Management of Ingested Foreign Bodies in Children

Abstract

Foreign body ingestions in children are some of the most challenging clinical scenarios facing pediatric gastroenterologists. Determining the indications and timing for intervention requires assessment of patient size, type of object ingested, location, clinical symptoms, time since ingestion, and myriad other factors. Often the easiest and least anxiety-producing decision is the one to proceed to endoscopic removal, instead of observation alone. Because of variability in pediatric patient size, there are less firm guidelines available to determine which type of object will safely pass, as opposed to the clearer guidelines in the adult population. In addition, the imprecise nature of the histories often leaves the clinician to question the timing and nature of the ingestion. Furthermore, changes in the types of ingestions encountered, specifically button batteries and high-powered magnet ingestions, create an even greater potential for severe morbidity and mortality among children. As a result, clinical guidelines regarding management of these ingestions in children remain varied and sporadic, with little in the way of prospective data to guide their development. An expert panel of pediatric endoscopists was convened and produced the present article that outlines practical clinical approaches to the pediatric patient with a variety of foreign body ingestions. This guideline is intended as an educational tool that may help inform pediatric endoscopists in managing foreign body ingestions in children. Medical decision making, however, remains a complex process requiring integration of clinical data beyond the scope of these guidelines. These guidelines should therefore not be considered to be a rule or to be establishing a legal standard of care. Caregivers may well choose a course of action outside of those represented in these guidelines because of specific patient circumstances. Furthermore, additional clinical studies may be necessary to clarify aspects based on expert opinion instead of published data. Thus, these guidelines may be revised as needed to account for new data, changes in clinical practice, or availability of new technology.

Magnetiniai svetimkūniai vaikų virškinamajame trakte: klinikinė išraiška, diagnostika, gydymas

“…The general consensus among the NASPGHAN experts has been that if conservative management is chosen, direct patient observation in a controlled setting should be maintained. In addition, serial abdominal films and clear ''ownership'' of the patient until a passage of the magnets can be confirmed are vital [2]. Patients should be instructed to return if they experience abdominal pain or have symptoms suggestive of perforation or obstruction.…”

“…Numerous reports document instances of multiple magnets adhered tightly together, thus appearing as a single object on x-ray. Therefore, at least 2 views of the chest or abdomen should be obtained to determine the number of magnets present [2]. Although some authors suggest that if the object is below the diaphragm, further radiographs are generally unnecessary [11].…”

“…The small size and shiny surface of magnets make them an attractive target for ingestion by infants and toddlers. Ingestions by older children and adolescents, however, are also common, because they use the magnets to simulate a variety of face and body piercings [2].…”

Prevention of ingestion injuries in children

“…4), with 85% requi ring removal by means of endoscopy, laparoscopy or laparotomy. [19] Electric disc cells (commonly known as button Accidental caustic and foreign body ingestion by young children lead to a high number of emergency department visits, especially in lower-and middle-income countries. Some of these cause minimal tissue injury or pass spontaneously and uneventfully through the gastrointestinal tract; others may cause major morbidity, or rarely mortality.…”

“…4) in the USA. [19,27] Examples of unresolved challenges to primary prevention locally and elsewhere include:…”