Foreign Body Ingestion in Pediatrics: Distribution, Management and Complications

Background and Objectives: Foreign body (FB) ingestion is a common problem in children, causing serious complications. This study aimed to identify the distribution of types and locations of these foreign bodies and create Chiang Mai University (CMU) Guidelines. Materials and Methods: A retrospective descriptive study was conducted. All patients under 15 years old with foreign body ingestion (International Statistical Classification of Diseases and Related Health Problems; ICD-10 codes T18) treated in CMU Hospital from January 2006 to December 2017 were included. The data were analyzed using descriptive statistics. The guidelines were created, which paralleled the standard guidelines. Results: In total, 194 episodes of FB ingestion were recorded. These included 53.6% males and 46.4% females with a median age of 43.5 months. A history of foreign body ingestion complaints occurred in 77.8% of cases. Presentation was divided into asymptomatic (44.3%) and symptomatic (55.7%). The most common symptom was vomiting (23.2%). In the majority of cases, foreign bodies were located in the esophagus (37%). The most common type of foreign body was a coin (41.2%). Management included spontaneous passing (60.3%), endoscopy (35.6%), and others (3.1%). Complications before treatment were recorded in 9.3% of cases and after treatment in 2.1% of cases. Conclusions: Foreign body ingestion is common among children younger than four years old. Coins are the most common foreign body found, and the esophagus is the most common location. We recommend our created CMU Guidelines for management.

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Tendency to Ingest Foreign Bodies in Mentally Retarded Patients: A Case with Ileal Perforation Caused by the Ingestion of a Teaspoon

Case Reports in Surgery ◽

10.1155/2016/8075432 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3

Author(s):

İhsan Yıldız ◽

Yavuz Savaş Koca ◽

Gökhan Avşar ◽

İbrahim Barut

Keyword(s):

Mental Retardation ◽

Foreign Body ◽

Foreign Bodies ◽

Mentally Retarded ◽

The Body ◽

Foreign Body Ingestion ◽

Emergency Laparotomy ◽

Ileal Perforation ◽

History Of ◽

The Right

Introduction. Unintentional foreign body ingestion commonly occurs accidentally in children aged between 3 months and 6 years and at advanced ages or results from psychiatric disorders such as hallucination in patients with mental retardation. Most of the ingested foreign bodies are naturally discharged from the body but some of them may require surgical intervention.Presentation of Case. A 29-year-old mentally retarded female patient was admitted to the emergency service with a two-day history of abdominal pain, nausea, and vomiting. Physical examination revealed abdominal tenderness, defense, and rebound on palpation. Radiological examination revealed diffuse air-fluid levels and a radiopaque impression of a metal object in the right upper quadrant. The metal teaspoon causing ileal perforation was extracted by emergency laparotomy. On postoperative day 7, the patient was uneventfully discharged following a psychiatric consultation.Discussion. Foreign body ingestion can occur intentionally in children at developing ages and old-age patients, or adults and prisoners, whereas it may occur unintentionally in patients with mental retardation due to hallucination. However, repeated foreign body ingestion is very rare in individuals other than mentally retarded patients.Conclusion. Mentally retarded patients should be kept under close surveillance by surgeons and psychiatrists due to their tendency to ingest foreign bodies.

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Increase of foreign body and harmful substance ingestion and associated complications in children: a retrospective study of 1199 cases from 2005 to 2017

10.21203/rs.3.rs-45920/v1 ◽

2020 ◽

Author(s):

Arne Speidel ◽

Lena Woelfle ◽

Benjamin Mayer ◽

Carsten Posovszky

Keyword(s):

Foreign Body ◽

Linear Regression Analysis ◽

Harmful Substance ◽

Female Ratio ◽

Retrospective Data Analysis ◽

Asymptomatic Children ◽

Classification Of Diseases ◽

International Statistical Classification ◽

History Of ◽

The University

Abstract Background Children with a history of caustic or foreign body ingestions (FBI) are frequently presented at the emergency department. An uncertain case history, the different objects and diverse clinical presentation may complicate or delay a proper management and cause serious complications. Methods A structured retrospective data analysis of patients presented in between January 2005 and December 2017 at the University Medical Centre Ulm was performed. All patients up to 17 years of age with food impaction, foreign body or harmful substance ingestion were included by selection of the corresponding International Statistical Classification of Diseases and Related Health Problems (ICD10-GM) codes. Descriptive statistics, parametric or non-parametric tests, and linear regression analysis were performed. Result In total, 1199 cases were analysed; mean age 3.3 years (SD 3.12; range 7 days to 16 years), male to female ratio 1.15:1, thereof 194 (16.2%) were hospitalized. The majority (n = 619) had no symptoms, 244 out of 580 symptomatic patients complained retching or vomiting. The annually recorded cases increased from 66 in 2005 to 119 in 2017 with a rise of the percentage of all emergency cases by 0.52% since 2010 to 1.34% in 2017. Most frequently, coins were ingested (18,8%). Radiopaque objects accounted for 47.6%, and sharp objects for 10.5% of the FBI, which were significantly more often ingested by girls (p < 0.000015 and p < 0.000024, respectively). Button battery ingestion was recorded in 63 cases with a significant annual increase (R2 = 0.57; beta = 0,753; p < 0.003). The annual rate of complications raised significantly (R2 = 0.42; beta = 0,647; p < 0.017). Conclusion Children with FBI are increasingly presented at emergency departments. Special attention is necessary to prevent serious complications, especially in asymptomatic children. Further preventive measures within the home environment are needed to stop this trend.

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Ingestion of Bell Clappers by a Shaman in Jumla, Nepal: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.4055 ◽

2019 ◽

Vol 57 (215) ◽

Author(s):

Niresh Thapa ◽

Subi Basnyat ◽

Muna Maharjan

Keyword(s):

Foreign Body ◽

Psychiatric Illness ◽

Foreign Bodies ◽

Surgical Intervention ◽

Interesting Case ◽

Foreign Body Ingestion ◽

Ileocecal Junction ◽

Post Operative Period ◽

History Of ◽

Significant Injury

Accidental foreign body ingestion is a common problem encountered in Emergency. Deliberate foreign body ingestion may result due to an act of insanity or an act of daring. A shaman locally known as Dhami was brought to Emergency with the history of ingestion of bell clappers. He denied the history of psychiatric illness or substance abuse. On physical examination, there were signs of peritonitis. Laparotomy was done to remove the foreign bodies. Post-operative period was uneventful. Apart from the surgical intervention, psychological counselling was given to him. This is a rare interesting case due to the fact that the 15 cm long foreign bodies passing all the way through without significant injury and finally causing obstruction in ileocecal junction and perforation in the distal ileum.

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Multiple esophageal foreign bodies in an infant: a rare case of serious parental neglect

Clinics and Practice ◽

10.4081/cp.2016.841 ◽

2016 ◽

Vol 6 (3) ◽

Author(s):

Arunabha Chakravarti ◽

Sunil Garg ◽

Rahul Bhargava

Keyword(s):

Foreign Body ◽

Rare Case ◽

Foreign Bodies ◽

Foreign Body Ingestion ◽

Parental Neglect ◽

Rigid Esophagoscopy ◽

The Family ◽

History Of ◽

Esophageal Foreign Bodies

A case of multiple esophageal foreign bodies, which were retrieved successfully by rigid esophagoscopy in a 1-year old child is being reported. There are few cases of multiple esophageal foreign bodies in children reported in the literature; this case was unique in presentation as there was no history of foreign body ingestion. This case also highlights the serious neglect present in our society towards children of lower socio-economic strata despite this child being the 1<sup>st</sup> child in the family.

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Intestinal perforation by ingested foreign bodies

International Surgery ◽

10.9738/intsurg-d-15-00303.1 ◽

2017 ◽

Author(s):

Xinping Li ◽

Bujun Ge ◽

Hongmei Zhao ◽

Wei Jin ◽

Daojing Huang ◽

...

Keyword(s):

Foreign Body ◽

Intestinal Perforation ◽

Foreign Bodies ◽

Bowel Perforation ◽

Optimal Choice ◽

Diagnosis And Treatment ◽

Foreign Body Ingestion ◽

X Ray ◽

Common Location ◽

Background Data

Abstract Objective The aim of our manuscript is to study the incidence, diagnosis, and treatment of bowel perforation by foreign body ingestion. Summary of Background Data Bowel perforation, by foreign body ingestion, has been believed to be relatively rare, and most commonly caused by fish bones, chicken bones, and toothpicks. Our clinical experience,however, suggests such perforations may be more common than previously thought, and caused by various other objects as well. Methods Medical records of all patients diagnosed with foreign body-induced intestinal perforation, from the Department of General Surgery at Shanghai Tongji Hospital, from January 2000 to June 2015, were retrospectively analyzed. Results Among the 25 total patients, 4 ingested foreign bodies intentionally, while the other 21 cases were accidental.The foreign bodies were identified by plain X-ray film in 2 patients and by multidetector computed tomography (MDCT) in 11 patients, thus supporting the correct preoperative diagnosis (13 cases, 52%). The most common location of the perforation was the terminal ileum (n = 17).The offending objects were date stones (n=13), bones(n=7), and metallic objects (n=5). The most common treatment was removal ofthe foreign body and closure of the perforation with simple suture(n=22). Ten patients were treated laparoscopically. Conclusion The present study shows that the most common foreign bodies causing intestinal perforation are date stones and bones. Although about 50 percent of the foreign bodies could be identified by MDCT, definite diagnosis remained preoperatively difficult. Laparoscopy may be the optimal choice for diagnosis and treatment of bowel perforation by foreign bodies.

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Unique Pattern of True Foreign-Body Ingestion in the Valley of Kashmir; Sharp Foreign Bodies Outnumbering the Blunt Ones

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_74_18 ◽

2019 ◽

Vol 10 (01) ◽

pp. 028-032

Author(s):

Nisar Ahmad Shah ◽

Showkat Ahmad Kadla ◽

Asif Iqbal Shah ◽

Bilal Ahmad Khan ◽

Inaam Ul Haq ◽

...

Keyword(s):

Foreign Body ◽

Success Rate ◽

Foreign Bodies ◽

Foreign Body Ingestion ◽

Young Females ◽

The People ◽

Early Endoscopy ◽

Normal Individuals ◽

Structural Abnormalities ◽

The Impact

ABSTRACT Background and Aims: Foreign-body ingestion is a common phenomenon, especially in children. In normal adults, foreign-body ingestion is usually accidental and mostly ingestion occurs with food and impaction is a result of structural abnormalities of the upper gastrointestinal tract (UGIT). However, accidental ingestion of nonfood products is unusual; especially ingestion of pins (scarf or safety pins) and needles is unknown. We come across ingestion of these unusual/sharp foreign bodies routinely from the past few years. The aim of this study was to observe, over a period of 1 year, the spectrum of nonfood or true foreign-body ingestion in our community and to see the impact of an early endoscopy on outcome or retrieval of the ingested objects. Materials and Methods: In a prospective observational study, we studied the profile of foreign-body ingestion in normal individuals of all ages and both sexes, excluding the individuals with any structural abnormalities of the gut and the people with psychiatric ailment. Results: Of total 51 patients with foreign-body ingestion, 42 (82%) were 20 or <20 years of age with females constituting 86.3% of the total and males constituting only 13.7%. Foreign bodies ingested included 38 pins (74.5%), seven coins (13.7%), four needles (7.8%), and one denture and a nail (2%) each. Overall 26 (51%) foreign bodies were seen in UGIT (within reach of retrieval) at the time of endoscopy and all of them were retrieved. Nineteen (37.3%) patients reported within 6 h of ingestion, and majority of them (16 = 84.2%) had foreign bodies within UGIT and all of them were removed. Those patients (n = 32; 62.7%) who reported beyond 6 h, only 10 (31.25%) had foreign bodies in UGIT as a result of which the success rate of removal in these patients was only 32%. Conclusion: Most of our patients were young females and the common foreign bodies ingested were sharp including scarf pins followed by coins and needles. The success rate of retrieval was high in those who reported within 6 h of ingestion of foreign body. The rate of retrieval was 100% if foreign body was found on esophagogastroduodenoscopy. Hence, we recommend an early endoscopy in these patients and some alternative to use of scarf pins.

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Application of MRI for the Diagnosis of Neoplasms

BioMed Research International ◽

10.1155/2018/2715831 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Ewa Bejer-Oleńska ◽

Michael Thoene ◽

Andrzej Włodarczyk ◽

Joanna Wojtkiewicz

Keyword(s):

Benign Neoplasms ◽

Young Males ◽

Classification Of Diseases ◽

Icd 10 ◽

Mri Scans ◽

International Statistical Classification ◽

The Central Nervous System ◽

Spss Software ◽

The Brain

Aim. The aim of the study was to determine the most commonly diagnosed neoplasms in the MRI scanned patient population and indicate correlations based on the descriptive variables. Methods. The SPSS software was used to determine the incidence of neoplasms within the specific diagnoses based on the descriptive variables of the studied population. Over a five year period, 791 patients and 839 MRI scans were identified in neoplasm category (C00-D48 according to the International Statistical Classification of Diseases and Related Health Problems ICD-10). Results. More women (56%) than men (44%) represented C00-D48. Three categories of neoplasms were recorded. Furthermore, benign neoplasms were the most numerous, diagnosed mainly in patients in the fifth decade of life, and included benign neoplasms of the brain and other parts of the central nervous system. Conclusions. Males ≤ 30 years of age with neoplasms had three times higher MRI scans rate than females of the same age group; even though females had much higher scans rate in every other category. The young males are more often selected for these scans if a neoplasm is suspected. Finally, the number of MRI-diagnosed neoplasms showed a linear annual increase.

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Endobronchial Foreign Body Presenting as Exacerbation of Asthma

Case Reports in Emergency Medicine ◽

10.1155/2017/6863083 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

James E. Tsang ◽

June Sun ◽

Gaik C. Ooi ◽

Kenneth W. Tsang

Keyword(s):

Foreign Body ◽

Respiratory Distress ◽

Foreign Bodies ◽

Main Bronchus ◽

Fiberoptic Bronchoscopy ◽

Clinical History ◽

Medical Personnel ◽

History Of ◽

Normal Chest ◽

Low Dose Computed Tomography

Airway foreign bodies are a leading cause of death among children and require urgent recognition by medical personnel. While most cases are diagnosed readily from a clinical history of acute respiratory distress, some cases remain more indolent and present later. We report the case of a 7-year-old boy who aspirated a “LEGO” toy and presented with a week history of increasing respiratory distress compatible with known asthma. Despite a normal chest X-ray, a low-dose computed tomography showed the presence of a foreign body in the left main bronchus, which was subsequently removed by fiberoptic bronchoscopy. Our case serves to reemphasize the importance of considering airway foreign bodies as a cause of respiratory distress, especially in young children.

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Foreign Body Aspiration: Potential Cause of Coughing and Wheezing

Pediatrics in Review ◽

10.1542/pir.10.2.59 ◽

1988 ◽

Vol 10 (2) ◽

pp. 59-63

Author(s):

H. James Holroyd

Keyword(s):

Foreign Body ◽

Respiratory Symptoms ◽

Foreign Bodies ◽

Pediatric Population ◽

Congenital Defects ◽

Natural Tendency ◽

History Of ◽

Possible Cause ◽

Cardiopulmonary System ◽

Infants And Young Children

As many as half of routine ill-patient visits in pediatrics practice involve respiratory symptoms. It is not surprising that we see so much coughing and wheezing when we consider that children are still developing immunologically and are, therefore, more susceptible to infection. In early life, most of these infectious diseases occur in the respiratory and gastrointestinal tracts. In addition, the gradual exposure of the constitutionally allergic child to environmental allergens pre-disposes to the development of respiratory symptoms. Childhood is also a time for congenital defects of the cardiopulmonary system to become apparent. A sometimes overlooked cause of respiratory symptoms in infants and young children—and one that can become rapidly and severely complicated if misdiagnosed—is the aspiration of foreign bodies. Aspiration or ingestion of foreign bodies remains a significant cause of morbidity and mortality in the pediatric population. Children between 8 months and 4 years of age are at highest risk. Not all cases of aspiration are of the acute, obstructive variety, and pediatricians should consider a foreign body as a possible cause of coughing and wheezing even when no definite history of aspiration is obtained. Children of course are curious and their natural tendency is to reach out and explore new objects. Bringing objects to their mouths to taste and to test textures is common.

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Foreign Body Ingestion

10.2310/gastro.5503 ◽

2015 ◽

Author(s):

Kunal Jajoo ◽

Allison R Schulman

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Management Strategies ◽

The United States ◽

Foreign Body Ingestion ◽

Gi Tract ◽

Food Bolus ◽

Therapeutic Decisions ◽

Food Bolus Impaction ◽

Bolus Impaction

Foreign-body ingestion and food bolus impaction are common causes of esophageal obstruction, with an annual incidence of 13 cases per 100,000, and represent approximately 4% of all emergency endoscopies. Although the majority of foreign bodies that travel to the gastrointestinal (GI) tract will pass spontaneously, 10 to 20% must be removed endoscopically, and 1 to 5% will require surgery. Key diagnostic and therapeutic decisions are based on common factors, including the type of ingested object, number of objects, timing between ingestion and presentation, anatomic location of the object, and presence or absence of symptoms. Complications relating to foreign-body ingestion are typically uncommon; however, the associated morbidity may be severe and occasionally life threatening, and despite the fact that overall mortality has been extremely low, it has been estimated that up to 1,500 deaths occur annually in the United States as a result of foreign-body ingestion. The initial and follow-up management strategies are crucial to preventing morbidity. This review details the epidemiology, etiology and pathophysiology, diagnosis, management, and complications of foreign-body ingestion. Figures show examples of foreign bodies in the esophagus and stomach, three esophageal areas where a foreign body is likely to be impacted, examples of a meat bolus in the esophagus, radiograph of a patient who swallowed one nail and three batteries, and examples of linear erosions of the esophagus and stomach. Tables list the most common GI pathology predisposing individuals to esophageal foreign-body impaction, timing and management of food bolus impaction and foreign-body ingestion, endoscopic management strategies for food bolus impaction and ingested foreign bodies, and radiographic and surgical management strategies for monitoring progress of foreign-body passage through the GI tract. This review contains 5 highly rendered figures, 4 tables, and 78 references.

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