethodsFrom a census of patients from 1 April 2020 to 30 July 2020, four cases of COVID-19 in pregnancy representing different severity levels were selected. A patient tracer activity was done for each patient, documenting events that the patient and healthcare team experienced from admission to discharge. A case series on these patients was written. A focus group consisting of an OB-GYN resident, OB-GYN consultant, OB-GYN nurse, OB-GYN infectious disease consultant, and internal medicine resident and consultant, was formed. Each case was presented to the focus group to establish the context of risk assessment. Risks were identified using the framework of Enterprise Risk Management. Each risk was classified according to their risk domain and severity. Root cause analysis via the fishbone method was used to identify the causes of the risks.ResultsOperational risks identified were delayed swab results, false negative swab results, and delayed patient transport. Clinical/Patient risks identified were COVID-19 exposure of healthcare workers and other non-COVID patients, inadvertent community exposure, risk for severe clinical manifestations of COVID-19, and lack of specific treatment for COVID-19. Risk to human capital identified were COVID-19 infection of hospital staff and decreased quantity of workforce due to quarantine. Most risks were assessed to be moderate risk or high risk in terms of severity. Root cause analysis showed that common causes of risks were due to exposure to asymptomatic patients and delayed and false-negative swab results.ConclusionThe results of this study may be used towards the final steps of ERM: risk evaluation, treatment and management, in a low resource setting.DisclosuresJudith P. Peralta, Doctor of Medicine, Fellow of Philippine Obstetrical and Gynecological Society, Fellow of Philippine Infectious Disease Society for Obstetrics and Gynecology, Research Fellow - Harvard Medical School Department of Obstetrics and Gynecology and Reproductive Medicine (2014-2015), Member - International Society of Infectious Diseases (Brookline, MA), Pfizer (Employee, November 2020 to present)

Background/Objectives: Antimicrobial resistance (AMR) is a critical global health threat, with sub-Saharan Africa disproportionately affected. Antimicrobial stewardship (AMS) programs are essential in combating AMR; however, data on their implementation in resource-limited settings like Zambia remain scarce. This study assessed the post-implementation status of World Health Organization (WHO) AMS core elements in selected public hospitals in Zambia. Methods: A cross-sectional pre- and post-intervention survey was conducted in 11 public hospitals across Zambia’s 10 provinces. Baseline (pre-implementation) and 12-month follow-up (post-implementation) assessments were carried out using the WHO-adapted Periodic National and Healthcare Facility Assessment Tool. The six AMS core elements evaluated included leadership, accountability, AMS actions, education, monitoring, and feedback. Results: The average AMS program score increased from 59% at pre-implementation to 81% at post-implementation. Significant improvements were observed in education and training (+36%) and accountability (+31%). While leadership and monitoring also showed positive trends, gaps persisted in AMS actions (63%) and feedback/reporting mechanisms (68%). Drug and Therapeutics Committee (DTC) functionality improved by 23%, with 90% of facilities now holding regular DTC meetings. Implementation of AMS actions, such as ward rounds, rose from 0% to 73%. Challenges remained in clinical audit feedback, resource mobilization, and prescribing optimization. Variability across facilities highlighted differences in leadership, resources, and technical capacity. Conclusions: AMS implementation in Zambia improved substantially across key domains. However, sustained leadership, adequate financing, and continuous capacity-building are needed to address persistent gaps and ensure long-term success in mitigating AMR.