Evaluation of a Symptom-Based Algorithm for Managing Battery Ingestions in Children

2021 ◽  
Author(s):  
James A. Fraser ◽  
Kayla B. Briggs ◽  
Wendy Jo Svetanoff ◽  
Thomas M. Attard ◽  
Tolulope A. Oyetunji ◽  
...  
Keyword(s):  
Foreign Body ◽  
Small Bowel ◽  
Conservative Management ◽  
Chart Review ◽  
Gastroesophageal Junction ◽  
Retrospective Chart Review ◽  
X Rays ◽  
Button Battery ◽  
Additional Imaging ◽  
Endoscopic Retrieval

Abstract Objectives While complications from battery ingestion can be severe, especially with the emergence of stronger battery elements, not all ingestions require prompt removal. We aim to evaluate a symptom-focused algorithm for battery ingestion that emphasizes observation over intervention to investigate its safety. Materials and Methods Patients were identified through a query of foreign-body ingestion radiographs obtained between 2017 and 2020. A retrospective chart review was then performed of all patients who presented with button battery ingestions to identify compliance with our algorithm, overall outcomes, and complications. Results In total, 2% of all radiographs (44/2,237) demonstrated button battery ingestions. The median age of patients was 3.8 years (interquartile range, 2.6–5.3). Most batteries were found in the stomach (64%, n = 28), but were also identified in the esophagus (14%, n = 6), small bowel (14%, n = 6), and colon (9%, n = 4). All esophageal batteries were managed with immediate endoscopic retrieval. Ten gastric batteries were not managed per protocol, with seven admitted for observation despite being asymptomatic and repeat abdominal X-rays demonstrating persistent gastric location of the battery. Four patients underwent esophagogastroduodenoscopy; however, in two patients the battery had migrated past the stomach prior to intervention. All small bowel batteries and three of four asymptomatic colon batteries were managed per protocol; one patient had additional imaging that demonstrated battery passage. Conclusion Adherence to a symptom-focused protocol for conservative management of button battery ingestions beyond the gastroesophageal junction is safe and frequently does not require admission, serial imaging, or intervention.

scholarly journals A study on radio opaque foreign body in digestive tract of children

2018 ◽  
Vol 4 (2) ◽  
pp. 352
Author(s):  
Bharathi Mohan M. ◽  
Satish Kumar P. ◽  
Vikram V. J. ◽  
Kiruthiga M.
Keyword(s):  
Foreign Body ◽  
Foreign Bodies ◽  
Gastroesophageal Junction ◽  
Button Battery ◽  
Ingested Foreign Body ◽  
Pseudo Aneurysm ◽  
Pass Through ◽  
Sharp Foreign Body ◽  
Rigid Oesophagoscopy ◽  
Safety Pin

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">An estimated 40 percent of foreign body ingestions in children are not witnessed, and in many cases, the child never develops symptoms. Sharp foreign body, button battery must be carefully removed and followed up for any complications. Foreign bodies that have passed the gastroesophageal junction should be assured that the foreign body will probably pass through the GI tract. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A retrospective analysis of the records of the children below 12 years with foreign body ingestions were analysed and the radio-opaque foreign body were included in the study period between March 2012 to March 2015. The x-ray were analysed, type of foreign body, treatment and complications were noted.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">There were 45 children included in the study who had ingested foreign body and on radiological evaluation radio opaque foreign body was found. The coin topped the list with 30, button battery- 7 numbers, safety pin- 5 numbers. In 2 children who ingested button battery suffered cricopharyngeal stricture, which was treated with serial dilatation with bougies, while one child with open safety pin ingestion, developed pseudo- aneurysm of arch of aorta and one ear stud developed stridor with sub glottic stenosis. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The radio opaque foreign though is easy to visualise, but in some case it can dangerous complications. Rigid oesophagoscopy and prompt removal of foreign body is the treatment of choice.</span></p>

Use of Early Gastrografin Small Bowel Follow-through in Small Bowel Obstruction Management

2013 ◽  
Vol 79 (8) ◽  
pp. 794-796 ◽  
Author(s):  
Nicholas Galardi ◽  
Jay Collins ◽  
Kara Friend
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Operative Management ◽  
Operative Intervention ◽  
Early Implementation ◽  
Non Operative Management ◽  
Mean Time

Small bowel follow-through (SBFT) is a diagnostic tool commonly used in the management of patients with small bowel obstruction (SBO). This study assessed whether early implementation of Gastrografin SBFT would reduce the time to resolution of the SBO and decrease the time to operative intervention. In this retrospective chart review, 103 patients with the clinical diagnosis of adhesive SBO were evaluated. End points of the study were resolution of SBO with non-operative management or operative intervention. The patient group that had received a SBFT was then compared with those that did not receive a SBFT. There were 103 patients with adhesive SBO who met inclusion criteria for this study. Seventy-two of 103 patients had undergone Gastrografin SBFT and 31 did not. In the SBFT group, mean time to the operating room was 1.0 days after SBFTs, whereas in the group that did not receive SBFT, it was 3.7 days ( P < 0.0001). Mean time to nonoperative resolution of SBO in the SBFT group was 1.8 days and 4.7 days in the no SBFT group ( P < 0.0001). There were no Gastrografin-related complications. Obtaining Gastrografin SBFT in patients with adhesive SBO leads to both a shorter time in identifying the need for operative intervention and to resolution of SBO with nonoperative management. SBFT seems to be a more definitive assessment of whether an SBO will resolve on its own or if operative intervention is necessary.

The utility of guaiac stool testing in the detection of gastrointestinal complications in infants with critical congenital heart disease

2019 ◽  
Vol 29 (5) ◽  
pp. 655-659 ◽  
Author(s):  
Melanie Muller ◽  
Cortney Foster ◽  
Jessica Lee ◽  
Caroline Bauer ◽  
Casey Bor ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Chart Review ◽  
Caloric Intake ◽  
Retrospective Chart Review ◽  
X Rays ◽  
Critical Congenital Heart Disease ◽  
Gastrointestinal Complications ◽  
Feeding Tolerance

AbstractBackground:Guaiac stool testing has been routinely used as a method to detect gastrointestinal complications in infants with critical congenital heart disease (CHD); however, the sensitivity and specificity have not been established.Methods:A retrospective chart review was performed investigating the presence of heme-positive stools and subsequent gastrointestinal complications as well as time to goal caloric intake and radiograph exposure.Results:The presence of heme-positive stools was not a statistically significant factor in patients with critical CHD that experienced gastrointestinal complications. Additionally, patients with heme-positive stools did undergo more abdominal X-rays than those with heme-negative stools.Conclusions:The routine use of guaiac stool testing in infants with critical CHD is not a predictor of possible gastrointestinal complications and leads to more radiograph exposure for the patient. Close clinical monitoring can be used to evaluate feeding tolerance in infants with critical CHD.

scholarly journals The Impact of Global Alignment and Proportion Score and Bracing on Proximal Junctional Kyphosis in Adult Spinal Deformity

2021 ◽  
pp. 219256822110018
Author(s):  
Elizabeth L. Lord ◽  
Ethan Ayres ◽  
Dainn Woo ◽  
Dennis Vasquez-Montes ◽  
Yesha Parekh ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Chart Review ◽  
Adult Spinal Deformity ◽  
Retrospective Chart Review ◽  
Global Alignment ◽  
X Rays ◽  
Proximal Junctional Kyphosis ◽  
Upper Instrumented Vertebra ◽  
The Impact ◽  
Junctional Kyphosis

Study Design: Retrospective chart review. Objective: The goal of this study is to examine the relationship between global alignment and proportion (GAP) score and postoperative orthoses with likelihood of developing proximal junctional kyphosis (PJK). Methods: Patients who underwent thoracic or lumbar fusions of ≥4 levels for adult spinal deformity (ASD) with 1-year post-operative alignment x-rays were included. Chart review was conducted to determine spinopelvic alignment parameters, PJK, and reoperation. Results: A total of 81 patients were included; baseline and 1-year postoperative alignment did not differ between patients with and without PJK. There was no PJK in 53.1%, 29.6% had PJK from 10-20°, and 17.3% had severe PJK over 20° (sPJK). At baseline, 80% of patients had severely disproportioned GAP, 13.75% moderate, 6.25% proportioned. GAP improved across the population, but improved GAP was not associated with sPJK. Greater correction of the upper instrumented vertebra to pelvic angle (UIV-PA) was associated with a larger PJK angle (PJKA) change (R = -0.28) as was the 1 year T1-upper instrumented vertebra (T1-UIV) angle (R = 0.30), both P < .05. GAP change was not correlated with PJKA change. Postoperative orthoses were used in 46% of patients and did not impact sPJK. Conclusions: There was no correlation between PJK and GAP or change in GAP. Greater correction of UIV-PA and larger postop T1-UIV was associated with greater PJKA change; suggesting that the greater alignment correction led to greater likelihood of failure. Postoperative orthoses had no impact on PJK.

scholarly journals Foreign bodies in esophagus

2019 ◽  
Vol 5 (3) ◽  
pp. 608
Author(s):  
Anchal Gupta ◽  
Apurab Gupta ◽  
Padam Singh Jamwal
Keyword(s):  
Foreign Body ◽  
Chart Review ◽  
Foreign Bodies ◽  
Retrospective Chart Review ◽  
Thoracic Esophagus ◽  
Female Ratio ◽  
Patient Demographics ◽  
Rigid Esophagoscopy ◽  
Male Female Ratio ◽  
Length Of Hospitalization

<p class="abstract"><strong>Background:</strong> The presence of a foreign body in the esophagus is a challenging problem. Perforations may result in death. Impaction mandates immediate extraction.</p><p class="abstract"><strong>Methods:</strong> A retrospective chart review was made of all patients hospitalized in Department of ENT, SMGS Hospital with a diagnosis of foreign bodies in the gastrointestinal tract between July 2017 to February 2018. Forty patients were identified. The charts were reviewed for the following: patient demographics, preoperative diagnosis, kind and location of the foreign body, timing of the procedure and the length of hospitalization.  </p><p class="abstract"><strong>Results:</strong> The youngest patient in our study was 8 months old while the oldest was 60 years old. The male: female ratio of 2.3:1. The most common site of impaction was cricopharynx (55%) followed by thoracic esophagus (40%) and lower end of esophagus (5%). The most common foreign body was coin (50%) and all were seen in children upto 7 years of age. 25 (62.5%) patients were children of age less than 10 years. 20 children showed coin ingestion, 1 child of 8 months presented with impaction of fruit seed and 4 children with battery button ingestion. The length of retention of foreign body ranged from 2 hours to 6 days. All the patients were managed with rigid esophagoscopy under general anesthesia all within 12 hours of admission.</p><p class="abstract"><strong>Conclusions:</strong> Rigid endoscope as the instrument of choice for extracting foreign bodies from the esophagus as delay in extracting foreign bodies from the esophagus may lead to retention of foreign body and hence perforation.</p>

scholarly journals Traumatic Endophthalmitis due toCellulosimicrobium cellulans

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Pimkwan Jaru-ampornpan ◽  
Anita Agarwal ◽  
Narinder K. Midha ◽  
Stephen J. Kim
Keyword(s):  
Case Report ◽  
Foreign Body ◽  
Chart Review ◽  
Foreign Bodies ◽  
Retrospective Chart Review ◽  
Intraocular Foreign Body ◽  
First Report ◽  
Cellulosimicrobium Cellulans

Purpose. To report a case of traumatic endophthalmitis due toCellulosimicrobium cellulans.Design. Case report.Methods. Retrospective chart review.Results. To our knowledge, this is the first report of traumatic endophthalmitis due toC. cellulans, which did not respond to intravitreal antibiotics or repeat vitrectomy and ultimately led to the discovery of an occult intraocular foreign body.Conclusions.C. cellulansis a rare cause of endophthalmitis. Greater awareness of this bacterium in the ophthalmic literature as a cause of endophthalmitis and its association with foreign bodies may allow earlier and more purposeful intervention in future cases.

scholarly journals Unilateral rhinorrhoea and button battery: a case report

2019 ◽  
Vol 7 (3) ◽  
pp. e000137
Author(s):  
Geng Ju Tuang ◽  
Nik Roslina Nik Hussin ◽  
Zainal Azmi Zainal Abidin
Keyword(s):  
Case Report ◽  
General Practitioner ◽  
Foreign Body ◽  
Nasal Discharge ◽  
Age Group ◽  
Septal Perforation ◽  
Button Battery ◽  
X Ray ◽  
Paediatric Age ◽  
Endoscopic Retrieval

Unilateral rhinorrhoea in the paediatric age group could be an alarming sign that warrants a clinician attention. These patients are routinely brought to see general practitioner as parents may not be aware of the urgency to intervene surgically. Herein we describe a case of a toddler who presented initially to a general practitioner with unilateral nasal discharge. He was subsequently referred to the otorhinolaryngology department for unresolved rhinitis. The child was examined, and the diagnosis of an embedded foreign body was made. X-ray of the paranasal sinus unveiled an embedded button battery. An emergency endoscopic retrieval of the button battery was performed under general anaesthesia. Unfortunately, the case was complicated with a huge septal perforation.

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