Foreign Body and Caustic Substance Ingestion in Childhood

A peculiar foreign body ingestion in 2-year-old girl complicated by esophageal perforation: case report and review of the literature

Foreign body ingestion is a common pediatric gastrointestinal emergency, which should be suspected in all patients who present with signs of airway obstruction or upper GI bleeding, especially if it developed after the child was left unwitnessed for a while. The most common foreign bodies identified in the literature are button batteries or coins. Early identification and management of suspected foreign body ingestion is crucial as it can lead to devastating complications including bleeding, fistula formation, perforation, mediastinitis, or abscess. Here we report a case of a peculiar foreign body ingestion resulting in esophageal perforation in a 2-year-old girl.

Developing the minimum data set of the corrosive ingestion registry system in Iran

Background

Corrosive ingestion is still a major health problem, and its outcomes are often unpredicted. The implementation of a registry system for poisoning with corrosive substances may improve the quality of patient care and might be useful to manage this type of poisoning and its complications. Therefore, our study aimed to establish a minimum data set (MDS) for corrosive ingestion.

Methods

This was an applied study performed in 2022. First, a literature review was conducted to identify the potential data items to be included in the corrosive ingestion MDS. Then, a two-round Delphi survey was performed to attain an agreement among experts regarding the MDS content, and an additional Delphi step was used for confirming the final MDS by calculating the individual item content validity index (CVI) and content validity ratio (CVR) and by using other statistical tests.

Results

After the literature review, 285 data items were collected and sent to a two-round Delphi survey in the form of a questionnaire. In total, 75 experts participated in the Delphi stage, CVI, kappa, and CVR calculation. Finally, the MDS of the corrosive ingestion registry system was identified in two administrative and clinical sections with 21 and 152 data items, respectively.

Conclusions

The development of an MDS, as the first and most important step towards developing the corrosive ingestion registry, can become a standard basis for data collection, reporting, and analysis of corrosive ingestion. We hope this MDS will facilitate epidemiological surveys and assist policymakers by providing higher quality data capture to guide clinical practice and improve patient-centered outcomes.

Caustic ingestion in children treated at a tertiary centre in South Africa: can upper endoscopy be omitted in asymptomatic patients?

PURPOSE

Considering that clinical presentation and gastrointestinal tract (GIT) injuries post-caustic ingestion vary in children, this study aims to establish whether a correlation exists between clinical presentation and endoscopic findings.

METHODS

This retrospective study comprised patients referred to a paediatric surgical unit between 2016 and 2018 within 72 h post-caustic ingestion. Data collected included caustic agents ingested, clinical presentation, endoscopic findings and management. Oesophageal injuries were graded according to the Zargar's endoscopic classification and gastric injuries classified as mild to severe.

RESULTS

Fifty patients with a mean age of 2.4 years were managed during the study period. Potassium permanganate (KMNO4) was the most frequently ingested substance in 27 (54%) patients. All 30 (60%) asymptomatic patients had no positive endoscopic findings regardless of clinical signs. Among the symptomatic patients (n = 20), 15 (75%) had oesophageal injuries (p = 0.01). Stridor was associated with a higher grade of oesophageal injury (p = 0.007).

CONCLUSIONS

Clinical signs and symptoms post-caustic ingestion correlated with endoscopic findings in our study. Endoscopy can be safely omitted in asymptomatic patients, including those with isolated staining secondary to KMNO4 ingestion. Symptomatic patients should have an endoscopy performed within 48-72 h of the insult to diagnose injuries.

Duodenal dislodgement of an ingested sharp foreign body by mucosal unfolding "Gilan maneuver"; A novel surgical approach

Introduction and importance

Foreign body (FB) ingestion is a common challenge for pediatric health care providers globally. Although endoscopic approach for FB extraction is recommended, surgery remains life giving specifically in developing countries. We presented a novel surgical approach called ‘Gilan maneuver’ for removal of FB which lodged in duodenal loop.

Case presentation

An eighteen months old male infant referred to emergency department while he lied on his mother's arm. Parents stated their son has ingested a sharp metallic pointy thick needle which applies for cattle injection. On examination mid epigastric tenderness was remarkable. Laboratory finding was normal. Plain thoracoabdominal radiologic study confirmed the diagnosis. Patient underwent explorative laparotomy and the needle was removed through ‘Gilan maneuver’ in which mucosal unfolding of duodenal loop facilitated dislodgement of the FB and it was extracted on the jujenal side.

Clinical discussion

Duodenal lodge of sharp FB is rare and could be masked by gastric deposition diagnosis. Mucosal folding, narrow luminal diameter, retroperitoneal adherence, and hard surgical anatomy of the duodenal loop make both sharp and large FBs spontaneous dislodgement and favorable surgical outcome relatively unanticipated.

Conclusion

Despite rarity of duodenal deposition of FB it is possible and could be harmful due to adjacent unforgiving organs. Although endoscopic extraction of FB is generally recommended in guidelines, surgical approach is safe and could be considered.

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Thick metazlic sharp needle ingestion although is rare, could lodge in duodenal mucosal fold.

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Mucosal unfolding of duodenum could safely dislodge foreign body and prevent major complication.

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Gilan maneuver facilitates intraluminal passage of foreign body by pyloric valve extraction and jujenal pulling gently.

Unusual esophageal foreign body in neonates: A case report

INTRODUCTION AND IMPORTANCE

Esophageal foreign body mostly occurs in children aged 6 months to 5 years old. In neonates (babies less than 28 days old), such report is extremely rare. In this case, we report the first esophageal foreign body in neonates without any symptoms.

CASE PRESENTATION

A 28-day-old baby boy, with normal body weight, from a low socio-economic status family, came to us with a history of ingested foreign body. No sign of unconsciousness, excessive saliva, dysphagia, and respiratory distress. The chest X-ray revealed a radiopaque foreign body in the upper third of the esophagus. The patient underwent extraction of the foreign body using a flexible endoscope under general anesthesia. We found a 1.9 cm in diameter pendant with no sign of bleeding nor inflammation in the esophageal lumen. After the foreign body removal, the patient is in good condition and recovered uneventfully.

CLINICAL DISCUSSION

Foreign body in children under 6 months old is very rare. A high index of suspicion for foreign body ingestion must be considered in unattended children from lower socio-economic status, primarily if witness statements are present and confirmed with radiological examination. Most common impaction site is at the level of the cricopharyngeus muscle. Currently, flexible endoscopy is the standard for foreign body removal in children.

CONCLUSION

High index suspiciousness, witness statements and radiological examination are the important points in diagnosing ingested foreign body in neonates. Clinicians are required to provide education to parents to supervise their children when playing together.