Pediatric aero-digestive foreign bodies in the emergency setup: an otorhinolaryngologist’s perspective (original) (raw)
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Foreign bodies in digestive tract of children: A tertiary care hospital experience
International Journal of Medicine and Public Health, 2014
Introduction: Foreign bodies in the digestive tract are an important cause of morbidity and mortality in paediatric age group and pose diagnostic and therapeutic challenges We performed this study to evaluate our experience of foreign bodies of digestive tract in children over a fi ve year period in a tertiary referral center. Patients and Method: A retrospective study was conducted over a 5-year period between April 2009 and March 2013. All patients who were managed for foreign body in digestive tract up to 12 years of age were included and analysis was performed from case record of patients. Results: Total 97 patients with FB in digestive tract were included in the study FB was most commonly lodged in Upper esophagus in 61 patients, middle esophagus in 12 cases lower third of esophagus in 14 cases and beyond gastro-oesophageal junction in 10 cases. The most common clinical presentations were dull pain. Coins were the most common type of foreign body in the esophagus accounting for 71.1% of patients. Plain neck and chest x-rays antero-posterior and lateral view was diagnostic in all cases, with all FB being opaque. Rigid oesophagoscopy and removal under general anesthesia was the main treatment modality performed in 63 (65.8%) and Magill forceps extraction was done in 20 cases. Conclusion: Foreign bodies in digestive tract of children are a common problem with diverse presentation. Disc battery ingestion is prone for complication and expedient removal is required & associated conditions can pose risk for lodgment of foreign bodies.
South African Journal of Radiology, 2021
Foreign body ingestion Children aged 5 years and below account for approximately 70 000 cases of FB ingestion annually in the United States alone, with a peak incidence reported between 6 months and 3 years. 1 In most cases (80%-90%), although the FB will pass through the gastrointestinal tract (GIT) without requiring intervention, 10%-20% will require endoscopically assisted FB retrieval and 1% will require surgical intervention for the extraction of a FB or to treat a complication. 2,3 Clinical symptoms vary with the age of the patient, size and location of the FB. Symptoms such as drooling, gagging and poor feeding are common presentations in infants affected with ingested FBs, whilst older children may present with odynophagia, dysphagia and chest pain. When the FB is in the proximal or mid-oesophagus and close to the airways, children may present with cough, wheezing or symptoms of respiratory distress. In the absence of mucosal injury or obstruction, FBs in the stomach or bowel are less likely to cause symptoms; when symptoms present, these include abdominal pain, vomiting and hematemesis. In most cases, retained FBs in the paediatric age group are not dramatic. 4 The most commonly ingested FBs in descending order are as follows: coins, magnets, batteries, small toys, jewellery, buttons and bones. 5 Coins Coins are the most commonly ingested FBs in children. The initial evaluation of a child suspected of coin ingestion is radiography of the neck, chest and abdomen. Apart from regular anterior-posterior (AP) views, a lateral view of the neck can be obtained to better localise the coin. A coin is recognised on a radiograph by its metallic density and flat disk shape. On AP and lateral views, a coin in the oesophagus will appear as a radiodense circular object ('en face') and as a thick line ('on edge or in profile'), respectively (Figure 1a and b). In comparison, a coin in the Children, especially toddlers, because of their behaviour, physiology and anatomical characteristics such as oral exploration of their surroundings, have a tendency to place objects in their mouth. Therefore, ingestion or aspiration of foreign bodies (FBs) in children is a potentially life-threatening and common problem seen across the world. In this second part of our pictorial review on ingested and aspirated FBs, we focus on the paediatric population, reviewing the current literature and examining the epidemiology, clinical presentation, anatomic considerations, appropriate imaging modalities, key imaging characteristics associated with clinically relevant FBs in the emergency department (ED) and current management protocols.
Foreign bodies in the aerodigestive tract in pediatric patients
Auris Nasus Larynx, 2003
Objective: To investigate pediatric foreign body cases in the aerodigestive tract, and to elucidate the characteristic problems in Japan. Methods: A total of 310 pediatric patients (age 15 or below), gathered from two medical university hospitals (University of Tokyo and Jichi Medical School), were included in this study. Data were collected by retrospective chart review and were statistically analyzed. Results: Two-year-olds were the most common patients, and the range from age 1 to age 4 included 67.7% of all the patients. The most involved sites were the nose (39.4%) and the pharynx (38.4%), followed by the esophagus (12.9%) and the trachea-bronchi (6.5%). Fish bones and toys were the representative foreign bodies (30.7 and 13.6%, respectively). Other foreign bodies often encountered included coins, food, candy, peanuts and nuts, and batteries. The type of foreign body was closely related to the site in which foreign bodies were lodged: 77.3% of foreign bodies in the pharynx were fish bones, and toys were the most common impacted foreign body in the nose. In the esophagus, representative impacted foreign bodies were coins (35.7%), but disktype battery ingestion has been increasing in recent years. Although most foreign bodies in the esophagus were safely removed, one case of a disk-type battery had a serious sequela. In the trachea-bronchi, peanuts, food, cotton, and coins were impacted. A rigid bronchoscope was basically used to remove foreign bodies, but in some cases, a fine flexible endoscope, with a channel for fiber forceps, was useful, because it could be inserted into narrow bronchi. Advance of a flexible endoscope will make it an excellent tool for diagnosis and management of the trachea-bronchial foreign body. Conclusions: Fish bones in the pharynx, which were closely related to Japanese eating habits, and toys in the nose, were the typical foreign bodies encountered in this study. In the esophagus, an increased incidence of disk-type battery ingestion has become a serious problem in recent years. Since prevention is the most essential way to manage foreign body cases, feedback from studies to public education should be encouraged. #
Pediatrics …, 2010
OBJECTIVE: In the young children, particularly those aged from 1 to 3 years, aerodigestive tract foreign bodies (FB) are a common pediatric problem. The aim of this work is to characterize the risk of complications and prolonged hospitalization due to foreign bodies (FB) in the upper digestive tract in terms of the characteristics of the injured patients (age, gender), typology and features of the FBs, the circumstances of the accident and the hospitalization's details. METHODS: A retrospective study in 19 Hospitals of corresponding 19 European countries was realized on 2103 children aged 0-14. In 186 cases, it was reported an injury due to the presence of a FB in the mouth, esophagus and stomach (ICD935). RESULTS: Complications arose in 14 cases and hospitalization was required in 164 cases. No deaths were observed. A higher incidence of hospitalization in males (61%) was observed. Median age for children who experienced complications was 2 years old. The most common FB removal technique was esophagoscopy. In the majority of the cases, children were treated by ENT Department. The most common FBs were nuts, seeds, berries, corn and beas: in general, small, round crunchy foods pose a risk of choking. CONCLUSION: Coins, batteries and fish bones among food were the most common type of FB. Since recent development of technology has accelerated broad use of disk-type batteries, parents should be aware of this hazard, and an educational campaign for public education for this serious problem might be advisable.
FOREIGN BODY IN AERO-DIGESTIVE TRACT: A DESCRIPTIVE ANALYSIS AT TERTIARY CARE TEACHING HOSPITAL
Asian Journal of Pharmaceutical and Clinical Research Journal, 2022
Objectives: The objectives of the study were to analyze some of the key issues about the presentation, types, complications, and management arising about foreign body in the upper aero-digestive tract. Methods: All the patients presenting with or without history of swallowing or inhaling foreign bodies with symptoms such as dysphagia, drooling of saliva, stridor, and acute respiratory distress were included in study. Extraction of foreign body in airway tract was done by bronchoscopy and in digestive tract by esophagoscopy. Patient’s demographic details, types, symptoms and nature, size, and location of the inhaled foreign bodies were analyzed. Results: Patients aged more than 10 years constituted maximum number 14 (28%) in digestive tract. Patient aged 1–2 and 2–3 years accounted for most of the cases 10 (50%) in airway. Sensation dysphagia (100%) and foreign body sensation including cough (100%) were the most common symptom of digestive tract and airway tract, respectively. Currency coins (64%) were the most common type of foreign body in case of digestive tract ground nut (30%) was the most common type of airway foreign body. Conclusions: This study concluded that symptoms of foreign bodies in the aerodigestive tract are mainly nonspecific and needs high degree of suspicion, experience, and clinical acumen to diagnose and manage these patients.
Management of oesophageal foreign bodies in children
East African Medical Journal, 2002
Objective: Oesophageal foreign bodies (EFBs) are a common emergency issue in paediatrics, and few studies have revealed its clinical features and treatment methods. We conducted this retrospective study to provide our 10-year clinical evidence for the diagnosis and treatment of EFB and reduce the incidence of complications. Methods: We retrospectively reviewed all paediatric cases diagnosed with EFB from January 2012 to December 2021 at Shenzhen Children's Hospital. The age and sex of the patients, types of foreign bodies (FBs), preoperative examination, location and duration of FB impaction, clinical symptoms, surgical methods, therapeutic effects and complications were analysed. Results: Among the 1355 cases, 759 were boys and 596 were girls, with a median age of 2.9 years (4 months to 16 years). The shortest FB lodged time was 1 hour, while the longest time was 3 months. The types of foreign bodies included coins and blunt objects (812,59.9%), bones and sharp objects (278,20.5%), button batteries (86,6.3%), food impactions (84,6.2%), toys (51,3.8%) and plastic objects (44,3.2%). A total of 720 of 812 cases impacted by coins and blunt subjects were successfully treated with a Foley catheter without any complications. A total of 558 patients underwent rigid oesophageal endoscopy under general anaesthesia, and foreign bodies were successfully removed in 525 cases. No FB was found in 33 cases, and FBs pushed into the lower digestive tract during operation in 5 cases. Oesophageal injury was found in 130 cases (23.3%). Our study showed that the age of the patient, time of foreign body incarceration, type of foreign body, location of the lodged foreign body, and fever or cough were risk factors leading to oesophageal foreign body complications, and the differences were statistically significant (P < 0.05). Conclusion: Children with EFB have a risk of complications, especially if the FB is a button battery. The appropriate surgical method should be selected through the analysis of the clinical characteristics of the foreign body in the oesophagus and the risk factors for complications to reduce the incidence of complications. Health education and effective care are the keys to the prevention of EFB.
Management of oesophageal foreign bodies in pediatric patients: our experience
International Journal of Otorhinolaryngology and Head and Neck Surgery
Background: Amongst pediatric patients, oesophageal foreign bodies (OFBs) are relatively common clinical problem. Majority pass harmlessly through gastrointestinal tract, some can cause complications or morbidities. Our study considered and reviewed our experience in managing OFBs in pediatric patients, with emphasis on the management and outcomes of complicated cases.Methods: 77 cases of OFBs (diagnosis established), upto 12 years of age admitted at our tertiary hospital between January 2015 to December 2020 (duration of 6 years) were reviewed and analysed. On the basis of our analysis accounting demographic data, presenting symptoms, workup investigation, management, complications and outcomes, results and conclusions were derived.Results: Amongst cases, 43 were male and 34 female. Mean age for our cases was 5.4 years. 56 cases (72.7%) cases presented in the hospital within first 24 hours. Commonest foreign body found in 64 cases (83.1%) was coin. Most cases had history of witness...
Foreign bodies in the aerodigestive tract: time for comprehensive preventive measures
African Health Sciences
Background: Foreign body (FB) in the aerodigestive tract presents more commonly in children and remains a surgical emergency with potential for fatal complications. Objectives: To describe management and outcomes of aerodigestive FB managed at University of Ilorin Teaching Hospital (UITH) and proffer preventive measures. Methods: A 9-year retrospective review of all patients with foreign body in the aerodigestive tract managed between March 2011 and July 2020. Results: Sixty-six patients were studied. Median age was 9years with M:F ratio =1.6:1. FB was ingested in 38(57.6%) patients, aspiration occurred in 28(42.4%). Denture was most common FB 20(30.3%); plastic whistle/valve placed in dolls or football accounted for 4(6.1%). When ingested, FB was impacted in cervical 17(44.7%), upper thoracic 10(26.3%) and middle thoracic 2(5.3%) oesophagus. Oesophagoscopy was used in 30(8.9%) for retrieval. When aspirated, FB was located in the right bronchus 10(35.7%), left bronchus 7(25.0%), hyp...
2016
Copyright © 2012 Beata Rybojad et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We discuss clinical symptoms and radiological findings of variable esophageal foreign bodies as well as therapeutic procedures in Caucasian pediatric patients. A retrospective study of 192 cases of suspected esophageal foreign bodies between 1998 and 2010 was conducted. Data were statistically analyzed by chi-square test. A foreign body was removed from a digestive tract of 163 children aged 6 months to 15 years (mean age 4.9). Most objects were located within cricopharyngeal sphincter. Dysphagia occurred in 43%, followed by vomiting (29%) and drooling (28%). The most common objects were coins. Plain chest X-rays demonstrated aberrations in 132 cases, and in doubtful situations an esophagram test was ordered. In the group of thirty-se...
Complications in Children From Foreign Bodies in the Airway
Acta Otorrinolaringologica (english Edition), 2016
Introduction and objectives: Foreign body aspiration in childhood is a common and potentially serious problem. Complications may be the result of the aspiration episode itself, delayed diagnosis or treatment. We describe our experience in a paediatric hospital in Argentina. Methods: We retrospectively evaluated 56 patients with complications due to foreign body aspiration recorded in the Susy Safe Project between January 2010 and November 2013. The clinical variables analysed were sex, age at time of aspiration, foreign body location and type, time elapsed from the event until object removal, extraction technique, complications, need for hospitalisation and circumstances of the event. Results: 58.9% of the cases described occurred in males, with high presence of adults (76.8%) at the time of aspiration. The incidence was slightly higher in children older than 3 years. In 37 cases (66.1%), the foreign body was located in bronchus; sunflower seeds and ballpoint caps were the most common foreign objects. Only in 10 cases (17.9%) was the object extracted within 24 hours of the event. The most common complications were pneumonia (18 cases), granuloma (15 cases) and mucosal erosion (9 cases). Hospitalisation was necessary for 41 patients. Conclusion: Early diagnosis and immediate control through specialised teams are essential to ensure proper treatment, usually endoscopic, without risk of complications.