Retained Foreign Body in the Alimentary Tract in Children
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.
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