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

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.

Tracheobronchial Foreign Bodies in Children: Imaging Assessment

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.

Button batteries have been recognized as one of the dangerous foreign bodies to children for more than 30 years, but few related studies have been published to give more concern in China. We reported 6 cases of button battery intake as foreign body in children. The Chinese literature on button battery as foreign body in children was reviewed. The interval between the accidental ingestion and battery removal ranged from 6 hours to 3 days. Two patients had no sequela, 3 patients had tracheoesophageal fistulas, and 1 patient had nasal septal perforation. Twenty-eight articles about button battery as foreign body in children were obtained by Chinese-language literature searches including 25 case reports, 2 health education articles, and 1 imaging article. In total, 172 cases of button battery intake as foreign body in children were identified, 23 and 10 of the 159 cases involving nasal button battery lodgment developed nasal septal perforation and nasal adhesion, respectively. Tracheoesophageal fistula was identified in 4 of the 12 ingestion cases. One case of button battery intake was in external auditory canal. A small number of children with button battery as foreign body were reported in China, which is 1 of the biggest countries with large population of children.

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

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.

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

This study sought to investigate the safety and efficacy of the fluoroscopic Foley catheter technique (FFCT) for removal of esophageal foreign bodies (EEBs) in children, and to identify factors associated with decreased success. An 11-year retrospective review of all pediatric patients undergoing the FFCT for removal of EFBs at a tertiary-care children's hospital was performed. Four-hundred and fifteen cases are reported. The median age was 29 months (range, 4 to 193); children < or = 24 months accounted for 45% (185) of the cases. Of all episodes 86% (355) involved children without known esophageal pathology. Coins comprised 76% (316) of the EFBs. The FFCT was successful in 91% (378) of the cases. In the 60 episodes involving children with underlying esophageal pathology, the technique had an 83% success rate compared to 92% in children without known pathology (P < .05). There were 290 patients where the duration of impaction was known. The success rate was 96% if the duration was 3 days or less compared to 50% if the duration was longer (P < .0001). Though the overall success in children < or = 24 months was less than older children (88% vs 94%, P < .05), this effect disappeared when corrected for duration of impaction. Minor complications occurred in 2% of the episodes, and major complications were noted in 1%. The FFCT appears to be a safe and effective method for removal of EFBs especially in children without underlying esophageal lesions and a duration of impaction < or = 3 days. Major complications are rare.

To determine the proportion of children with nasal foreign bodies who had button batteries as the foreign body. To describe the clinical care and outcome of those children with a button battery foreign body. A retrospective review of all children presenting to the accident and emergency room with a nasal foreign body or unilateral nasal discharge during a 6-month period was assessed. Forty-four children were included. The most common object found was a plastic bead (27%), followed by foam, paper, or tissue fragments (23%); food matter represented 15%. A button battery was found in 3 patients (7%); other foreign bodies included stones, buttons, crayons, erasers, and a pellet. Thiry-six (82%) had their foreign body removed without anesthetic and 8 (18%) required a general anesthetic. All 3 children with a button battery went undiagnosed until examination in the operating theater. Because there was no previous indication of the presence of a button battery in the 3 children, the removal of the foreign body under general anesthesia was scheduled for the following day. The removal of the button batteries would have been expedited had a plain radiograph been obtained, possibly resulting in less morbidity for our patients. We recommend a plain radiograph in all children presenting with a nonvisible foreign body or unilateral nasal discharge.

Foreign body (FB) ingestion is a common problem in pediatric populations. The aim of this study was to investigate the epidemiological, clinical features, and outcomes of pediatric esophageal foreign bodies ingestion with particular focus on complicated cases. We retrospectively reviewed all pediatric cases diagnosed with esophageal foreign body (EFB) from January 2014 to December 2022. We analyzed patient characteristics, foreign body types, sites and duration of impaction, clinical manifestations, treatment outcomes, and complications. Among the 95 cases, 56 were boys and 39 were girls, with a median age of 4 years (3-7 years). The average consultation delay was 6 hours. The most common symptom was dysphagia (30.5%). All patients had neck and chest X-rays. The upper esophagus was the most common site of impaction (62.1%). EFB included coins and blunt objects (87.4%), bones and sharp items (9.5%), and button batteries (2.1%). Ninety-four patients underwent rigid esophagoscopy, and foreign bodies were successfully removed in 75 cases. Complications occurred in 6.3% of cases, including minor mucosal lesions of the esophagus, bronchospasm, esophageal stenosis, and esophageal perforation. Main predictors of complications were sharp FB and button batteries. Rigid esophagoscopy remains an effective approach for foreign body removal in children. Clinicians should be mindful of these complications mainly in cases of sharp FB and button batteries. To prevent dangerous complications, it is essential to emphasize parental education and prompt and accurate diagnosis to opt for the suitable endoscopic approach.

Asphyxiation by an inhaled foreign body is a leading cause of accidental death among children younger than 4 years. We analyzed the recent epidemiology of foreign body aspiration and reviewed the current trends in diagnosis and management. In this article, we discuss anesthetic management of bronchoscopy to remove objects. The reviewed articles total 12,979 pediatric bronchoscopies. Most aspirated foreign bodies are organic materials (81%, confidence interval [CI] = 77%-86%), nuts and seeds being the most common. The majority of foreign bodies (88%, CI = 85%-91%) lodge in the bronchial tree, with the remainder catching in the larynx or trachea. The incidence of right-sided foreign bodies (52%, CI = 48%-55%) is higher than that of left-sided foreign bodies (33%, CI = 30%-37%). A small number of objects fragment and lodge in different parts of the airways. Only 11% (CI = 8%-16%) of the foreign bodies were radio-opaque on radiograph, with chest radiographs being normal in 17% of children (CI = 13%-22%). Although rigid bronchoscopy is the traditional diagnostic "gold standard," the use of computerized tomography, virtual bronchoscopy, and flexible bronchoscopy is increasing. Reported mortality during bronchoscopy is 0.42%. Although asphyxia at presentation or initial emergency bronchoscopy causes some deaths, hypoxic cardiac arrest during retrieval of the object, bronchial rupture, and unspecified intraoperative complications in previously stable patients constitute the majority of in-hospital fatalities. Major complications include severe laryngeal edema or bronchospasm requiring tracheotomy or reintubation, pneumothorax, pneumomediastinum, cardiac arrest, tracheal or bronchial laceration, and hypoxic brain damage (0.96%). Aspiration of gastric contents is not reported. Preoperative assessment should determine where the aspirated foreign body has lodged, what was aspirated, and when the aspiration occurred ("what, where, when"). The choices of inhaled or IV induction, spontaneous or controlled ventilation, and inhaled or IV maintenance may be individualized to the circumstances. Although several anesthetic techniques are effective for managing children with foreign body aspiration, there is no consensus from the literature as to which technique is optimal. An induction that maintains spontaneous ventilation is commonly practiced to minimize the risk of converting a partial proximal obstruction to a complete obstruction. Controlled ventilation combined with IV drugs and paralysis allows for suitable rigid bronchoscopy conditions and a consistent level of anesthesia. Close communication between the anesthesiologist, bronchoscopist, and assistants is essential.

Background: Ingestion of foreign bodies in children is a common occurrence and can affect from harmless to life-threatening situations. While laparotomy for ingested foreign body, in children is generally safe and effective, it is more important to take steps to prevent foreign body ingestion in the first place. Objective: The aim of this study was to evaluate the cases that underwent laparotomy for foreign body ingestion and the management of any complications. Methods: This retrospective study was conducted in the Division of Paediatric Surgery, Bangladesh Shishu Hospital &amp; Ins titute, Dhaka, Bangladesh from January 2013 to December 2022. Total 83 patients were admitted for ingestion of foreign body of which 32 foreign bodies were removed endoscopically and 40 patients expelled foreign bodies with defecation without any intervention. For the remaining 11 patients, laparotomy was performed and associated complications were managed accordingly. Results: In this study, the average age of the children were 38.7 months, of which majority were male (81.8%). Common presenting symptoms were dysphagia, (18.2%), abdominal pain (45.5%), vomiting (27.3%), and fever (27.3%). Whereas,36.4% were asymptomatic. The time interval between ingestion and treatment were about 56.5 hours. The primary indication for laparotomy was perforation (45.5%) and failed endoscopic removal (36.4%). Most ingested objects were magnets (36.4%), predominantly found in the jejunum and ileum (45.5%). The commonest per operative complication (81.8%) was intestinal obstruction. The average operation time was 68.4 minutes. Post-operative hospital stay was 7.5 days on average, with a 4.2-month follow-up. There were incidents of postoperative complications, with 18.2% experiencing postoperative ileus. Conclusion: Careful follow up of children with Ingested foreign bodies specially sharp and pointed objects, is warranted for its occasional requirement of surgical intervention, predominantly due to failure of endoscopic removal or spontaneous passage. Multiple ingestion of magnets or a single button battery ingestion can lead to life threatening complications, requiring surgical intervention. DS (Child) H J 2023; 39(1): 36-43

A bstract Background: Foreign bodies in the ear are common findings in growing children as they explore their environment. They vary from a range of objects within the environment of the child. When left unattended, it can result in various complications. Objectives: To assess the prevalence of incidental foreign bodies in the ears of some primary school children in Enugu State, Nigeria. Materials and Methods: This is a cross-sectional study evaluating 413 healthy primary school children from selected primary schools in Enugu state, Nigeria who, alongside caregivers, are unaware of the presence of any ear foreign bodies. Basic health details of participants were gathered, and an otoscopy was done. Results: A total of 17 (4.1%) out of the 413 children had incidental foreign bodies in their ears. The mean age of participants with incidental ear foreign bodies was 7.35 ± 1.54 years, and 94.1% were aged 5–9 years. There was a slight male preponderance (58.8%). More foreign bodies were found in the left ear (52.9%). Beads (29.4%) were the most common objects found, while other objects were erasers (17.6%), bean seeds (17.6%), paper (17.6%), and stones (17.6%). A significant number was asymptomatic (41.2%), while others complained of ear pain (29.4%) and itching (29.4%). Mild edema was noted within the canal (29.4%). There was no tympanic membrane perforation observed. Conclusion: Approximately one in every 25 primary school pupils in Enugu, Nigeria has incidental aural foreign body, and over a third of the cases are asymptomatic. Caregivers should be educated on the types of objects commonly found in children’s ears and the importance of keeping such items out of reach.