Bilateral vocal cord paralysis caused by accidental button battery ingestion in children: A case report and literature review

Button battery ingestion in pediatric populations is a common occurrence with severe sequelae. Multiple case reports have established the occurrence of death, fistula formation, mucosal erosion, esophageal perforation, and bleeding post-ingestion of button batteries. However, there is a gap in the literature on the occurrence of bilateral vocal cord paralysis post-lithium battery ingestion. We present a case in which a 12-month-old male developed bilateral vocal cord paralysis following ingestion of a button battery. We compare our case to eleven other reports that exist in the literature based on age, sex, time until removal, clinical presentation, day upon which vocal cord paralysis developed, anatomic location, and post-operative course. We conclude that bilateral vocal cord paralysis is a time-sensitive complication which requires prompt diagnosis. Any child with stridor following button battery ingestion should undergo consultation with pediatric otolaryngology immediately. In addition, long-term follow-up is necessary to evaluate return of normal vocal cord function.

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.

Ingestion of heated tobacco sticks containing a micro-blade by children: the importance of performing a radiograph

INTRODUCTION

Some tobacco sticks, such as TEREA™ heat sticks for IQOS ILUMA™, contain a blade. Both the nicotine part of the device and the micro-blade can be ingested by children.

CASE SUMMARIES

We report two children, an 18-month-old boy and a 10-month-old girl, who ingested a heat stick containing a micro-blade.

IMAGES

Radiography revealed the micro-blade to be in the child's mouth in the first case and the stomach in the second. Endoscopy was performed on the second child, confirming the presence of the blade in the stomach.

CONCLUSION

We recommend performing a radiograph on all children who ingest tobacco sticks containing a micro-blade. If a metallic object is present, we recommend endoscopic removal to avoid traumatic lesions from the sharp edges.

Radiolucent foreign body leading to complete small bowel obstruction: a diagnostic dilemma - a case report

Introduction and importance

Foreign body ingestion leading to luminal obstruction in both the small and large bowels is rare, especially in children. The authors present a case of a 7-year-old patient who presented with a small bowel obstruction caused by an ingested radiolucent foreign body. The previous herniotomy surgery 1 year back led to initial diagnostic confusion, highlighting the need for a broad differential diagnosis.

Case presentation

A 7-year-old child with a history of herniotomy presented with symptoms of small bowel obstruction. Radiological imaging revealed a soft tissue mass mimicking a polyp or cystic lesion. During exploratory laparotomy, a cystic structure was discovered in the terminal ileum. The foreign body, identified as a fluid-filled balloon, was inaccessible to endoscopy and was gently maneuvered into the ascending colon. It was punctured and removed during on-table colonoscopy.

Clinical discussion

This case underscores the challenges of diagnosing and managing luminal obstruction caused by radiolucent foreign bodies in children. The presence of previous surgery can mislead clinicians, necessitating a broad differential diagnosis. Radiological imaging played a crucial role in identifying the foreign body. Surgical intervention guided by an on-table colonoscopy allowed successful removal.

Conclusion

Foreign body ingestion leading to luminal obstruction should be considered, even in cases with previous abdominal surgery. Radiological imaging aids in identification, and timely surgical intervention, guided by on-table colonoscopy, facilitates foreign body removal. Awareness of such cases is essential for optimal care in pediatric patients with luminal obstruction caused by foreign body ingestion.

Utilization of Single-Incision Laparoscopy in the Management of Ingested Magnets

Background: A ban on neodymium magnets was lifted by the U.S. Consumer Product Safety Commission in 2016. Pediatric gastroenterologists and surgeons were increasingly tasked with removing these problematic objects. The purpose of this study was to assess the utility of single-incision laparoscopic surgery (SILS) in the management of ingested magnets. Patients and Methods: This is a single-center, retrospective assessment of surgical interventions for ingested magnets. International Classification of Disease, 10th revision codes were used to identify 349 patients ≤21 years of age evaluated for foreign body ingestion over a 4.5-year period. A medical record review helped isolate 29 (8.3%) magnet ingestions, 9 requiring surgical intervention. RedCap was used for analysis. Results: Of 9 surgical patients, 7 underwent SILS intervention by 1 surgeon. Another surgeon performed an open operation, whereas a third performed a multiport operation. Of the 7 SILS cases, 3 were completed without conversion to open. In one of these cases, bowel resection with primary anastomosis was performed. For SILS cases, average operating room time was 109 minutes (38-170 minutes), time to enteral feeds was 23 hours (0.28-79.2 hours), and hospital length of stay (LOS) was 3.8 days (1.96-6.68 days). Thirty-day readmission for SILS was 14.3%. No other complications were observed. Conclusions: SILS has been safely utilized for magnet retrieval. It offers an ability to identify the affected intestinal segment and an opportunity to intervene extracorporeally through an uncapped port. In addition, knowing where matted bowel is located can direct a limited incision during conversion to laparotomy. This may confer benefits of decreased pain, shortened time to enteral feeds, and decreased hospital LOS.

Ask Doctor Smartphone! An App to Help Physicians Manage Foreign Body Ingestions in Children

BACKGROUND

Foreign body ingestion (FBI) represents the most common cause of emergent gastrointestinal endoscopy in children. FBI's management can be quite challenging for physicians because of the variability of the clinical presentation, and the decision tree becomes even more intricate because of patient-specific variables that must be considered in the pediatric age range (e.g., age of patients and neuropsychiatric disorders) in addition to the mere characteristics of the foreign body. We present an application for smartphones designed for pediatricians and pediatric surgeons based on the latest guidelines from the official pediatric societies. The app aims to help physicians manage FBI quickly and properly in children.

MATERIALS AND METHODS

The latest pediatric FBI management guidelines were reviewed and summarized. The flow chart we obtained guided the development of a smartphone application. A questionnaire was administered to all pediatric surgeon trainees at our institute to test the feasibility and helpfulness of the application.

RESULTS

An app for smartphones was obtained and shared for free on the Google Play Store and Apple Store. The app guides the physician step by step in the diagnostic process, analyzing all patient- and foreign body-specific characteristics. The app consultation ends with a suggestion of the most proper decision to make in terms of further radiological investigations and the indication and timing of endoscopy. A questionnaire administered to trainees proved the app to be useful and easy to use.

CONCLUSION

We developed an app able to help pediatricians and pediatric surgeons manage FBI in children, providing standardized and updated recommendations in a smart and easily available way.

Water Beads-Exploratory Learning or Exploratory Laparotomy?

Small brightly colored water beads have become increasingly popular toys in the pediatric population, marketed specifically for sensory exploration and learning. Unfortunately, the water-absorbing polymer which gives these toys their ability to grow also serves as means of obstruction if ingested. We report a case of a pediatric patient presenting with small bowel obstruction following the ingestion of a water bead, which was diagnosed and treated swiftly without complication. With the increasing incidence of water bead ingestion, it is essential that the public be aware of the potential risks and the necessity of seeking medical attention if companies do not withdraw such dangerous products from the market.

When Meals Turn Into a Medical Mystery: A Case Report of Sigmoid Colon Impaction by a Chicken Bone

The presence of foreign objects in the digestive system can lead to various complications within the gastrointestinal (GI) tract. In certain cases, ingesting foreign objects can pose a significant dilemma for surgical teams, primarily because they can lead to blockages or punctures in the upper or lower sections of the GI tract. On occasion, foreign objects located in the lower regions of the digestive tract, such as the colon and rectum, might have entered via the anal pathway, thereby carrying the potential risk of causing perforations in the rectum or sigmoid colon. The other complications encompass the creation of abscesses, blockages in the bowel, fistula, and bleeding. Although these issues associated with foreign objects can arise in a healthy bowel, they can pose challenges in diagnosis when occurring in a bowel that is already affected by inflammation, constrictions, or malignancy. We present a unique case report of a 72-year-old female who presented to the emergency department with left lower quadrant pain associated with nausea and vomiting. Following a detailed clinical evaluation and radiographic imaging, a chicken bone was identified as the culprit, causing an unusual impaction in the sigmoid colon. The patient's medical history revealed no prior GI complications, making this case particularly noteworthy. Timely identification and precise diagnosis of complications arising from foreign bodies are essential to efficiently handle and prevent unfavorable consequences.

Accidental Sewing Pin Ingestion by a Tailor: A Case Report and Literature Review

Foreign body ingestion is a frequently encountered emergency in healthcare institutions. It mostly affects pediatric populations, although it can also affect adults with developmental delays, those with psychiatric diseases, drug abusers, and prisoners. Endoscopy is a diagnostic and treatment method for suspected foreign body ingestion. In this article, we discuss a 45-year-old tailor who swallowed a sewing pin while at work. The abdominal X-ray showed a needle-shaped metal shadow in the stomach region. During an upper endoscopy, it was discovered that a sewing pin with a sharp edge was stuck in the pylorus. The sewing pin was extracted endoscopically, and the patient was discharged the same day in good condition. Since the estimated risk of complications of foreign body ingestion in the adult population is about 35%, and the most common complications include impaction, laceration, bleeding, or perforation of the gastrointestinal wall, endoscopic or surgical removal is necessary. This also emphasizes the importance of a careful endoscopic evaluation of some at-risk occupations for foreign body ingestion with or without gastrointestinal complaints.

Toothpick: An Unusual Cause of Small Bowel Perforation in an Adult

Foreign body ingestion is a common complaint in the pediatric population; however, in adults, this entity remains quite rare. Most cases are managed conservatively with serial examinations and imaging. Rarely, foreign body ingestion may cause small bowel perforation and peritonitis in adults. Perforation often warrants operative management, and assessment of bowel viability is crucial. Here, we present a case of foreign body ingestion requiring exploration, without the need for bowel resection or repair. Although the need for operative intervention in adults after foreign body ingestion remains rare, it is crucial to recognize those patients who are both at risk for foreign body ingestion and have underlying small bowel narrowing that puts them at risk for perforation. A high index of suspicion in these instances is mandatory as early recognition and appropriate treatment will improve outcomes.

Arterio-Esophageal Fistula: A Complication of Button Battery Ingestion

Button battery (BB) ingestion is one of the rare foreign body ingestion (FBI) emergencies. Nevertheless, it carries high morbidity and mortality rates. In this case, we present a child with button battery ingestion complicated after successful removal by massive hematemesis and cardiopulmonary arrest. The patient was resuscitated and admitted to the intensive care unit (ICU). The event resulted in multiple neurological sequelae as demonstrated by radiological study as well as clinical examination.

Foreign Body Ingestion: An Unusual Case in a Patient with Dementia

Foreign body ingestion is a problem seen frequently in the emergency department, particularly in children. In this case report, we present an uncommon example: foreign body ingestion in an elderly patient with a history of dementia. This patient's symptoms of dysphagia, cough, and pooling secretions in the posterior oral cavity suggested food impaction, and after further investigation, coins were found in the upper and middle esophagus. Most of the coins were removed, the patient was monitored, and outpatient follow-up was organized to ensure the safe elimination of all the coins. This case illustrates the importance of having a high pretest probability for certain diagnoses based upon how specific patient populations present.

Blister Pack Ingestion in an Elderly Patient With a Communication Barrier: A Case Report

Foreign body ingestion is a common problem among elderly patients and can pose a serious health risk, particularly for those with communication barriers, cognitive impairments, or obscure medical histories. This report presents the case of a 67-year-old female inpatient who had a language communication barrier and accidentally ingested a blister pack. Effective communication was facilitated through an interpreter, and prompt endoscopic intervention was conducted to remove the foreign body safely. The patient was discharged with no further symptoms during follow-up. This case highlights the importance of prompt evaluation and intervention for foreign body ingestion in elderly patients, particularly those with communication barriers.

Two Stacked Coins Mimicking an Esophageal Button Battery: A Case Presentation and Review of the Literature

As button battery (BB) ingestion has become a popular topic with growing public awareness in recent years, pediatric otolaryngologists maintain a high index of suspicion for this diagnosis. Several recent reports have revealed the possibility for benign objects to masquerade as BBs, such as two coins stacked together or a coin with different metals in concentric rings. A 4-year-old female presented to the ED after unwitnessed ingestion of a foreign body. The child was reportedly seen playing with her sister's coin collection prior to the acute onset of drooling and dysphagia. She was vitally stable and without any shortness of breath, stridor, or wheezing. Plain film X-ray revealed a round, metallic object with a double density on the frontal view and beveled step-off on the lateral view at the level of the thoracic inlet. Due to high radiographic concern for BB ingestion, the patient was taken emergently to the operating room for a rigid esophagoscopy. A metallic object was seen at the thoracic inlet and removed with Magill forceps. The object was found to be two coins stuck together, with a smaller coin in the center of a larger coin mimicking the shape of a BB. The patient was discharged the next day without complication. This case highlights stacked coins as a radiologic masquerade for BBs as well as the emphasis on prompt esophagoscopy for both identification and removal. Radiographic densities alone cannot be relied upon to distinguish BBs from more innocuous objects, and esophagoscopy remains the mainstay of management for pediatric esophageal foreign bodies.

Unwitnessed Foreign Body Ingestion Causing Significant Morbidity in a Pediatric Patient Who Died During Resuscitation Secondary to Acute Upper Gastrointestinal Bleeding

Foreign body (FB) ingestion is a common presenting complaint to the emergency department in the pediatric age group; however, management and intervention vary based on the object ingested, location, time since ingestion, and clinical presentation. One of the rare presentations of foreign body ingestion is extreme complications such as upper gastrointestinal (GI) bleeding that requires urgent resuscitation and might need surgical intervention. We urge critical healthcare providers to consider foreign body ingestion in the differential diagnosis of acute unexplained upper gastrointestinal bleeding and maintain a high index of suspicion, and they must endeavor to obtain a complete history.

Histopathologic Findings of Button Battery-Related Changes in a Perforated Meckel's Diverticulum: Report of Three Cases

Background: A button battery can cause perforation of Meckel's diverticulum if sequestered in this blind ending bowel segment. Reported cases focused on clinical manifestations, management options, radiologic and intraoperative findings. We highlight the histopathologic features in perforated Meckel's diverticula due to ingested button batteries. Case report: Three toddlers presented with perforated Meckel's diverticula after button battery ingestion. Histologic examination of the diverticula showed multiple burn-like mucosal ulcerations and liquefactive wall perforations of the tips, associated with prominent siderotic pigment deposits and calcifications. There were various residual materials with variable staining patterns in the luminal debris, necrotic tissue and adjacent to submucosal blood vessels. Conclusion: There is accelerated deposition of iron and calcium associated with button batteries.

Bacteremia Associated With a Toothpick Lodged in the Duodenal Wall

Toothpick ingestion and perforation of the gastrointestinal tract, although a very rare phenomenon, carries a very high mortality risk. Most cases of toothpick ingestion remain unnoticed until very late. The symptoms are often vague, with the most common being abdominal pain. Any obscure case of abdominal pain with bacteremia must be investigated for foreign body ingestion and perforation. A CT scan is the best initial diagnostic modality for toothpick perforation but has low sensitivity with laparoscopy, and endoscopy is the preferred diagnostic tool. No single bacterium is involved in bacteremia due to toothpick ingestion. Surgical or endoscopic removal of the impacted toothpick along with prompt antibiotic therapy leads to excellent outcomes. If left untreated or in case of a late diagnosis, it may lead to life-threatening consequences. Here, we present a case of a 44-year-old man who had ingested a toothpick that pierced through and was lodged in the duodenal wall, leading to bacteremia. The patient was successfully treated and discharged.

Misdiagnosis of thyroid penetration caused by fishbone ingestion: a case report and literature review

Background

Foreign body ingestion is a common occurrence. However, thyroid penetrating injury caused by fishbone migration is rare.

Case Description

In this study, we present a rare misdiagnosed case of a fishbone fixed in the thyroid with a negative diagnosis on laryngoscopy examination. A 52-year-old woman experienced severe and persistent left anterior cervical pain when eating fish. Laryngoscopic imaging at an external hospital, revealed a cyst with a maximum length of 2 cm on the epiglottis, and epiglottic cyst resection under a laryngoscope was performed. The pain was not relieved, and the patient was referred to our hospital. Computed tomography and ultrasound examinations showed a sloping foreign body with a length of approximately 2.5 cm from top to bottom in the left lobe of the thyroid gland. The possibility of a penetrating fishbone injury was considered, and the foreign body was surgically removed. Postoperative drainage, fasting, and antibiotics were prescribed for 3 days, and then the patient was discharged. Follow-ups for 40 days suggested that she had recovered well without complications.

Conclusions

The presence of a migratory fishbone should be considered when a patient has a history of fishbone ingestion but laryngoscopy or esophagoscopy assessment of foreign body ingestion is negative.

Esophageal perforation and septic shock after accidental coin ingestion in elderly person

An 88-year-old man ingested coins accidentally and developed mediastinitis and septic shock. Esophageal injuries by sharped-shape foreign bodies are often reported, but esophageal perforation by round coins is rare. Even rounded-shape foreign bodies that are unlikely to injure esophagus may lead to severe outcomes.

Acute Pericarditis Hiding an Esophageal Perforation

Esophageal perforations due to foreign body ingestion are uncommon; however, they can be associated with extremely high mortality rate. The most dreadful complication of this entity is the infection of adjacent structures, namely, the mediastinum and the pericardium. A prompt diagnosis and a precocious start of treatment are essential to the prognosis. Thus, a high degree of suspicion is required, especially in older patients. Therapeutic options are highly variable, depend on several factors, and should be individualized to every patient and their clinical status. Surgical treatment with esophageal exclusion and diversion, in extreme circumstances, is mandatory to control the infection source site and prevent further contamination. We report a case of esophageal perforation, presenting 48 hours after onset, that led to multifactorial shock (septic and cardiogenic) due to pericarditis with pericardial and pleural effusion.

Time Is Money in Case of a Button Battery Ingestion

Button battery (BB) ingestion is a preventable pediatric health hazard with important morbidity and mortality due to complications. We present 3 pediatric patients with a complicated course after BB ingestion and discuss current guidelines. Urgent endoscopic removal is necessary for every BB impacted in the esophagus. A new strategy before endoscopic removal is the administration of honey or sucralfate. During endoscopy, rinsing the esophageal mucosae with acetic acid can neutralize the alkalic environment and prevent late complications. Prevention of ingestion needs to be pursued by increasing awareness and changing legislation of packaging of BB.

The Impact of the COVID-19 Pandemic on Foreign Body Ingestion Trends in Children: A Comparison of the Pre-Pandemic Period to 2020

Foreign body ingestion (FBI) among children is associated with morbidity and mortality. We used the National Electronic Injury Surveillance System to compare FBI trends from 2017-2019 to 2020 during the spread of SARS-CoV-2. The pandemic and associated stay-at-home orders were associated with uptrends in button battery and magnet ingestions but unchanged total FBI trends.

Role of Nose to Pelvis Imaging in the Evaluation of Foreign Body Ingestion: A Case of Magnet Ingestion in a 2-Year-Old

Foreign body ingestion (FBI) of small-rare-earth-magnets (SREM) sets are associated with high morbidity and mortality, as these tend to cause significant mucosal injury. Current clinical guidelines for the evaluation of FBI do not include imaging of the nose and neck. A 2-year-old patient presented with known SREM ingestion, with location confirmed in the right lower quadrant on imaging at the time of initial evaluation. Subsequent imaging involving the neck revealed additional magnets lodged in the patient's hypopharynx, which were missed on initial evaluation. This case highlights the importance of considering advanced imaging of the nose and neck to uncover extraintestinal foreign bodies.

Unexpected death from hepatic abscess 16 months after toothbrush ingestion

The development of a hepatic abscess secondary to foreign body (FB) ingestion remains rare in forensic practice. Herein, we present a case of a prisoner who died in the hospital and a forensic autopsy was performed to confirm the cause of death. A 14.5-cm-long toothbrush handle was found in the duodenum and had penetrated the right lobe of the liver, consistent with the repeated abdominal pain in his clinical history. The clinical history and investigation confirmed that he had ingested the toothbrush handle 16 months prior. This case highlights a rare complication of intentional ingestion of foreign bodies, and pathologists should be aware of this rare entity which links hepatic abscess and FB ingestion.

Pen Foreign Body Ingestion Mimicking Crohn's Disease in a Pediatric Patient

Foreign body ingestion is common in pediatrics, particularly in children with psychiatric illness. Foreign bodies present for extended periods of time can trigger a local inflammatory reaction causing weight loss, abdominal pain, and elevated inflammatory markers, mimicking inflammatory bowel disease (IBD). We report a case of intentional pen ingestion in a 13-year-old, whose clinical presentation with elevated inflammatory markers and terminal ileitis suggested on imaging was initially suspicious for Crohn's disease but was found on colonoscopy to be due to foreign body reaction from ingestion of a pen.

Decade of the dangers of multiple magnet ingestion in children: A retrospective review

AIM

Magnet ingestion has become more frequent in children as magnetic toys and jewellery have been popularised, with the potential to cause significant morbidity. Our aim was to describe our experience at a tertiary paediatric surgical centre.

METHODS

Retrospective review of patients admitted with multiple magnet ingestion (January 2011-December 2020). Division into an intervention group and conservative group. Comparisons included demographics, number of magnets and clinical outcomes. Data analysis with a Student's t-test and ROC Curve, P value of <0.05 was significant.

RESULTS

A total of 23 patients were identified with a total of 150 magnets ingested. The majority required an intervention for magnets retrieval (15/23, 65.2%), 11/15 (73.3%) surgical and 4/15 (26.7%) endoscopic. In the surgery group, 6/11 (54%) presented with an initial perforation and 1/11 (9.1%) an entero-enteric fistula. One patient (9.1%) had a multi-site anastomotic leak post-operatively. The conservative group had a significantly lower median number of ingested magnets (2 (2-6) vs. 7 (2-40), P = 0.03) and median length of stay (1 (1-4) vs. 7 (1-24), P = 0.03). ROC curve analysis revealed ingestion of >3 magnets had a sensitivity of 86.7% (95% CI: 62.1-97.6%) and specificity of 87.5% (95% CI: 53.0-99.4%) for requiring an intervention.

CONCLUSION

This series highlights a significant morbidity in children with a higher incidence of intervention following ingestion of more than three magnets. There is a strong requirement for the creation and adherence to new legislature involving industry standards.

The impact of the coronavirus disease 2019 pandemic on pediatric hospitalization in Kitami, Japan

BACKGROUND

Coronavirus disease 2019 (COVID-19) has drastically changed the recommended activities and environment for patients worldwide. Our aim was to assess the impact of COVID-19 on pediatric hospitalizations in Kitami, Japan.

METHODS

A retrospective, single-center study was conducted on hospitalized patients aged 0-14 years at the Japanese Red Cross Kitami Hospital. We compared the incidence of pediatric patients hospitalized in 2020 with those in 2017-2019.

RESULTS

The number of pediatric hospitalized patients dropped significantly in 2020 compared to that in 2017-2019 (median 43.0 vs 78.5 per month, P < 0.001). The patients were significantly older in 2020 (4.3 vs 3.4 years, P < 0.001). Hospitalization from respiratory (8.5 vs 30.5, P < 0.001) and gastrointestinal infections (3.0 vs 6.0, P = 0.004) significantly decreased. Admission due to respiratory syncytial virus (0.0 vs 4.0, P < 0.001), human metapneumovirus (0.0 vs 1.0, P = 0.005), influenza (0.0 vs 0.0, P = 0.009), adenovirus (0.0 vs 1.0, P = 0.003), and rotavirus infection (0.0 vs 0.0, P = 0.025) also decreased significantly. The <1-5 age groups significantly decreased (<1 year old, 6.5 vs 12.5, P < 0.001; 1-3 years old, 13.0 vs 29.5, P < 0.001; 4-5 years old, 5.5 vs 11.5, P < 0.001). Hospitalization due to foreign body ingestions increased significantly in 2020 (1.0 vs 0.0, P = 0.010).

CONCLUSIONS

The COVID-19 control measures inadvertently reduced the number of hospitalized pediatric patients, especially younger children with respiratory and gastrointestinal infections.

What Do Saudi Children Ingest?: A 10-Year Retrospective Analysis of Ingested Foreign Bodies From a Tertiary Care Center

OBJECTIVES

Few studies investigated the correlation between foreign body (FB) ingestion and occurrence of complications. The local literature is limited to case reports and small case series on esophageal FBs. We conducted this study to identify the high-risk factors predisposing to complications among Saudi children ingesting FBs.

METHODS

The medical records of 436 children (boys, 59.6%; mean age, 4.4 ± 2.7 years) presenting to the emergency department (ED) between 2007 and 2016 were retrospectively reviewed. Relative risk analysis of clinical variables was performed between 2 groups: The first group constituted children without FB-related complications (n = 389), and the second group included those with major complications (n = 14). Major complication was defined as any event associated with significant morbidity such as esophageal stricture, esophageal perforation, esophageal fistula, and intestinal perforation or fistula formation.

RESULTS

Most of the 436 cases presented between ages 2 and 4 years (35.1%). Coin was the most commonly ingested FB (22.9%) followed by button battery (19.5%). Most of the ingested FBs passed spontaneously without intervention (69%). Upper endoscopy was performed in 121 cases (27.7%). By multivariate analysis, the variables that were significantly associated with major complications included the following: very young age group (0-2 years; odds ratio [OR], 11.5), button battery (OR, 4), FB impacted at upper esophagus (OR, 8.7), and longer time duration to visit the ED (OR, 14.7).

CONCLUSION

Button battery impaction at upper esophagus in very young children and delayed presentation to the ED were the most significant risk factors of FB-related complications.

Ligamentum arteriosum calcification that presented as an esophageal perforation caused by duck bone ingestion

Ligamentum arteriosum calcification is the calcification or ossification of arterial ligaments. However, on computed tomography images, ligamentum arteriosum calcification is often mistaken for esophageal perforation when a patient has a medical history of foreign body ingestion. Ligamentum arteriosum calcification is uncommon in clinical practice. In this case report, we confirm the presence of this condition intraoperatively, which has seldom been reported previously. Increased awareness of the clinical characteristics of this uncommon disease can help thoracic surgeons with proper patient management.

A 3-year-old boy with rapid obstructive symptoms secondary to coin ingestion and gastric impaction

Foreign body ingestion is a common problem in children; blunt objects occur most frequently, and coins are the most common culprit. Rarely does coin ingestion lead to serious consequences other than esophageal impaction. In this report, we present the case of a healthy 3-year-old boy who developed rapid obstructive symptoms after the ingestion of a coin that required endoscopic retrieval from the stomach. Obstruction attributed to an ingested coin once post-esophageal is a rare complication of a relatively common presenting complaint.

An algorithm for retrieval tools in foreign body ingestion and food impaction in children

The aim of this study is to review the experience on managing foreign body ingestion in children with special emphasis on the endoscopic techniques and specific retrieval devices used for foreign body (FB) extraction. The charts of 341 children were reviewed retrospectively. Demographic data, ingested material, removal technique and tool, level of FB, complications, and outcomes were recorded. A total of 364 FBs were removed from 341 children. Among these, 56.5% (n: 206) were entrapped in esophagus, 39% (n: 142) were in stomach, and 4.5% (n: 16) in duodenum and intestine. The most frequently ingested items were coin (42.5%), button batteries (20.6%), and safety pins (12%). Optical forceps (37.9%) were the most commonly used tool and they were used during retrieval of esophageal FB by rigid endoscopy. Retrieval net (20.7%) was the second most common tool and the most common one during flexible endoscopy. Depending on our experience, we strongly advocate rigid endoscopy for esophageal FBs and food impaction in children because it allows both to use optical forceps with a strong grasping ability for blunt FBs and to position sharp and pointed objects inside the rigid endoscope. We recommend retrieval net as the first tool for the extraction of blunt objects and rat tooth retrieval forceps is the best tool for sharp and pointed FBs in stomach.

Foreign Body and Caustic Substance Ingestion in Childhood

Foreign body and caustic substance ingestion in childhood are common and require accurate and timely diagnosis to provide appropriate management consistent with the ingested substance/foreign body and clinical presentation as well as the associated risk status to prevent significant complications and morbidity. The aim of this paper was to present foreign body and caustic ingestion in childhood in terms of epidemiology, pathophysiology, diagnostic work-up and appropriate management and potential complications in accordance with clinical presentation and the type of ingested substance/foreign body.

Abdominal skin inflammation as an initial symptom of a perforating gastric foreign body: A case report

RATIONALE

Foreign bodies are frequently ingested, but only approximately 1% of them cause perforation. Perforations in the lesser curvature of the stomach are exceedingly rare. Here, we report a case of gastric perforation in the lesser curvature caused by a foreign body. The patient presented to the clinic complaining of abdominal skin swelling and reddening with upper abdominal discomfort as the initial symptoms.

PATIENT CONCERNS

An 83-year-old female presented with a mass in the middle of the epigastrium for 10 days. Physical examination found an apparent local tenderness and inflammatory mass in the upper abdominal wall. Her body temperature was normal (37.5°C) and the white blood cell count was elevated (8.12 × 10/L [reference value 3.5-9.5 × 10/L]).

DIAGNOSES

The ultrasound examination of the abdomen revealed a 4 cm strip-like hyperechoic object entangled in the muscles of the abdominal wall. The computed tomography scan revealed a thin strip of bone-like hyperdense shadow. Intraoperative findings showed a sharp fishbone protruding from the lesser curvature of the stomach into the abdominal cavity, part of which remained in the gastric cavity. The postoperative pathological report revealed chronic suppurative inflammation with abscess and sinus canal formation.

INTERVENTIONS & OUTCOMES

The patient underwent a gastric foreign body removal with partial gastrectomy. Anti-inflammatory treatment post-surgery rapidly relieved the patient's symptoms of discomfort in the upper abdomen. At the 1-month follow-up, the patient showed no discomfort in the upper abdomen and the inflammatory mass was no longer present.

LESSONS

A foreign body had penetrated through the lesser curvature of the stomach, an area with a flat gastric wall, which occurs infrequently. In such cases, computed tomography is the gold standard for diagnosis of foreign bodies in the digestive tract. Ultrasound can also be used as a supplemental diagnostic technique. It is recommended that people who wear dentures should exercise caution while eating, especially when the food contains bones.

Magnet ingestion by children: A retrospective study in a medical center in Taiwan

BACKGROUND

The ingestion of multiple magnets may lead to severe complications including bowel obstruction, perforation, fistula, peritonitis, short bowel syndrome, life-threatening injuries, and even death. The annual case number of high-powered neodymium magnets ingestion has been increasing in the western world and the dearth of available data demonstrates that this issue has been neglected in Taiwan.

METHODS

We searched the electronic medical records of our institution for patients younger than 18 years old who were diagnosed with, who had ever visited our emergency department, or been hospitalized for magnetic foreign body ingestion between January 2009 and March 2018. Demographic data including the number, shape, and size of magnets ingested, the clinical presentation, type of intervention, and complications were reviewed.

RESULTS

Thirteen patients who met the enrollment criteria were analyzed. One patient was documented between 2009 and 2013, and twelve were documented between January 2014 and March 2018. Five of the cases documented between 2014 and 2018 had ingested Buckyballs. The median age of the patients was 5 years. All of the patients with clinical symptoms had ingested more than one magnet and required endoscopic or surgical intervention. Bowel perforation or deep ulcer with impending perforation was found in three patients during surgery.

CONCLUSION

The number of children who visited our emergency department or were hospitalized due to the ingestion of magnets has increased recently. The presence of high power of neodymium magnets in many products increases the risk of ingesting multiple magnets resulting in serious complications. Therefore, stricter policies are needed to prevent children from obtaining products that contain magnets.

Foreign Body Ingestion: A Curious Case of the Missing Denture

Foreign body ingestion is an under-recognized hazard in adults, especially in the elderly where it may lead to significant morbidity and even mortality. We present the case of an elderly patient who ingested her denture without any reported symptoms. After early recognition, endoscopic retrieval of the item was performed. We provide support for endoscopy as a safe and effective intervention for removing ingested foreign bodies in the geriatric population.

Magnet Beads Impacted in the Appendix of a Child: A Case Report and Review of the Literature

Foreign body ingestion is a commonly encountered problem in the pediatric population, which can be a source of severe distress to parents and caregivers. Certain foreign bodies such as magnets, bones, and button batteries can be particularly dangerous and lead to some serious complications like gastrointestinal obstruction, perforation, or bleeding depending on the nature of the foreign body, the location of impaction, and the period since ingestion. In this report, we discuss a case of a 23-month-old girl who ingested multiple magnets that got trapped within the appendix resulting in continuous vomiting.

A Child With a Gastrocolic Fistula After Ingesting Magnets: An Unusual Complication

Foreign body ingestion is frequently the cause of emergency visits in the pediatric population, and these cases are challenging to diagnose and manage. In particular, the ingestion of magnets is dangerous and can lead to serious complications and even death. Urgent endoscopic intervention or surgical exploration remains the best approach for removing multiple ingested magnets and preventing further injury to the gastrointestinal (GI) tract. We report a nine-year-old child with an adjustment disorder who developed a gastrocolic fistula following the deliberate ingestion of multiple magnets. The magnets were successfully retrieved after an emergency laparotomy, and the fistula was subsequently repaired.

Successfully endoscopic retrieval of ingested toothpicks in colorectum : a report of four cases

BACKGROUND

Toothpick ingestion is a rare event, but due to the low efficacy of radiographic examination, it can induce severe complications including perforation, abscess, and sepsis.

CASE REPORT

Four patients with either defecation problems or abdominal/anal pain were admitted to our hospital. Colonoscopy showed all four cases had a toothpick impacted in the colorectal wall without perforation. Direct retrieval of the toothpick under endoscopy was achieved. All four patients were relieved and remained well during the follow-up.

CONCLUSION

Endoscopy is the most effective method to discover or retrieve ingested wooden foreign bodies when there are no severe complications.

Foreign Body Ingestion in Pediatrics: Distribution, Management and Complications

Background and Objectives: Foreign body (FB) ingestion is a common problem in children, causing serious complications. This study aimed to identify the distribution of types and locations of these foreign bodies and create Chiang Mai University (CMU) Guidelines. Materials and Methods: A retrospective descriptive study was conducted. All patients under 15 years old with foreign body ingestion (International Statistical Classification of Diseases and Related Health Problems; ICD-10 codes T18) treated in CMU Hospital from January 2006 to December 2017 were included. The data were analyzed using descriptive statistics. The guidelines were created, which paralleled the standard guidelines. Results: In total, 194 episodes of FB ingestion were recorded. These included 53.6% males and 46.4% females with a median age of 43.5 months. A history of foreign body ingestion complaints occurred in 77.8% of cases. Presentation was divided into asymptomatic (44.3%) and symptomatic (55.7%). The most common symptom was vomiting (23.2%). In the majority of cases, foreign bodies were located in the esophagus (37%). The most common type of foreign body was a coin (41.2%). Management included spontaneous passing (60.3%), endoscopy (35.6%), and others (3.1%). Complications before treatment were recorded in 9.3% of cases and after treatment in 2.1% of cases. Conclusions: Foreign body ingestion is common among children younger than four years old. Coins are the most common foreign body found, and the esophagus is the most common location. We recommend our created CMU Guidelines for management.

Sudden Unexpected Death Due to Left Subclavian Artery-esophageal Fistula Caused by Fish Bone

A 53-year-old woman was admitted to the hospital due to unexpected dizziness and died the following morning. To investigate the cause of death, a forensic autopsy along with histological examination was performed 3 days after her death. The major findings of the autopsy were that a fish bone had pierced the left subclavian artery after perforating the esophagus with 680 mL of blood in the stomach and bloody and tarry contents were present in the intestines, and the cause of death was confirmed to be subsequent hemorrhagic shock. Unfortunately, none of her family realized that she had eaten a fish 4 days before the tragedy until the fish bone was found. The present case is rare and instructive. The histopathological findings of left subclavian artery-esophageal fistula induced by a fish bone can be used as a reference in forensic practice.

Diverticular Perforation Secondary to a Chicken Bone: Food for Thought

A 56-year-old man presented to the emergency department with a one-day history of lower abdominal pain and fever. Clinical examination revealed generalized peritonitis. A computed tomography (CT) scan identified a linear hyperdensity straddling the site of a perforated sigmoid diverticulum. The patient proceeded to emergency laparotomy, which confirmed feculent peritonitis secondary to chicken bone perforation through the sigmoid colon diverticulum. After removal of the bone, Hartmann’s procedure was performed, and the patient subsequently made an excellent recovery.

Silent colonic perforation and enterocutaneous fistula by a ball point pen 13 years after ingestion in a patient with schizophrenia

Patients with mental illness do not get medical and surgical attention as required. Here is a case of poor, unemployed gentleman with an ulcer which was carefully evaluated and treated appropriately. The presentation is novel in many other ways. The object of size 6 × 2.5 cm usually does not cross the duodenum, but in his case an 11-cm long pen had reached the splenic flexure. It also had stayed dormant for over 13 years before causing complications. When the pen perforated the bowel, the patient is expected to present with acute abdomen, but in this case it presented as enterocutaneus fistula. This case is first of its kind in medical literature.

Double Jejunoileal Fistula after Ingestion of Magnets

A double jejunoileal fistula was diagnosed intraoperatively 10 months since a 4-year-old boy had swallowed an object consisted of multiple magnetic items. Magnet ingestion presents characteristics that are misdiagnosing, critical time-consuming, dangerous, and occasionally fatal. The particularities and pitfalls of ingested magnetic items are outlined.

Foreign body ingestion and food impaction in adults: better to scope than to wait

Background and objective

To assess clinical outcomes after foreign body ingestion and food impaction; to identify predictors of foreign body presence at the time of endoscopy.

Methods

A prospective study including consecutive adult patients with foreign body ingestion or suspected food impaction between May 2014 and August 2016.

Results

In total, 521 patients were included, 320 with foreign body ingestion and 201 with suspected food impaction. Food impaction patients were significantly older and more frequently had a history of oesophageal disease. The foreign body was encountered in the upper digestive tract in 43% of the patients with foreign body ingestion, and food impaction was confirmed in 87%. Older age (odds ratio (OR)_year 1.04, 95% confidence interval (CI) 1.02-1.06) and early presentation (OR_{first six hours} 4.41, 95% CI 2.24-8.66) were independent predictors of foreign body presence, while a history of psychiatric disease was an independent predictor of food impaction (OR 6.69, 95% CI 1.66-26.9). Successful endoscopic treatment was achieved in more than 90% of the cases, with adverse events occurring in fewer than 5%. Foreign body forceps was the preferred device in foreign body ingestion, while retrieval basket and mobilisation were preferred in food impaction. The need to use more than one instrument was significantly higher in food impaction.

Conclusion

Foreign bodies are encountered at endoscopy in almost half of the cases. Older age and earlier presentation are independent predictors of its presence. Given the high proportion of patients with foreign body at endoscopy and the low risk of complications, endoscopic evaluation is probably justified in the majority of cases.

Chronic penetrating renal trauma due to iron wire ingestion: An unusual case report

Foreign body ingestion is a common presentation in the emergency room. However, the complication such as penetrating renal trauma due to sharp objects ingestion is relatively rare. We herein describe an unusual case of penetrating renal trauma in the absence of any other urinary symptoms. A 53-year-old man who had a history of iron wire ingestion went to our hospital, on examination, he only had slight abdominal tenderness due to swallowing a ball pen and 1 cap nut 1 day before, radiological imaging showed penetrating renal trauma, the blood test showed his renal function is normal. Surgical strategies were recommended to remove the pen and the iron wire simultaneously, nonetheless the patient eventually agreed to only receive surgical removal of the swallowed ball pen and cap nut, meanwhile leave the kidney untreated. During 30 months follow-up by phone and regular outpatient examination, he recovered unevenly and had no special complaint. Such cases remind us that chronic penetrating renal trauma due to foreign object ingestion may have no obvious symptoms. It is easily to be neglected. We should try to minimize the possibility of missed lesions by adhering to a meticulous examination technique.

An analysis of foreign body ingestion treatment below the pylorus in children

We retrospectively studied records of patients who received conservative therapy or surgical operation for ingested foreign body (FB) located below the pylorus, and aimed to analyze the different treatment methods including prevention or operation of foreign bodies (FBs) when we found them in children of different age.The records of 16 patients (11 men and 5 women) who were hospitalized for FB ingestion between 2011 June and 2014 June were evaluated retrospectively. Mean age of the patients was 5.5 years (65.9 ± 61.0 mo). Nine patients underwent operations and 7 patients received conservative therapy. Approximately, 75% of the patients or their families recorded a positive FB swallow history. According to the results of plain radiographs, 81% patients had positive FB findings. Five patients experienced intestinal perforation. The mean duration of hospitalization was 9.13 ± 6.29 days.Intestinal perforation due to FBs is uncommon but needs to be taken into consideration especially when the FB is a magnet. It is not appropriate to give whole nuts to children (age <2 years). Radiographs should be taken 6 to 12 hours apart, and vital signs should be observed when observing a child who has ingested a sharp FB. Lastly, our society should pay more attention to psychotherapeutic needs in prepubertal children.

Recognition and management of foreign body ingestion and aspiration

Foreign body ingestion and foreign body aspiration commonly affect children. The most vulnerable age is between six months and four years, when children tend to explore new objects with their mouths. Many of these events remain asymptomatic, with the swallowed object passing through the gastrointestinal tract without causing harm. However, the frequency of serious complications as a result of the ingestion of hazardous objects has increased in recent years, in particular button batteries and magnets. To increase the likelihood of identifying foreign body ingestion and aspiration, healthcare professionals should maintain a high index of suspicion, be aware of the variation in presentations and include it as a differential diagnosis in children presenting with non-specific symptoms, such as fever, cough, drooling, dysphagia and abdominal pain. Management of most foreign body ingestions is conservative, using a 'watch-and-wait' approach. Children should be triaged as an emergency if they have signs or symptoms of airway obstruction or a history that indicates dangerous foreign body ingestion. Early recognition and management leads to improved outcomes for patients. Nurses have a vital role in providing education and practical advice to parents, which reduces the occurrence of these events. Stronger legislation is required to ensure manufacturers emphasise the potential dangers of certain products and design child-safe devices.

Usefulness of Ultralow-Dose (Submillisievert) Chest CT Using Iterative Reconstruction for Initial Evaluation of Sharp Fish Bone Esophageal Foreign Body.AJR Am J Roentgenol. 2015;205:985-990. [PMID: 26496545 DOI: 10.2214/AJR.15.14353]

OBJECTIVE

The purpose of this article was to evaluate the usefulness of ultralow-dose chest CT as an initial imaging study for evaluation of sharp fish bone esophageal foreign body (FB).

MATERIALS AND METHODS

A total of 57 subjects who underwent ultralow-dose chest CT were included in this retrospective study. All subjects had a history of ingestion and symptoms of esophageal FB. All ultralow-dose chest CT data were reconstructed twice, once with filtered back projection (FBP) and once with iterative reconstruction, and three observers reviewed the images independently. ROC analysis was used to evaluate diagnostic performance of ultralow-dose chest CT. Intraclass correlation coefficient (ICC) was calculated for analysis of interobserver agreement.

RESULTS

Among 57 patients, 42 were confirmed as having esophageal FB. Significant objective noise reduction of mediastinum was achieved using an iterative reconstruction technique. Subjective image noise of iterative reconstruction was significantly better than that of FBP. Overall diagnostic performance of ultralow-dose chest CT for esophageal FB of iterative reconstruction (AUC = 0.999) was significantly better than that of FBP (AUC = 0.95) (p = 0.02). Interobserver agreement was greater for iterative reconstruction (ICC = 0.944) than for FBP (ICC = 0.778).

CONCLUSION

Ultralow-dose chest CT using iterative reconstruction provided satisfactory diagnostic image quality for identifying fish bone esophageal FB with reduced radiation dose and high observer accuracy. Therefore, ultralow-dose chest CT would be adequate as a first-line imaging modality for fish bone esophageal FB.