Retained Foreign Body in the Alimentary Tract in Children

Authors

  • Rangsan Niramis Department of Surgery, Queen Sirikit National Institute of Child Health. (Children's Hospital), Bangkok, Thailand.
  • Sukawat Watanatittan Department of Surgery, Queen Sirikit National Institute of Child Health. (Children's Hospital), Bangkok, Thailand.
  • Maitree Anuntkosol Department of Surgery, Queen Sirikit National Institute of Child Health. (Children's Hospital), Bangkok, Thailand.
  • Tongkao Rattanasuwan Department of Surgery, Queen Sirikit National Institute of Child Health. (Children's Hospital), Bangkok, Thailand.
  • Veera Buranakitjaroen Department of Surgery, Queen Sirikit National Institute of Child Health. (Children's Hospital), Bangkok, Thailand.

Abstract

Background / Purpose: Foreign body ingestion is a common problem in pediatric emergency. The aim of this study was to review the clinical presentation and evaluation of the treatment of foreign body retention in the alimentary tract in children.

Methods: Medical records of the patients who were admitted to the Queen Sirikit National Institute of Child Health for foreign body ingestion during 1988 to 1998 were reviewed. Clinical presentation, radiological findings, modes and results of the treatment were studied.

Results: One hundred and forty-eight patients were assessed for foreign body retention in the alimentary tract; 93 were male and 55 were female. Age of the patients ranged from 7 months to 13 years. Eighty-nine cases (60.1%) were 3 years of age or younger, and 38 cases (25.7%) were between 3 to 6 years of age. Vomiting, dysphagia, salivation and coughing were the common symptoms found in 38.5, 18.2, 15.5 and 15.5 per cent of the cases respectively. One-third of the patients (35.8%) had absence of symptoms after foreign body ingestion. Blunt foreign bodies were proven in 125 cases (84.5%) and metallic coins were the most common objects in this group. Sharp foreign bodies were noted in 23 cases (15.5%), and straight pins, safety pins, chicken and fish bones were common. Radiological and endoscopic findings revealed the location of the foreign bodies at the hypopharynx, esophagus, stomach and intestine in 4, 127, 11 and 6 cases, respectively. The success rate of direct laryngoscopic and esophagoscopic removal of foreign bodies in the hypopharynx and the esophagus was 85.5 per cent (112 in 131 cases). The patients with foreign bodies in the stomach and the intestine were treated conservatively. Most foreign bodies could be passed spontaneously within 3 -15 days. Five patients (3.4%) underwent surgery for various indications, I for small bowel perforation and peritonitis 3 days after button battery ingestion, 2 for pin fixation at the duodenum over 3 days. In one case, a cervical esophagotomy was undertaken in order to remove a rubber toy which could not be removed during esophagoscopy because of vacuum effect. The remaining one patient underwent a thoracotomy and esophagotomy for removal of a curled wire in the mid position of the esophagus. There was no mortality among these 148 cases.

Conclusions: Prevention of foreign bodies ingestion should focus on toddlers to 6-year-old children. Vomiting, dysphagia, salivation and coughing were the common symptoms but absence of symptoms could not exclude retained foreign body in the gastrointestinal tract. Direct laryngoscopy and esophagoscopy under general anesthesia were the suitable procedure for removal of foreign bodies in the hypopharynx and the esophagus. Almost all of the patients with foreign bodies in the stomach and the intestine could be conservatively treated with exception in a few cases.

Downloads

Download data is not yet available.

References

1. Groff DB. Foreign bodies and bezoars. In: Welch KJ, Randolph JG, Ravitch MM, O'Neill JA, Rowe MI, eds. Pediatric Surgery. 4thed. Chicago: Year Book Medical Publishers, 1986: 907-11.

2. Schwartz GF, Polsky HS. Ingested foreign bodies of the gastrointestinal tract. Am Surg 1976; 42: 236-8.

3. Blatnik DS, Toohill RJ, Lehman RH. Fatal complication from alkaline battery foreign body in the esophagus. Ann Otol Rhinol Laryngol 1977: 86:611-5.

4. Suita S, Ohgami H, Yakabe S, et al. Delayed diagnosis of foreign body in the esophagus: a case report. Clin Pediatr 1986;25: 372.

5. Gilchrist BF, Valeric EP, Nguyen M, Coren C, Klotz D, Romenofsky ML. Pearls and perils in the management of prolonged, peculiar, penetrating esophageal foreign bodies in children. J Pediatr Surg 1997; 32: 1429-31.

6. Byard RW. Mechanisms of unexpected death in infants and young children following foreign body ingestion. J Forensic Sci 1996; 41: 438-41.

7. Cass DT, Lai B. Oesophageal perforation caused by a coin. J Pediatr Child Health 1993; 29: 239-40.

8. Samed L, Ali M, Ramzi H. Button battery ingestion: hazards of esophageal impaction. J Pediatr Surg 1999; 34: 1527-31.

9. Cheng W, Tam PKH. Foreign body ingestion in children: experience with 1,265 cases. J Pediatr Surg 1999; 34: 1472-6

10. Votteler TP, Nash JC, Rutledge JC. The hazard of ingested alkaline disk batteries in children. JAMA 1983; 249:2504-6.

11. Macpherson RI, Hill JG, Othersen HB, Tagge EP, Smith CD. Esophageal foreign bodies in children : diagnosis, treatment and complications. AJR 1996; 166:919-24.

12. Suita S, Ohgami H, Nagsaki A, Yakabe S. Management of pediatric patients who have swallowed foreign objects. Am Surg 1989; 55: 585-90.

13. Hawkins DB. Removal of blunt foreign bodies from the esophagus. Ann Otol Rhinol Laryngol 1990; 99: 935-40.

14. Crysdale WS, Sendi KS, Yoo J. Esophageal foreign bodies in children. 15-year review of 484 cases. Ann Otol Rhinol Laryngol 1991; 100: 320-4.

15. Panieri E, Bass DH. The management of ingested foreign bodies in children - a review of 663 cases. Eur J Emerg Med1995; 2:83-7.

16. Sharp RJ. Esophageal foreign bodies. In: Ashcraft KW, Holder TM, Eds. Pediatric Surgery. Orlando: Grune and Stratton, 1986: 137-49

17. Slovis CM, Tyler-Werman R, Solightly DP. Massive foreign object ingestion. Ann Emerg Med 1982; 11: 432-5.

18. Jackson RM, Hawkins DB. Coin in the esophagus. What is the best management? Int J Pediatr Otorhinolaryngol 1986;12:127-35.

19. Bigler FC. The use of a Foley catheter for removal of blunt foreign bodies from the esophagus. J Thorac Cardiovasc Surg 1966; 51:759-60.

20. O'Neill JA, Holcomb GW, Neblett WW. Management of tracheobronchial and esophageal foreign bodies in childhood. J Pediatr Surg 1983; 18: 475-9.

21. Campbell JB, Quattromani FL. Foley catheter removal of blunt esophageal foreign bodies. Experience with 100 consecutive children. Pediatr Radiol 1983; 13: 116-8.

22. Binder L, Anderson WA. Pediatric gastrointestinal foreign body ingestion. Ann Emerg Med 1984; 13: 112-7.

23. Manning PB, Wesley JR, Polly TZ, et al. Esophageal and tracheobronchial foreign bodies in infants and children. Pediatr Surg Int 1987: 2: 246-51.

24. Emslander HC, Bonadio W, Klatzo M. Efficacy of esophageal bougienage by emergency physicians in pediatric coin ingestion. Ann Emerg Med 1996; 27:726-9.

25. Calkins CM, Christians KK, Sell LL. Cost analysis in the management of coins: endoscopy versus bougienage. J Pediatr Surg 1999, 34: 412-4.

26. Campbell JB, Condon VR. Catheter removal of blunt esophageal foreign bodies in children. Survey of the Society for Pediatric Radiology. Pediatr Radiol 1989; 19: 361-5.

27. Kelley JE, Leech HM, Carr MG. A safe and cost-effective protocol for the management of esophageal coin in children. J Pediatr Surg 1993; 28: 898-900.

28. Schunt JE, Harrison AM, Corneli HM, Nixon GW. Fluoroscopic Foley catheter removal of esophageal foreign bodies in children: experience with 415 episodes. Pediatrics 1994;94:709-14.

29. Dokler ML, Bradshaw J, Mollitt Di, Tepas JJ 3rd. Selective management of pediatric foreign bodies. Am Surg 1995:61:132-4.

30. Harned RK 2nd, Strain JD, Hay TC, Douglas MR. Esophageal foreign bodies: safety and efficacy of Foley catheter extraction of coins. AJR 1997; 168: 443-6.

31. Morrow SE, Bickler SW, Kennedy AP, et al. Balloon extraction of esophageal foreign bodies in children. J Pediatr Surg 1998; 33: 266-70.

32. Litovitz TL, Schmitz BF. Ingestion of cylindrical and button batteries: an analysis of 2382 cases. Pediatrics 1992; 89:747-57.

33. Litovitz TL. Button battery ingestion. A review of 56 cases. JAMA 1983;249:2495-2500.

34. Bass DH, Millar AJ. Mercury absorption following button battery ingestion. J Pediatr Surg 1992; 27: 1541-2.

35. Mc Dermott' VG, Tayler T, Wyatt JP, Mac Kenzie S, Hendry GM. Orogastric magnet removal of ingested disk batteries. J Pediatr Surg 1995; 30: 29-32.

Downloads

Published

2000-06-30

How to Cite

1.
Niramis R, Watanatittan S, Anuntkosol M, Rattanasuwan T, Buranakitjaroen V. Retained Foreign Body in the Alimentary Tract in Children. Thai J Surg [Internet]. 2000 Jun. 30 [cited 2022 Oct. 4];21(2):41-54. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/243350

Issue

Section

Original Articles

Most read articles by the same author(s)

1 2 3 > >>