Chronic esophageal foreign bodies in pediatric patients: a retrospective review

A Retrospective Review of the Management of Impacted Coin Ingested in Children

INTRODUCTION

Accidental coin ingestion is a common presentation amongst paediatric patients in emergency departments (ED) worldwide, necessitating prompt management to prevent complications.

OBJECTIVES

This study aimed to describe the clinical features of paediatric patients with impacted oesophageal coins at Dr. George Mukhari Academic Hospital ED and compare outcomes between the balloon catheter and oesophagoscopic techniques for coin extraction.

METHODS

This was a retrospective review of the medical records of patients aged ≤12 years over 5 years. Data were collected from the hospital records and analysed using SAS® (SAS Institute Inc, Cary, NC), Release 9.3, running under Microsoft Windows.

RESULTS

The analysis included 95 patients (51 females, 44 males) with a median age of 3 years, ranging from 0.70 to 10 years. Coins were predominantly located in the upper oesophagus (71.6%). Thirty-five (36%) children presented 8 h after the ingestion of the coin. At presentation, 82 (86.3%) patients were asymptomatic. The most observed symptoms were hypersalivation in 17 (17.9%) patients and vomiting in eight (8.4%) patients. Of the 62 patients for whom the balloon catheter was solely used, it was successful in 77.4% of the cases. Rigid oesophagoscopy was used in 33 patients as the first procedure (34.7%), and its overall success rate was 100% (44 patients).

CONCLUSIONS

This study contributes valuable insights into the management of oesophageal coin ingestion in a resource-constrained setting, emphasising the safety and efficacy of the balloon catheter and the role of rigid oesophagoscopy in cases of failure or delayed presentation.

Pulmonary manifestations masquerading a longstanding neglected metallic foreign body in the esophagus of a paediatric patient from Tanzania: Rare case report

INTRODUCTION

Paediatric foreign body (FB) ingestion remains to be a common encounter in otorhinolaryngology and may manifest with pulmonary manifestations. Pulmonary manifestations masquerading chronic esophageal FBs in children is rare in clinical practice. This is perhaps the first documented case in Tanzania.

CASE PRESENTATION

The patient was a 6-year old boy with a 6-month history of ingesting a metallic object. The child was reported to have presented with sudden onset of drooling of saliva and difficulty in swallowing that lasted for several hours. While preparing to visit a hospital, no more drooling of saliva was noted thus the visit was cancelled. A month later the patient presented with recurrent episodes of dry cough associated with wheezing and unresponsive to medical treatment. Upon attending other health facilities no chest X-ray was ordered but rather prescribed antibiotics, mucolytics, antihistamines and antileukotrienes without relief. Chest x-ray was indicated and revealed an esophageal metallic object. Rigid esophagoscopy under general anaesthesia yielded the rusted metallic object in piece meals. Postoperative antibiotic, analgesic and an oral corticosteroid were prescribed. Postoperative visits were uneventful.

CLINICAL DISCUSSION

The patient underwent esophagoscopy and the rusted` metallic object was extracted in piece meals. Postoperative antibiotic, analgesic and oral corticosteroid were prescribed. Postoperative visits were uneventful.

CONCLUSION

It is always important to suspect FB ingestion in a child with a history of sudden onset of drooling of saliva and difficulty in swallowing. Imaging should be advocated to avoid delayed diagnosis otherwise pulmonary manifestations can masquerade the diagnosis of chronic esophageal FBs.

Impacted esophageal foreign bodies in children

PURPOSE

Foreign body (FB) ingestion in children has varied presentation. When unwitnessed, it poses therapeutic and diagnostic challenges especially in the presence of pre-existing anatomical pathology. We aim to analyze the clinical course, management, and outcome of children with impacted esophageal FBs.

METHODS

Retrospective chart review (Jan 2000-Feb 2018) recruiting children with impacted esophageal FBs. FBs in cricopharynx and those that moved to stomach were excluded. Investigations/management were based on underlying anatomical pathology, duration of impaction, and difficult FBs. Clinical details, management, and outcomes were collated.

RESULTS

Of 86 children, N1 = 31 had identifiable predisposing anatomic pathology and N2 = 55 had impactions in normal esophagus or difficult FBs. N1 group presented early (42 months), had recurrent impactions (1-6), and needed multiple dilatations (0-8) and longer follow-up (avg 35 months). Food matter was commonest impaction. Many had persistent symptoms. N2 group had commonly coin impactions and strictures developed in long standing or corrosive FBs. Most were asymptomatic.

CONCLUSION

Abnormal esophageal anatomy predisposes to impaction with organic food bolus. Age of presentation is earlier with recurrent impactions requiring multiple dilatations/surgery and longer follow-up. Metallic FBs commonly impact in normal esophagus and are often innocuous. Atypical/multiple FBs may mirror an underlying psychiatric illness.

A Rare Case of a Vocal Cord Foreign Body in an Infant: A Case Report

A foreign body (FB) is an object or item that is foreign to the area in which it is found. FB in the airway, accompanied by the esophagus, is a common overnight emergency in pediatric otolaryngology. Here we report a case of a healthy 11-month-old girl who presented in the emergency room with stridor and a weak cry. The patient was admitted as a case of croup (laryngotracheobronchitis) and treated with multiple antibiotics for more than five days but showed no improvement, then consulted the ear, nose, and throat team (ENT).

Esophageal Perforation following Accidental Ingestion of a Razor Blade

Background

Ingestion of sharp foreign bodies is uncommon and often underreported. It can present with esophageal perforation which is a life-threatening complication requiring prompt diagnosis and management. Case Presentation. We report a case of accidental ingestion of a razor blade in a chronic alcoholic who presented with hematemesis after an esophageal perforation, the diagnosis of which was confirmed by radiology.

Conclusion

Early recognition of esophageal perforation is crucial for early intervention. Proper history taking and radiological investigations are a key to reaching a diagnosis.

Multiple Atypical Esophageal Foreign Bodies in an Infant

Foreign body ingestion is a common accidental emergency in children. We report an unusual case of multiple blunt and sharp esophageal foreign bodies in a female infant probably associated with homicidal intent and its management.

Lost Denture Found in Esophagus After a Decade: A Rare Case Report

Dentures are accidentally ingested foreign bodies, especially in the geriatric population. They get frequently lodged in the esophagus because of their larger size, rigidity, and pointed edges. But, it is unusual for a denture to remain asymptomatic in the esophagus for a decade. We report a case of 45-year-old female who presented with the complaints of progressive dysphagia for six months. Endoscopy revealed an impacted denture in the mid-esophagus. The patient recollected that she lost her denture 13 years back and was unaware that she swallowed it. Right thoracotomy and esophagotomy were done to remove the impacted denture. The esophagotomy site was buttressed with vascularised intercostal muscle flap.

Ingested sharp foreign body presented as chronic esophageal stricture and inflammatory mediastinal mass for 113 weeks: Case report

Introduction

Impacted foreign bodies in the esophagus have the potential to cause serious complications. Ingested sharp objects carry the risk of acute complications as: perforation, acute mediastinitis, and acute bleeding. Rarely, such foreign bodies might migrate through the esophageal wall and present as chronic esophageal foreign body.

Case presentation

We present a case of a 36-month-old girl presented with solid food dysphagia and regurgitation proved to be secondary to esophageal stricture after 26 months of accidental ingestion of aluminum can tab which has migrated through the wall of the upper esophagus into the mediastinum. After two trials of endoscopic treatment; she underwent thoracotomy and partial esophagectomy. Multiple trials of dilation and Mitomycin C injection were followed because of re-stricture.

Conclusion

Foreign body impaction or secondary stricture needs to be considered in the differential diagnosis of children presenting with new onset dysphagia and regurgitation. Metallic Foreign body might be even radiolucent. Practitioners should keep a high index of suspicion for a retained esophageal FB in the child with gastrointestinal or respiratory symptoms that do not respond to standard therapy.

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Foreign body impaction needs to be considered in the differential diagnosis of dysphagia and regurgitation.

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Metallic FBs might be even radiolucent, and X-ray might not be enough to exclude FB ingestion.

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Impacted FB in the esophagus may remain asymptomatic for some time and become symptomatic only when complications develop.

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Chronic esophageal foreign body can lead to complications that may enforce the physicians to go for aggressive surgeries.

Unsuspected Cause of Respiratory Distress: Unrecognized Esophageal Foreign Body

Summary

Foreign bodies in esophagus are avoidable accidents that occur most often in children younger than 3 years. The most common presenting symptoms are dysphagia, drooling, and vomiting. Revelation by respiratory distress is a rare and unusual condition.

Objective

We describe and discuss the case of an esophageal foreign body, in which the patient presented with respiratory distress.

Case report

A two-year-old child was admitted to the emergency department for acute respiratory distress. He had no history of choking episodes or dysphagia. Nevertheless, he was brought by his parents several times for a persistent cough and wheezing that was treated as asthma for a month. Pulmonary examination had revealed polypnea, suprasternal recession, scattered snoring, and diffuse wheeze. As part of his assessment, a chest X-ray was demanded. It had shown, as unexpected, a nonmetallic foreign body in the upper thoracic esophagus. A clothing button was removed by hypopharyngoscopy under sedation without any incident. Subsequent follow-up had not shown any complications related to this episode.

Conclusion

Large esophageal foreign bodies can impinge on the trachea causing upper respiratory tract signs. We alert clinicians on variation in the presentation of foreign body ingestion, and we emphasize the importance of an early diagnosis and management.

Delayed diagnosis of esophageal foreign body: A case report

INTRODUCTION

Foreign body (FB) ingestion, a common and serious problem in children, can present with a wide variety of symptoms. This paper describes and discusses the case of an esophageal foreign body (EFB), in which the patient presented with primarily respiratory clinical signs causing delayed diagnosis.

PRESENTATION OF CASE

A six month old boy presented with three months history of harsh cough, stridor and pulmonary congestion. He was repeatedly treated with steroids and antibiotics. His symptoms worsened progressively. On examination, he was tachypneic with suprasternal recession, scattered crepitations, diffuse wheeze and a continuous stridor. Chest X-ray was normal. The flexible bronchoscopy showed a posterior external compression on the middle wall of the trachea. The CT scan was normal. The contrast X-ray study of the esophagus revealed an endoluminal filling defect. The esophagoscopy revealed narrowing at 12cm of dental arch, and a bourgeoning yellow mass easily bleeding on contact. Esophageal biopsies were obtained, and histology was inconclusive. A surgical exploration was planned, but the infant forced out a pistachio shell after a chest physiotherapy session.

DISCUSSION

Ingestion of FB by small children is a common problem. The majority of EFBs pass harmlessly through the gastrointestinal tract; however, some EFBs can cause significant morbidities. The diagnosis may be delayed leading to several complications especially if the ingestion of the FB is unwitnessed and when the clinician does not think of FB ingestion as part of the differential diagnosis of chronic respiratory signs.

CONCLUSION

This case highlights, the importance of recognizing, the rare and often forgotten respiratory symptoms of EFB body to avoid diagnostic delay especially in unwitnessed FB ingestion.

A case of the long time presence of a large foreign body in esophagus without complication

Dentures are common accidentally ingested foreign bodies (FBs), especially in the aged population. It is usual for a FB to be swallowed in adults and lodge in the esophagus; however, it is unusual for a denture to remain in esophagus for a period of 9 months without any complication. We present, a 57-year-old deaf mute man swallowed his denture with the chief complaint of dysphagia and odynophagia only after 9 months. Although multiple attempts for removing the denture by rigid esophagoscopy were done, it entered the stomach, so gastrotomy was performed and the patient recovered uneventfully. In all cases with suspicion of esophageal FB, rigid esophagoscopy seems necessary, but in some unusual cases, large FBs may be remained in esophagus for a long time without perforation.

Intramural esophageal foreign body in a child

Foreign body ingestion is a common problem in the pediatric population. The majority of cases occur between 6 months and 3 years of age. Major complications, including bowel perforation and obstruction, have been reported. Forty percent of ingested foreign bodies are unwitnessed, and in fact, many are asymptomatic. We report the case of a 2-year-old girl who was referred to King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia (KFSH&RC) with suspected congenital esophageal stenosis. Upon investigation, she was diagnosed with intramural esophageal foreign body.

A case of battery ingestion in a pediatric patient: what is its importance?

This is a case of a two-year-old boy who has been suffering from food regurgitation and frequent vomiting over the past seven months which were progressively worsening with time. He was initially diagnosed with gastroesophageal reflux disease and treated accordingly but responded only minimally. Investigations and interventional procedures including a chest X-ray showed a metallic round object in the upper esophagus consistent with a button battery which was removed via a thoracotomy after an esophagoscopy was not successful. This child would not have developed such serious complications and would not have required major surgery had the foreign body been identified and removed early on.

Chronic cervical esophageal foreign bodies in children: surgical approach after unsuccessful endoscopic management

OBJECTIVES

We reviewed the surgical management of chronic cervical esophageal foreign bodies (CCEFBs) in a pediatric population after failed endoscopic retrieval.

METHODS

A descriptive analysis via a retrospective chart review of patients with CCEFBs who failed initial endoscopic management was performed between 2008 and 2013. Details were recorded regarding presenting symptoms, time from symptom onset to diagnosis of the CCEFB, surgical approach, and complications.

RESULTS

Three patients with CCEFBs unsuccessfully managed with endoscopy were identified. The range of ages at diagnosis was 14 months to 4.5 years. The foreign bodies (FBs) were present for at least 1 month before diagnosis (range, 1 to 10 months). Respiratory symptoms were predominant in all cases. Neck exploration with removal of the FB was performed in each case. Complications included esophageal stricture necessitating serial dilations (patient 1), left true vocal fold paresis that resolved spontaneously (patient 3), and tracheoesophageal fistula with successful endoscopic closure (patient 3). No long-term sequelae were experienced.

CONCLUSIONS

A high index of suspicion is required to recognize CCEFBs in children with respiratory distress. Although endoscopic management remains the first-line treatment, it may fail or may not be possible because of transmural FB migration. In this setting, neck exploration with FB removal is a safe and effective alternative.

Chronic Esophageal Foreign Body Presenting as Wheezing and Cough in a Toddler

The presentation, evaluation, and management of chronic esophageal foreign bodies are not well described in pediatric patients. Many patients present with ill-defined respiratory symptoms, making diagnosis challenging. We report on a 2-year-old girl who presented with several months of worsening cough and wheezing unresponsive to medical management. She also had recent onset of feeding difficulty with certain consistencies. She underwent a joint bronchoscopy with the otolaryngology team. Bronchoscopy demonstrated severe tracheal narrowing and esophagoscopy showed severe inflammation. A chest computed tomography scan showed inflammation between the esophagus and trachea. Repeat esophagoscopy revealed an esophageal foreign body embedded into the anterior wall, which was removed via thoracotomy.

Esophageal diverticulum arising from a prolonged retained esophageal foreign body

Esophageal foreign body impaction (EFBI) is a rare condition in childhood which needs urgent removal. However, if left untreated, its chronic impaction may lead to serious secondary complications. Symptoms associated with chronic EFBI are attributed to airway disease or gastroesophageal reflux, which further delays definitive diagnosis and management. We present a girl with ingestion of a bottle cap diaphragm that was embedded in her esophagus resulting in esophageal narrowing and a secondary diverticulum formation. As the disk was unable to be removed using standard grasping forceps, the authors used an injector needle to impale the disk and successfully removed it without any complications.

Children will eat the strangest things: a 10-year retrospective analysis of foreign body and caustic ingestions from a single academic center

BACKGROUND

Foreign body (FB) ingestions are common in children presenting to the emergency department. Health care providers are quickly challenged to determine which children need urgent endoscopy for diagnostic or therapeutic reasons. We performed a retrospective study to determine if esophageal injury caused by FB ingestion correlated to presenting signs or symptoms, location of impaction, duration of impaction, or denomination of coin (as this was the most commonly ingested FB).

METHODS

A retrospective chart review of children between birth and 17 years of age who presented for esophagogastroduodenoscopy for removal of upper gastrointestinal FB was performed. Demographic data collected from all children included age, sex, and race. For children with FB ingestion, the type of FB, location of the FB, underlying gastrointestinal pathology, duration of impaction, and endoscopic findings were recorded. Descriptive analysis of the data was performed using means, medians, SD, and percentages; χ test was used to test the association between categorical variables.

RESULTS

Over a 10-year period of review, a total of 3279 esophagogastroduodenoscopies were performed; 248 (7.8%) were done for FB removal. The mean age for children having endoscopy for FB removal was 3.9 (SD, 3.2) years (median, 3.1 years); there was a slight male predominance (male/female ratio = 1.6:1). The vast majority (81%) of retained FBs was coins. Most of the FBs were located in the upper esophagus (68%). Success rate for retrieval was greater for esophageal FBs (99%) than for more distally located FBs (70%; P < 0.001). Mucosal ulceration, seen in 59 children (30%), was related to a complaint of substernal pain but not vomiting, respiratory distress, or drooling. The finding of esophageal ulceration was not related to location of coin impaction or denomination of ingested coin but was related to duration of impaction and the unexpected finding of FB during chest radiograph. Underlying pathology was found more commonly in children with meat bolus impaction (100%) than in children with other FB ingestions (3.6%; P < 0.001).

CONCLUSIONS

Ingestion of FBs by children remains a significant problem faced by emergency department personnel. In our study, a complaint of substernal chest pain in children with an esophageal FB predicted esophageal ulceration. Also, esophageal FBs unexpectedly found on chest radiograph or known to be present greater than 72 hours were more likely to have esophageal ulceration. These clinical and historic clues can help direct appropriate prompt referral for endoscopic removal.

Epidemiology and management of oesophageal coin impaction in children

OBJECTIVE

The epidemiology of oesophageal coin impaction in children is poorly understood. We aimed to assess characteristics of patients with coin impaction and identify predictors of type of coin impacted and management strategies.

METHODS

Cases of coin impaction from 2002 to 2009 were identified by querying a tertiary care centre's billing, clinical, and endoscopy databases for the International Classification of Diseases, 9th Revision code "935.1 - foreign body in the oesophagus." Charts were reviewed to confirm case status and to extract pertinent data.

RESULTS

Of 113 patients with oesophageal coin impaction (55% male; 45% Caucasian; mean age 2.9 years), 65 (58%) swallowed a penny, 85 (80%) had the impaction in the proximal oesophagus, and 103 (91%) required a procedure. Thirty-five (34%) patients had an upper endoscopy performed by a gastroenterologist and 68 (66%) had a laryngoscopy or oesophagoscopy performed by an otolaryngologist. Only 2 minor complications were noted. There was no significant relationship between the coin type and location of impaction, but 99% of cases performed by otolaryngologists were for proximally impacted coins, compared to 49% for gastroenterologists (p<0.001).

CONCLUSIONS

Oesophageal coin impaction disproportionately affected young children and extraction was frequently required. Whilst pennies were the most commonly impacted coin, there were no clear predictors on impaction based on coin type.

Foreign bodies in children: a comparison between Argentina and Europe

RATIONALE AND AIM

Foreign bodies (FB) aspiration, ingestion, insertion or inhalation can be a serious occurrence, resulting in fatality if not promptly recognized and solved. The aim of the current paper is to present foreign body ingestion's cases observed at the Children's Hospital Gutierrez in Buenos Aires in 5 years of ORL activity and to compare main findings with data coming from other well known already published case series.

METHODS

A prospective study was realized on children having ingested, inhaled, aspirated or introduced FBs, with regard to age and sex distribution, FB's type, dimensions and consistency, FB's location, clinical presentation, removal and occurrence of complications.

RESULTS

FBs retrieved amounted to 2336 cases. The most common location was the nose (66.7%), where the most frequent FBs retrieved were inorganic (72.7%) and occurred in children younger than 3 years old (54.2%), the only position where children younger than 3 years are a majority in respect to the older ones. The presence of the adult was seen in the preponderance of cases (88.4%). Symptoms varied between the different anatomical systems, with cough as predominant when concerning aspiration, local pain or inflammation in inhalation and insertion, and vomiting in for the FBs ingestion cases. All the foreign bodies retrieved were clustered in categories, due to necessity when extremely various and with low absolute frequency. The most common FBs retrieved were pearls (20.2%), followed by stationery products (mostly rubbers) and coins. Complications had a low rate in all the studies.

CONCLUSIONS

The study stresses the importance of primary prevention, seen as the active care of adults toward children manipulating foreign bodies potentially dangerous. This presence may not avoid the event, but in case of FBs aspiration, ingestion, insertion or inhalation, it could be the main factor leading to a faster and correct treatment. Prompt removal of the foreign body decreases the risk of complications, resulting in a lower length of hospitalization. Symptoms were various and differed in all the studies, showing that their wide amount indicates the importance of registries to early recognize and therefore treat a pathology that might be mistaken for something different due to unspecific signs. Secondary prevention with specific training of doctors on clinical post-trauma guidelines for treatment and active participation of doctors to the broadening of the current registries seem to be other ways for lowering the outburst of FBs injuries.

Management of esophageal foreign bodies: experience in a developing country

BACKGROUND

The outcome of esophagoscopy for removal of suspected esophageal foreign bodies (EFBs) is dependent on the FB characteristics and the surgeon's experience. This study was conducted to review our experience and highlight challenges in the management of EFBs in a developing country. The value of radiologic signs in FB detection was also evaluated.

METHODS

We conducted a retrospective chart review of 131 patients: 58.8% males and 41.9% females aged 8 months to 64 years, treated for suspected EFBs in our institution over a 13-year period. Statistics were derived by univariate analysis

RESULTS

Foreign bodies were found and retrieved in 118 cases. Coins were the predominant FB in children (35%), and bones (25%) and dentures (17%) were predominant in adults. Plain radiography was highly useful in detecting FBs in children (coins/metals 100%) but less so in adults (bones 25%, dentures 11%). Repeated esophagoscopy attempts were encountered more in patients with impacted sharp objects (85%) and were recorded significantly among trainee surgeons (p = 0.004). Open esophagotomy was carried out in 13 (10%) difficult cases. Major complications including two iatrogenic esophageal perforations and one death occurred following esophagoscopy by trainee surgeons.

CONCLUSIONS

Rigid esophagoscopy is relatively safe and useful procedure in trained hands for removal of EFBs. Management of long-standing EFBs, dentures, and other sharp objects requires the skills of the most experienced members of the surgical team for a successful outcome. Open surgical treatment is unavoidable in cases of irretrievable esophageal FBs or in the presence of esophageal perforation.

Chronic esophageal foreign bodies and secondary mediastinitis in children

OBJECTIVES

The purpose of this study was to review the clinical presentation, diagnosis, and management of chronic esophageal foreign bodies complicated by mediastinitis in children.

METHODS

A retrospective study of children with a chronic esophageal foreign body and secondary mediastinal complications diagnosed at Rady Children's Hospital in San Diego over a 12-month period is reported.

RESULTS

Three patients received a diagnosis of an esophageal foreign body, retained from 1 to 12 months, and mediastinitis. Each patient presented primarily with respiratory signs and had been treated previously for alternate diagnoses (ie, asthma, reflux, and upper respiratory tract infection) by emergency or pediatric providers. The diagnosis of a foreign body was made after a chest radiograph was examined. Operative airway evaluation confirmed tracheal narrowing in all patients, and a computed tomographic scan of the chest was performed after removal of the foreign body to confirm mediastinal involvement. After medical and/or surgical treatment, the patients were released from the hospital tolerating soft diets. There were no reports of long-term complications in our series of patients.

CONCLUSIONS

It is critical to rule out esophageal and airway foreign bodies in pediatric patients with respiratory symptoms that do not respond to medical treatment. Timely recognition of an esophageal foreign body generally allows for removal with minimal morbidity, whereas the incidence of serious complications increases significantly when the diagnosis is delayed. Our series provides support for conservative management of mediastinal complications after removal of chronically retained esophageal foreign bodies in children.

Atypical presentation of an impacted radiolucent esophageal foreign body

Patients with impacted esophageal foreign bodies usually present with gastrointestinal and rarely with respiratory symptoms. Impacted esophageal foreign bodies may be identified by radiologic studies. Ingested radiolucent foreign bodies may be more difficult to diagnose, especially if the patient presents with minimal symptoms. We report a rare case of a child who presented with stridor and obstructive sleep apnea. The cause of respiratory symptoms was thought to be due to enlarged tonsils and adenoids, and the patient was scheduled for tonsillectomy and adenoidectomy. On re-evaluation by the surgeon on the day of surgery, the procedure was changed to diagnostic microlaryngoscopy and bronchoscopy to rule out any other cause. The patient's respiratory symptoms were resolved when an incidental discovery and retrieval of the radiolucent esophageal foreign body was made. The diagnosis of radiolucent esophageal foreign body can be difficult and can be easily missed without reasonable clinical suspicion.

Ingested foreign bodies causing complications and requiring hospitalization in European children: results from the ESFBI study

BACKGROUND

In young children, particularly those aged 1-3 years, aerodigestive tract foreign bodies (FB) are a common pediatric problem. The aim of the present study was therefore to characterize the risk of complications and prolonged hospitalization due to FB in the upper digestive tract in terms of the characteristics of the injured patients (age, gender), typology and features of the FB, the circumstances of the accident and hospitalization details.

METHODS

A retrospective study was done in 19 hospitals in 19 corresponding European countries of 186 cases of injury due to the presence of an FB in the mouth, esophagus and stomach (ICD935), out of the 2103 overall cases of FB reported in other locations.

RESULTS

Complications arose in 14 cases and hospitalization was required in 164 cases. No deaths were observed. A higher incidence of hospitalization in male patients (61%) was observed. Median age for children who experienced complications was 2 years old. The most common FB removal technique was esophagoscopy. In the majority of cases the children were treated by the ENT Department. The most common FB were coins, batteries and fish bones among food.

CONCLUSION

Because batteries, as well as coins and fish bones among food were the most common type of FB encountered, and because recent development of technology has accelerated broad use of disk-type batteries, parents should be aware of this hazard, and an educational campaign for public education for this serious problem is advisable.

Removal of a sewing needle from an occult esophageal ingestion in a 9-month-old

A healthy 9-month-old boy presented with a 1-month history of cough. A chest x-ray showed a linear metallic foreign body (FB) lying transversely in the posterior mediastinum. Computed tomographic scan confirmed the location and size of the metallic FB and also revealed a large pericardial effusion that was corroborated by echocardiogram. The patient underwent a right thoracotomy revealing a normal esophagus without mediastinitis and a 12-mm needle in the posterior mediastinum embedded in the pericardium with the sharp end abutting the left atrium. The needle was extracted uneventfully, and his postoperative course was unremarkable. The diagnosis and treatment for this case are discussed along with a review of the literature.

Magnitude and object-specific hazards of aspiration and ingestion injuries among children in Greece

OBJECTIVE

To assess the public health impact of injuries due to foreign body aspirations and ingestions among children in terms of overall magnitude and estimation of object-specific incidence.

METHODOLOGY

Two thousand two hundred and seven injuries due to aspiration and ingestion of foreign bodies were identified among 110 066 records of children (less than 15 years old) collected by the Hellenic Emergency Department Injury Surveillance System (EDISS) during the 5-year study period 1996-2000. Countrywide estimates of overall and object-specific injury incidence rates were computed using appropriate age and place of residence-sampling ratios. Simple cross-tabulations were performed along with a free text description analysis of injury events, whereas a composite score using (1) frequency of injury occurrence, (2) hospitalisation rate and (3) average length of hospitalisation was developed to measure the overall object-specific burden of injuries.

RESULTS

Aspirations and ingestions of foreign bodies accounted for 2% of the total burden of accident and emergency department visits, corresponding to an annual incidence of approximately 2.3 accidents per 1000 children. Fish bones and nuts prevailed among the high (44%) proportion of aspirations and ingestions due to edible foreign bodies, while the main inedibles involved were small objects. Toddlers, boys and migrant children were over-represented among children sustaining injuries due to inedibles. As expected, the vast majority of food-related injuries occurred in the kitchen, in most instances under parental supervision. Injuries due to edibles were of minor severity and treatment was provided in the emergency departments, while those due to inedibles were responsible for injuries resulting in higher hospitalisation rates, albeit of relatively short duration. The composite impact score was highest for nuts and other food, nails, pins and sharp instruments. X-rays were performed in nearly all cases; upper gastrointestinal endoscopy was required in about 1 out of 10 instances and laryngoscopy or bronchoscopy in 1 out of 20, whereas the object was spontaneously removed in less than 3% of the cases.

CONCLUSIONS

Depending on whether caused by edible or inedible objects, injuries due to foreign body aspirations and ingestions showed distinct epidemiological patterns. Composite scores taking into account measures of injury frequency and severity, seemed to reflect a country-specific spectrum of this type of injuries and provided useful information for the design of targeted public health oriented interventions.

Foreign body in the esophagus: a review

Foreign body in the esophagus is a common emergency presentation. The approach towards a patient with a foreign body in the esophagus comprises a thorough history and systematic examination followed by relevant investigations. However, there is considerable debate over the most appropriate treatment option for such patients. This review aims to develop a comprehensive approach towards patients presenting with foreign body ingestion by developing clinical practice guidelines. These guidelines address not only the initial evaluation of the patient but also the various management alternatives and their advantages, limitations and applicability in various scenarios, based upon a review of the literature.

Pediatric foreign bodies and their management

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.

Penetrating esophageal injury by ingestion of a wire bristle

Esophageal foreign bodies are frequently encountered in the pediatric population, and a high degree of suspicion should be maintained in the setting of postprandial dysphagia. We report the case of a 14-year-old boy with a penetrating esophageal injury after the accidental ingestion of a wire bristle from a grill brush.