Pediatric foreign bodies and their management

Abstract

Ingestion of foreign bodies is a common pediatric problem, with more than 100,000 cases occurring each year. The vast majority of pediatric ingestions are accidental; increasing incidence of intentional ingestions starts in the adolescent age group. In the United States, the most common pediatric foreign bodies ingested are coins, followed by a variety of other objects, including toys, toy parts, sharp objects, batteries, bones, and food. In adolescents and adults, meat or food impactions are the most common accidental foreign body ingestion. Esophageal pathology underlies most cases of food impaction. Management of foreign body ingestions varies based on the object ingested, its location, and the patient's age and size. Esophageal foreign bodies as a group require early intervention because of their potential to cause respiratory symptoms and complications, esophageal erosions, or even an aortoesophageal fistula. Ingested batteries that lodge in the esophagus require urgent endoscopic removal even in the asymptomatic patient due to the high risk of complications. Sharp foreign bodies increase the foreign body complication rate from less than 1% to 15% to 35%, except for straight pins, which usually follow a relatively benign course unless multiple pins are ingested. Magnets are increasingly ingested, due to their ubiquitous nature and the perception that they do not pose a risk. Ingestion of multiple magnets creates a significant risk of obstruction, perforation, and fistula development. Methods to deal with foreign bodies include the suture technique, the double snare technique, and the combined forceps/snare technique for long, large, and sharp foreign bodies, along with newer equipment, such as retrieval nets and a variety of specialized forceps.

Incidence of Foreign Bodies in Aerodigestive Tract in Vindhya Region: Our Experience

“…When any patient have history of ingested foreign body, investigation is mandatory regardless of the age or apparent absence of signs and symptoms [10].…”

Endoscopic management of ingested foreign bodies in children: A retrospective review of cases, and review of the literature

“…Button batteries may be misdiagnosed as coins on X-rays, but larger button batteries can be identified by the double contour around the edge [32]. Some authors state that gastric batteries typically pass through the remainder of the gastrointestinal tract without difficulty, with 80% passing within 48 hours [4]. This suggests that the batteries in the stomach only need to be removed if the patient is symptomatic or if the battery does not pass the pylorus within 48 hours, which may occur if it is larger than 15 mm in diameter [1,4,33].…”

“…Some authors state that gastric batteries typically pass through the remainder of the gastrointestinal tract without difficulty, with 80% passing within 48 hours [4]. This suggests that the batteries in the stomach only need to be removed if the patient is symptomatic or if the battery does not pass the pylorus within 48 hours, which may occur if it is larger than 15 mm in diameter [1,4,33]. Other physicians recommend that ingested batteries should be removed whenever possible [10,34].…”

“…It has been reported that 80% -90% of FBs that come to medical attention pass through the gastrointestinal tract uneventfully, 10% -20% require endoscopic removal, and 1% or less require surgery [4]. Although FB ingestion causes serious morbidity in less than 1% of cases, it is the cause of approximately 1500 deaths per year in the United States [5,6].…”

Intestinal Obstruction in Paediatric Age Group Due to Foreign Body Ingestion

“…(2,3,4,5) On imaging, x-ray abdomen showed opacity in the whole lower abdomen and multiple dilated bowel loops.…”