Management of oesophageal foreign bodies in children: a 10-year retrospective analysis from a tertiary care center

Abstract

Objective Oesophageal foreign bodies (EFBs) are a common emergency issue in paediatrics, and few studies have revealed its clinical features and treatment methods. We conducted this retrospective study to provide our 10-year clinical evidence for the diagnosis and treatment of EFB and reduce the incidence of complications. Methods We retrospectively reviewed all paediatric cases diagnosed with EFB from January 2012 to December 2021 at Shenzhen Children’s Hospital. The age and sex of the patients, types of foreign bodies (FBs), preoperative examination, location and duration of FB impaction, clinical symptoms, surgical methods, therapeutic effects and complications were analysed. Results Among the 1355 cases, 759 were boys and 596 were girls, with a median age of 2.9 years (4 months to 16 years). The shortest FB lodged time was 1 hour, while the longest time was 3 months. The types of foreign bodies included coins and blunt objects (812,59.9%), bones and sharp objects (278,20.5%), button batteries (86,6.3%), food impactions (84,6.2%), toys (51,3.8%) and plastic objects (44,3.2%). A total of 720 of 812 cases impacted by coins and blunt subjects were successfully treated with a Foley catheter without any complications. A total of 558 patients underwent rigid oesophageal endoscopy under general anaesthesia, and foreign bodies were successfully removed in 525 cases. No FB was found in 33 cases, and FBs pushed into the lower digestive tract during operation in 5 cases. Oesophageal injury was found in 130 cases (23.3%). Our study showed that the age of the patient, time of foreign body incarceration, type of foreign body, location of the lodged foreign body, and fever or cough were risk factors leading to oesophageal foreign body complications, and the differences were statistically significant (P < 0.05). Conclusion Children with EFB have a risk of complications, especially if the FB is a button battery. The appropriate surgical method should be selected through the analysis of the clinical characteristics of the foreign body in the oesophagus and the risk factors for complications to reduce the incidence of complications. Health education and effective care are the keys to the prevention of EFB.

Unwitnessed Foreign Body Ingestion Causing Significant Morbidity in a Pediatric Patient Who Died During Resuscitation Secondary to Acute Upper Gastrointestinal Bleeding

“…The nature of the complication depends on the type, time, and location of the foreign body. The longer the duration of impaction with a sharper foreign body, the higher the risk of complication [ 8 ].…”

Pediatric Esophageal Foreign Bodies: The Role of Socioeconomic Status in Ingestion Patterns

“…Delayed diagnosis or recognition results in prolonged foreign body impaction time, which can lead to significant morbidity such as esophageal perforation, airway injury, and death. 1,[5][6][7] Identification of risk factors is a fundamental step in developing preventive strategies and decreasing morbidity and mortality in children.…”

“…Younger age, prolonged impaction time, and developmental delay have been associated with increased foreign body ingestion rates and poor outcomes. 2,5,6,10,11 However, determinants of health that may impact EFB ingestion in this vulnerable population are still poorly understood.…”

“…As up to 40% of EFB ingestions are unwitnessed and up to 50% of children are asymptomatic following ingestion, 3,4 diagnosis is challenging for clinicians and the potential for the foreign body to cause harm may not be realized until it is too late. Delayed diagnosis or recognition results in prolonged foreign body impaction time, which can lead to significant morbidity such as esophageal perforation, airway injury, and death 1,5–7 . Identification of risk factors is a fundamental step in developing preventive strategies and decreasing morbidity and mortality in children.…”

“…Given the diagnostic challenge and increasing incidence, it is of paramount importance to characterize the frequency of dangerous EFB complications to better understand risk factors and identify targetable populations for prevention. Younger age, prolonged impaction time, and developmental delay have been associated with increased foreign body ingestion rates and poor outcomes 2,5,6,10,11 . However, determinants of health that may impact EFB ingestion in this vulnerable population are still poorly understood.…”