Overview on Gastrointestinal Foreign Bodies in Children

Introduction: Greatest percentage of the upper gastro intestinal accidently swallowed foreign bodies in adults are related to food bolus impaction with meat. Most patients who swallow a true foreign body typically are younger, however young children were recorded to accidently swallow other objects rather than food poluses. Males are more often recorded, and often have significant psychiatric illness and/or drug abuse. Foreign body (FB) ingestion is a very common problem in children. FB may pass through gastrointestinal (GI) system silently without any indication, or it may need an intervention to prevent complications. The diagnosis, decision for involvement and management may have some difficulties, and it’s usually decided according to the case, especially in cases with protracted lodgment. Complications caused by lodgment of ingested GI FBs varies according to many factors and are associated with important morbidity and mortality in children. Objectives: to show an overview of gastrointestinal foreign bodies in children, its epidemiology, risk factors, hazards and management.

A chicken bone stuck in a divertic sigmoid colon, accidentally detected during a colonoscopy

Introduction: The swallowing of foreign bodies is a common clinical disorder. Aim: The aim of this study is to present the case of a swallowed foreign body and discuss the possible endoscopic approaches. Case study: We present a case of a 56-year-old woman who had a stuck chicken bone in a divertic sigmoid colon. In CT the presence of the bone in the sigmoid colon with edema and thickening of a wall around the foreign body was confirmed. The bone was removed in a hospital setting during colonoscopy with the use of ‘rat teeth’ forceps without complications. Results and discussion: Swallowed foreign bodies are usually excreted from the gastrointestinal tract without any complications, however, sometimes they can lead to serious clinical problems such as obstruction, perforation or bleeding. Most stapled foreign bodies in a large intestine can be removed endoscopically without complications. About 5% of patients require surgical treatment. Conclusions: The bone removal performed in the hospital setting ensured the possibility of appropriate procedure in case of complications, such as intestinal perforation or bleeding. The endoscopic bone removal prevented the development of complications requiring surgical treatment.

A gastrointestinalis traktusból migrált, lenyelt idegen testek esetei

Migration of swallowed foreign bodies from the gastrointestinal tract is a rare phenomenon compared with the total number of ingestions. In the reported two cases, the serious septic condition indicated urgent surgical intervention. We found a piece of wire swallowed a few months earlier in the right lobe of the liver and the retroperitoneum in case one, and a piece of wire in the pericardium, which migrated from the stomach through the left lobe of the liver, in case two. Abscesses and phlegmonae were found in the retroperitoneum and then in the femoral region requiring a reoperation in case one, and in the liver and pericardium in case two. After the evacuation of abscesses, both patients made full recovery. Diagnostic difficulties and therapeutic challenges served the reasons to present these cases. Orv Hetil. 2019; 160(42): 1677–1681.

Foreign body ingestion in children

Introduction: Evaluation of results of the group of paediatric patients treated for swallowed foreign bodies in the digestive tract. Methods: Retrospective analysis of patients treated for foreign bodies in the digestive tract, managed at the University Hospital of Hradec Králové between 2011–2018. Results: 365 patients (182 boys, 183 girls) with a foreign 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 a pen or a plant 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. Conclusion: 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 a battery 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.

Symptomatology of gastrointestinal tract foreign bodies

Aim. To study the clinical problems and develop the symptomatology of the foreign bodies (FB) of the gastrointestinal tract (GIT). Materials and methods. Ninety patients with GIT foreign bodies were observed over the period from 1997 to 2017. To diagnose, a complex of endoscopic and radial methods was used. Localization, size and type of the detected foreign bodies were compared with the symptoms revealed. Results. Fifty patients intentionally swallowed foreign bodies, 40 – accidentally. Altogether, 90 patients swallowed 193 items (nails, needles, pieces of wire etc.). On the basis of the study, three forms of clinical course regarding the swallowed GIT FB were singled out: latent, manifest and complicated. The pathognomonic symptoms of GIT FB are “migrant” abdominal pains associated with migration of FB along the GIT lumen, intensification of pains while moving, exercise stress and palpation, feeling of “heaviness” in epigastric region. Multiple gastric FB cause the auscultative symptom of “ringing”. Pains, available with GIT FB, are not connected with taking food and are not ceased after taking antacids. Conclusions. Introduction of the developed GIT FB symptomatology into healthcare practice and training of physicians will contribute to earlier and more accurate diagnosis.

The presence of a foreign body in the digestive tract - case reports and literature review

The presence of foreign bodies in the digestive tract usually occurs in pediatric, adolescent and psychiatric patients. Current Protocols focus mainly on pediatricians and adults.We present some cases mainly of feminine age. Most swallowed foreign bodies will harmlessly pass through the GI tract, but some will lead to health problems if they become lodged (too big to pass, such as a spoon, or small objects like a pill that adheres to a moist surface); traumatize the mucosa (sharp or pointed object, like a razor blade or pin), or cause burn-like illness (biologically active, such as a button battery or a medication patch) may cause problems.which during X-Ray abdominal exfoliation show varying objects in the digestive tract at different levels. The following examinations highlighted the most accurate localization.Asymptomatic clinical data continued to deteriorate, despite imaging evidence. This article discusses the challenges involved in the management of foreign troops in the digestive tract and the re-evaluation of literature

Disk Battery Ingestion A Malpractice Case that Results in Pneumonia

Alkaline batteries have become the second most swallowed foreign bodies following coins. Most cases have an uncomplicated course, but some may lead to serious complications and even death.Here we report a 28 months old boy who had experienced discomfort, eating refusal, vomiting and slightly wheezing after falling from a sofa bed. He has been in three different county hospitals and two private hospitals due to complaints, has been examined by two pediatricians and a cranial surgeon. A cranial CT imaging, a cranial X-ray radiograph and a chest X-ray radiograph was obtained. Firstly, diagnosed as head and neck trauma, then diagnosed as acute bronchiolitis, and finally pneumonia. Hospitalized twice. Finally, a chest radiograph revealed a button battery in the esophagus. The foreign body was endoscopic removed. The child had a quick clinical impairment after removal of the battery.As a result, alkaline batteries with their increasing risk of engulfment poses very serious problems. The parents and physicians should be informed against increasing frequency of ingestion of alkaline batteries by infants and children. Also, clinicians should be careful about the risk of these batteries that they can cause pneumonia and infiltration which may make it difficult to detect the foreign body.

Lighter Ingestion as an Uncommon Cause of Severe Vomiting in a Schizophrenia Patient

Background. Foreign bodies in the gastrointestinal tract are important morbid and mortal clinical conditions. Particularly, emergency treatment is required for cutting and drilling bodies. The majority of ingested foreign bodies (80–90%) leave gastrointestinal tract without creating problems. In 10–20% of cases, intervention is absolutely required. Less than 1% of cases need surgery. In this paper, we present a schizophrenia patient who swallowed multiple lighters.Case. A 21-year-old male schizophrenic patient who uses psychotic drugs presented to the emergency department with the complaints of abdominal pain, severe vomiting, and inability to swallow for a week. His physical examination revealed epigastric tenderness. A plain radiograph of the abdomen revealed multiple tiny metallic densities. Gastroscopy was performed. The lighters were not allowing the passage, and some of them had penetrated the gastric mucosa, and bezoars were observed. One lighter was extracted with the help of the polypectomy snare. Other lighters as a bezoar were removed by surgery.Conclusion. Excessive vomiting of swallowed foreign bodies in the etiology of psychotic patients should be kept in mind. Endoscopic therapy can be performed in the early stages in these patients, but in the late stage surgery is inevitable.