Intestinal Perforation with Ingestion of Blunt Foreign Bodies: A Case Report

Foreign body ingestions are fairly common and present with obvious symptoms. Certain foreign bodies, like button batteries and magnets, are rarely ingested, but carry with them the extremely dangerous risk of bowel wall necrosis, intestinal perforation and fistula formation. Suspected cases of such ingestions require a high index of suspicion and any delay should be avoided once a diagnosis is made. Herein, we report a case of a 7-year-male patient who presented with abdominal pain and vomiting following similar foreign body ingestion, which resulted in multiple small bowel perforations. The foreign body was removed by a laparotomy, and the affected bowel segments were resected and anastomosed. The patient made an uneventful recovery and was discharged after 5 days.

Trauma hazards in children: An update for the busy clinician

Trauma and injury continue to be common in children and remain an important cause of mortality and morbidity. Legislation mandating the use of helmets for all cyclists appears to have been effective in reducing the incidence and severity of head and facial injuries, with no clear evidence of a reduction in cycling usage or activity. Straddle injuries, whilst uncommon and generally minor, require careful clinical assessment as they may be associated with urethral trauma. Quad bikes remain highly dangerous with continuing reports of deaths in child riders due to their inherent lack of stability: a ban on their use by children would seem the most effective solution. The popularity of mobile devices and toys, coupled with the development of higher voltage, lithium button batteries have seen a surge in the number of cases and subsequent complications from ingestion. The problems seen in children following ingestion of high-powered, rare earth magnets in the late 1990s and 2000s has now receded due to legislation introduced in 2012. Inhaled, typically organic foreign bodies remain a diagnostic challenge with rigid bronchoscopy still the most effective diagnostic and therapeutic modality. Corrosive ingestion, now seen much less commonly, continues to be a potentially devastating injury when occurring as a result of caustic soda. Recent publicity concerning the problem of childhood drowning highlights the need for constant parental vigilance, the limitations of pool fencing and the importance of community cardiopulmonary resuscitation training, together with repeated education of the risk of rips when swimming in the sea.

A systematic review of paediatric foreign body ingestion: presentation, complications, and management

BACKGROUND

Foreign body ingestion is a common problem among paediatric populations. A variety of foreign bodies are ingested, some of which are particularly harmful and life threatening such as button batteries, magnets and bones. Common household items such as small toys, marbles, batteries and erasers are often ingested. The aim of this systematic review is to study the problem of foreign body ingestion among paediatric populations in terms of commonly ingested objects, and attempt to identify the link between location of impaction, associated symptoms, complications, spontaneous passage, methods and timing of removal.

METHODS

A literature search of multiple databases including PubMed, Embase, Current Contents Connect and Medline were conducted for studies on foreign body ingestions. Based on strict inclusion and exclusion criteria, 17 studies were selected. A qualitative review of these studies was then performed to identify commonly ingested foreign bodies, symptoms, signs and complications of foreign body ingestion, rates of spontaneous passage and methods of retrieval of the ingested objects.

RESULTS

Coins are the most commonly ingested foreign body. A variety of gastrointestinal symptoms such vomiting and drooling as well as respiratory symptoms such as coughing and stridor are associated with foreign body ingestion. The oesophagus, in particular the upper third, is the common site of foreign body obstruction. Objects in the stomach and intestine were spontaneously passed more frequently than at any other sites in the gastrointestinal system. Complications such as bowel perforations, infection and death are more commonly associated with ingestion of objects such as batteries and sharp objects such as bones and needles. Ingested objects are most commonly removed by endoscopic means.

CONCLUSION

Foreign body ingestion is a common paediatric problem. Batteries and sharp objects should be removed immediately to avoid complications while others can be observed for spontaneous passage. Endoscopy has a high success rate in removing ingested foreign bodies.

Unwitnessed magnet ingestion in a 5 year-old boy leading to bowel perforation after magnetic resonance imaging: case report of a rare but potentially detrimental complication

Background

The ingestion of non-food items in children is a relatively common event, often unwitnessed, unknown, and unreported. For those children brought in for medical evaluation, less than 10% require intervention, and only 1% require surgery. This, however, is not the case for magnet ingestion. Magnets, in plurality, can become attracted to one another through intestinal walls, causing a variety of surgical emergencies.

Case presentation

We present a case of unwitnessed multiple magnet ingestion in a 5 year-old boy who presented to the emergency department with the atypical chief complaint of neck pain. The diagnostic work-up including a neck magnetic resonance imaging (MRI) potentially led to bowel perforations managed definitely by a subsequent exploratory laparotomy. The child had an uneventful postoperative recovery and was discharged to home upon surgical recovery.

Conclusions

Institutions should make all possible efforts to attempt to prevent such potential life-threatening circumstances. We propose a screening tool that can further enhance the care of children who cannot or do not report unwitnessed magnetic ingestion prior to MRI evaluation.