Management of Gastrointestinal Foreign Bodies with Brief Review of the Guidelines

A case of orthodontic splint ingestion misclassified as a sharp/pointed foreign body in a child: A case report

RATIONALE

Foreign body (FB) ingestion is common, particularly among children. While most FBs pass through the gastrointestinal tract without complications, some cases can lead to morbidity or even mortality. Management strategies depend on the size, sharpness, toxicity, and location of the FB. Plain radiographs are essential for diagnosis, treatment planning, and follow-up, especially for radiopaque FBs. Ingestion of dental-related FBs is rare, with reported cases involving orthodontic wires, braces, retainers, and other dental materials. Composite resin-wire splints are commonly used in orthodontics to manage dental traumatic injuries. We present a case of a patient who ingested a composite resin-wire splint, initially misclassified as a sharp FB, leading to unnecessary aggressive treatment.

PATIENT CONCERNS

A 2-year-old girl presented to the emergency department after accidentally ingesting a FB of dental origin. She had a recent traumatic dental injury and displayed no symptoms of ingestion. Initial radiographs revealed a dental wire in the stomach.

DIAGNOSES

Ingestion of orthodontic splint (composite resin-wire splint).

INTERVENTIONS

Considering the pointed tip of the wire, the emergency department physician transferred her to the endoscopy specialist for endoscopic removal. However, given the expected passage into the small bowel after a proper fasting period for endoscopy, close observation with follow-up radiographs was chosen amid parental anxiety.

OUTCOMES

Follow-up imaging showed FB migration to the ascending colon without perforation. Stool inspection revealed the dental wire and 4 composite resins, with the sharp tips covered by the resin, classifying it as a blunt FB. A retrospective review of radiographs revealed faint oval-shaped, mid-level radiopacities at each end of the wire covering the sharp/pointed tips.

LESSONS

In evaluating orthodontic splints as FBs, identifying faint composite resin on radiographs is crucial for planning milder treatment and alleviating parental anxiety.

Recent trends in foreign body ingestion (FBI) epidemiology: A national cohort study

BACKGROUND AND AIMS

Foreign body ingestion (FBI) in children is a critical health concern. This study aimed to describe the epidemiology of FBI in children in Italy.

METHODS

We retrospectively enrolled children <18 years admitted for FBI from January 2015 to December 2020. Data were collected across 21 hospitals with dedicated pediatric endoscopy services and normalized by the population of the corresponding municipalities.

RESULTS

A total of 5,771 FBI cases were analyzed. FBI incidents showed consistent time trends across age groups, with most events occurring at home and being witnessed (94.7 %). Children <6 years accounted for 74.3 % of cases. Comorbidities were present in 5.3 % of cases, primarily neurologic/psychiatric disorders in older children (6-17 years). Blunt objects accounted for 65.5 % of ingestions. Young males commonly ingested button batteries, while females showed higher rates of ingesting hair products and jewelry. Most children were discharged (60 %) or observed briefly (75 % of total admissions), with endoscopic removal performed in 24 % of cases.

CONCLUSIONS

Rates of FBI have remained stable over the years, including during the COVID-19 pandemic. FBI predominantly occurs in domestic settings among healthy young children, particularly those ≤5 years old. These findings emphasize the need for preventive measures to reduce the impact of FBI among children.

More than chest pain: A case of oesophageal foreign body ingestion

BACKGROUND

Physicians often focus on possible cardiac causes in patients presenting with chest pain. However, this case highlights a patient who presented with chest pain caused by ingestion of a foreign body after an uneventful meal eaten an hour prior to presentation. The fishbone was discovered after imaging. The article aims to raise awareness regarding the potential origins of chest pain, highlighting that it may stem from non-cardiac conditions.

METHODS

The methodology employed in this study involved conducting a case study that meticulously examined the repercussions and management strategies associated with foreign body ingestion.

RESULTS

The case report delineates the scenario of a 27-year-old male patient who inadvertently ingested a fishbone during a routine meal. It details the swift decline in clinical status, the meticulous diagnostic procedures employed, the subsequent management strategies implemented and the ultimate discharge of the patient in a stable condition.

CONCLUSION

This case highlights the importance of comprehensive history taking and considering a wide range of causes of chest pain when evaluating a patient. The foreign body ingested with the resulting cardiac complications could have been fatal if not promptly diagnosed.Contribution: This study contributed to advancing awareness surrounding foreign body ingestion, shedding light on potential complications and offering valuable insights into effective management strategies.

Imaging approach to ingested foreign bodies in the neck

Foreign body ingestion is a common clinical occurrence worldwide, with high morbidity in the pediatric population and in adult patients with intentional attempts. Coins and button battery ingestions are more common among children. Bone impaction and swallowed dentures are usually seen in older adults. While most ingested foreign bodies pass through the gastrointestinal tract spontaneously with no complications, some require endoscopic and/or surgical intervention. Complications such as pharyngoesophageal ulceration, perforation, stricture, and deep neck infection can develop without timely diagnosis and management. The purpose of this article is to familiarize radiologists with the imaging approach to assess for characteristics and impacted locations of ingested foreign bodies in the neck.

Foreign Body Ingestion in Children: An Experience of 99 Cases in a Tertiary Care Center in Delhi

Background

Accidental ingestion of foreign bodies in children is critical, as the inability to effectively communicate can potentially lead to devastating consequences. We aimed to determine the epidemiology of foreign body ingestion and variability according to age, gender, type, and location of foreign body, and describe its management.

Aim and Objective

The aim was to study the various types of foreign body ingestions in children admitted to pediatric surgery and their management.

Materials and Methods

A retrospective study was conducted from January 2020 to June 2022 on children under the age of 12 years with a confirmed diagnosis of foreign body ingestion. Patients were clinically and radiologically assessed, after which standard protocols were followed wherein patients were followed by either observation or emergent management. Emergent management included removal of the foreign body by either endoscopy or surgery. Comparisons among multiple age groups, gender, type of foreign body, location of foreign body, and their management were analyzed.

Results

Out of 99 subjects in our study, there were 76 boys and 23 girls. The median age of presentation was 5 years. Most children were asymptomatic at presentation. The most frequently ingested foreign body was a coin in all age groups. The majority of the foreign bodies were suspected to be in the small bowel. The foreign bodies that had crossed the duodenojejunal flexure (n = 74, 74.7%) were managed conservatively with the observation of a variable period of a minimum of 24 h and a maximum of 48 h. 21 cases were managed by endoscopic removal, while three cases required surgical intervention.

Conclusions

Overall, the most common gastrointestinal foreign body was a coin in all age groups. Button battery is the most worrisome foreign body; however, depending on its position, it can be managed conservatively. Upper GI foreign bodies can be safely removed endoscopically. Parental counseling is very important for the prevention of ingestion of foreign bodies.

Approaching a Fork in the Road: A Case of Aborting Endoscopy After Discovering a Retained Foreign Object

We describe a case of a 53-year-old female who presented for elective esophagogastroduodenoscopy (EGD) and eventually needed surgical intervention to remove a plastic fork that she accidentally swallowed twenty years prior while in prison. This article highlights approaches to retrieving a foreign object within the stomach via endoscopy, the importance of recognizing the risks of endoscopy, and serves as a reminder that we must be aware of the social determinants of health that pertain to our patients.

Magnet ingestion in growing children: a multi-center observational study on single and multiple magnet incidents

Over the past 15 years, there has been a noticeable uptick in incidents involving children ingesting multiple magnetic foreign bodies which can cause injuries and gastrointestinal complications including death. The current study aimed to identify the prevalence, clinical presentation, and management of single or multiple magnet ingestions. A retrospective multi-central cross-sectional study was conducted to include all pediatric patients < 18 years presented to the emergency department with ingestion of single or multiple magnets and admitted across hospitals in Qatar, UAE, KSA, Tunisia, and Turkey between January 2011 and December 2021. Demographics, symptoms, management, and outcomes were analyzed. There were 189 magnet ingestions, of which 88 (46.6%) were multiple magnet ingestions. Most patients (55.6%) were male, and the median age was 3.9 (IQR 2-7) years. An abdominal X-ray was obtained in all cases. 119 (62%) patients were conservatively treated, 53 (28%) required surgical intervention and 17 (8.9%) underwent gastroscopy. None of the patients with single magnet ingestions experienced morbidity or severe outcomes. Multiple magnet ingestions led to significant morbidity including hospitalizations, perforations (44.3%), severe intestinal necrosis (19.3%), peritonitis (13.6%), severe abdominal infection (10.2%), and septic shock (4.5%). The rate of surgical intervention (59.1% vs. 1.0%) and gastroscopy (15.9% vs. 3.0%) was significantly higher in the multiple ingestion group compared to the single magnet ingestion group. No deaths were identified. A high risk of serious complications, including the need for surgery to remove the magnets and substantial morbidity may result from swallowing more than one magnet. Magnet safety requirements, public education, and improved legislation are urgently required.

Safety beyond Sight: Handheld Metal Detectors as Diagnostic Allies in the Management of Children Suspected to have Ingested Foreign Bodies

BACKGROUND

Foreign body (FB) ingestion remains a common cause of pediatric emergency department referrals, and the gold standard for detection is whole-digestive-tract radiographic examination. Our study explores whether handheld metal detectors (HHMD) can effectively identify the presence and location of ingested metal objects, potentially reducing the need for additional radiographic examination.

METHODS

We collected medical data from children with suspected metal FB ingestion who were referred to our emergency department (October 2017-March 2023), focusing on object type and correlating metal detector findings with radiographic images.

RESULTS

Data from 43 children (39.5% female; mean age: 4 y) referred to our emergency department were analyzed. Coins (32.6%), button batteries (18.6%), and hairpins (11.6%) were the most common ingested objects. Metal detectors detected the presence of FBs in 81.4% of cases (sensitivity: 89.7%; specificity: 100%). Radiographs, taken for 40 children, showed that the most common locations were the stomach (37%) and intestine (33%). The metal detector signals matched the radiography results in 69.8% of cases. According to HHMD, 34.9% of objects were accessible via endoscopy, contrasting with 51.2% via radiography (p < 0.05).

CONCLUSION

While the findings obtained using handheld metal detectors often correlate well with radiograph findings in detecting metal FBs, for an important number of children, this confirmation is lacking, especially when determining the exact location of an object.

General anesthesia with endotracheal intubation ensures the quick removal of magnetic foreign bodies: A case report

BACKGROUND

The incidence of ingestion of magnetic foreign bodies in the gastrointestinal tract has been increasing year by year. Due to their strong magnetic attraction, if multiple gastrointestinal foreign bodies enter the small intestine, it can lead to serious complications such as intestinal perforation, necrosis, torsion, and bleeding. Severe cases require surgical intervention.

CASE SUMMARY

We report a 6-year-old child who accidentally swallowed multiple magnetic balls. Under timely and safe anesthesia, the magnetic balls were quickly removed through gastroscopy before entering the small intestine.

CONCLUSION

General anesthesia with endotracheal intubation can ensure full anesthesia under the condition of fasting for less than 6 h. In order to prevent magnetic foreign bodies from entering the small intestine, timely and effective measures must be taken to remove the foreign bodies.

A Retrospective Analysis of Foreign Body Ingestions Among the Pediatric Age Group in a Tertiary Care Hospital in Jeddah, Saudi Arabia

BACKGROUND

Foreign body ingestion (FBI) among the pediatric age group is considered a major clinical problem that can cause life-threatening complications, as it can obstruct the airway due to poor/immature airway protection reflexes.

OBJECTIVE

In this study, we aimed to retrospectively describe the epidemiology, clinical characteristics, and outcomes of FBI among the pediatric age group in Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia.

METHODS

We conducted a retrospective study of pediatric patients (0-14 years) presenting to a tertiary care hospital in Jeddah, Saudi Arabia, from January 2019 to October 2022. The study reviewed records of patients with FBI in the emergency department. Data collection included age, gender, comorbidities, foreign body (FB) type, anatomical location, presenting symptoms, time to emergency room (ER) presentation, need for endoscopy, and complications. We performed a statistical analysis using the Statistical Package for Social Sciences (SPSS) 25 (IBM SPSS Statistics, Armonk, NY), where p<0.05 was considered statistically significant.

RESULTS

We identified 244 FBI cases, with most cases being male (62.7%). The most common site of FB impaction was the stomach (38.9%), followed by the upper esophagus (29.1%). Clinical presentation was variable, with 20.5% of cases experiencing vomiting, 13.5% experiencing drooling, and 9.4% experiencing dysphagia. Out of 244 cases, 132 (54.1%) were referred to gastroenterology for urgent FB removal by endoscopy. A total of 186 cases (76.2%) did not have complications, whereas 3.6% had serious sequela. The association between age and FBI was statistically significant (p=0.00), whereas there was no association between gender and FBI.

CONCLUSION

Our results showed that FB ingestion was prevalent among children at our tertiary care hospital, with urgent endoscopy being the most common removal procedure. Early detection and immediate presentation to the emergency room are crucial for preventing complications. Common FBI included coins and batteries, with most incidents in 1-3-year-old males. Parents should be aware of the dangers of FBI and implement preventive measures to reduce its incidence.

Extraction of a metallic susceptor after accidental ingestion of the heated tobaccostick TEREA™: a case report

BACKGROUND

Tobacco ingestion is widely known to cause nicotine toxicity, which may result in severe symptoms. Two heated tobacco sticks, called TEREA™ and SENTIA™, were launched in 2021 by Philip Morris International (New York, NY, USA), and their ingestion is associated with a risk of bowel injury because they contain a partially pointed metallic susceptor. However, this risk is not well known to the general public or healthcare providers. To increase awareness of this risk, we herein report a case involving extraction of a metallic susceptor after ingestion of the heated tobacco stick TEREA™.

CASE PRESENTATION

A 7-month-old girl presented to the emergency department of a nearby hospital because she was suspected to have accidentally swallowed heated tobacco. Although she presented with no symptoms related to nicotine poisoning, abdominal X-ray examination revealed a metal object in her stomach. According to a statement released by the Japan Poison Information Center, the TEREA™ heated tobacco stick contains a metallic susceptor with a rectangular shape and sharp corners. The patient was transferred to our department because of the risk of bowel injury, and upper gastrointestinal endoscopy was performed. No cigarettes were found by endoscopic observation; however, a metallic susceptor was located in the second part of the duodenum. We grasped it with biopsy forceps and carefully removed it using an endoscope with a cap attached to the tip. The post-endoscopic course was uneventful.

CONCLUSIONS

Some patients who ingest heated tobacco sticks might be exposed not only to the effects of nicotine but also to physical damage caused by a metallic susceptor. Infants and toddlers especially could swallow these sticks, therefore tobacco companies need to make the problem more public. Clinicians also should alert the problem, and pay attention to this risk in the clinical setting.