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Meltzer L. Ileocolic Perforation Secondary to Disk Battery Ingestion in a Dog. J Am Anim Hosp Assoc 2018; 54:e54501. [PMID: 30039996 DOI: 10.5326/jaaha-ms-6606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 7 yr old spayed female shih tzu was evaluated for anorexia of 4 days duration. Conservative treatment for gastroenteritis had been administered by another veterinarian 2 days before presentation. Abdominal radiography revealed two round, disk-shaped, metallic-opacity foreign objects within the bowel with loss of serosal detail. Exploratory laparotomy was performed and revealed circumferential full-thickness necrosis and perforation of the intestines at the ileocolic junction with a small amount of peritoneal effusion. Two disk batteries were palpated in the colon and milked out of the rectum. An ileocolic anastomosis was performed without complication. However, the dog died following cardiopulmonary arrest shortly after extubation. Disk batteries are capable of causing severe tissue necrosis due to the generation of electric current when prolonged contact with mucosal surfaces occurs. Immediate removal is recommended to prevent gastrointestinal perforation and potential fatalities.
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Affiliation(s)
- Lauren Meltzer
- From Veterinary Orthopedics and Sports Medicine Group, Annapolis Junction, Maryland
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253
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Saadeh C, Ulualp SO. An uncommon source for oesophageal foreign body: Fidget spinner. SAGE Open Med Case Rep 2018; 6:2050313X18781229. [PMID: 29977556 PMCID: PMC6024347 DOI: 10.1177/2050313x18781229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/15/2018] [Indexed: 01/21/2023] Open
Abstract
Fidget spinner is a new handheld toy with potential choking and ingestion hazard. Our objectives are to describe clinical presentation of a child with fidget spinner ingestion and draw attention to danger associated with fidget spinner. A 3-year-old boy presented with painful swallowing and feeling of something stuck in the throat. A chest radiograph revealed a radiopaque foreign body with a disc-like component. Rigid oesophagoscopy revealed a foreign object with disc battery and battery holder circuit board. Clinicians should consider the fidget spinner as one of many varieties of toys that has potential for button battery ingestion or aspiration.
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Affiliation(s)
- Charles Saadeh
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Seckin O Ulualp
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Pediatric Otolaryngology, Children's Health, Dallas, TX, USA
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254
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Blevrakis E, Raissaki M, Xenaki S, Astyrakaki E, Kholcheva N, Chrysos E. Multiple magnet ingestion causing instestinal obstruction and entero-enteric fistula: Which imaging modality besides radiographs? A case report. Ann Med Surg (Lond) 2018; 31:29-33. [PMID: 29922465 PMCID: PMC6004778 DOI: 10.1016/j.amsu.2018.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/26/2018] [Accepted: 04/20/2018] [Indexed: 02/07/2023] Open
Abstract
Ingested foreign bodies occur in children younger than 3 years and pass uneventfully through the gastrointestinal tract. However, multiple magnet ingestion are associated with serious complications. A 9-year old male with abdominal pain and vomiting 3 days prior to admission, underwent abdominal radiographs showing radiopaque foreign bodies. Ultrasonography (US) independently discovered one magnet floating in the jejunum. Preoperative Computed Tomography (CT) confirmed the presence of two neighbouring magnets causing obstruction and beaking of an adjacent jejunal loop. Laparotomy led to uneventful recovery of transmesenteric fistula formation following pressure necrosis in two jejunal loops. We present the first case of multiple magnet ingestion managed in our institution, where the prevalence of magnet ingestions is low due to unpopularity of magnet toys. CONCLUSION Awareness of the potentially devastating effects of multiple magnets passing the pylorus and the contribution of different imaging modalities for the diagnosis are emphasized and discussed.
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Affiliation(s)
| | - Maria Raissaki
- Dept of Radiology. University Hospital of Heraklion, Crete, Greece
| | - Sofia Xenaki
- Dept of Pediatric Surgery. University Hospital of Heraklion, Crete, Greece
| | | | - Nelli Kholcheva
- Dept of Radiology. University Hospital of Heraklion, Crete, Greece
| | - Emmanuel Chrysos
- Dept of Pediatric Surgery. University Hospital of Heraklion, Crete, Greece
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255
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Mori T, Ihara T, Hagiwara Y. Pediatric food impaction detected through point-of-care ultrasonography. Clin Exp Emerg Med 2018; 5:135-137. [PMID: 29973037 PMCID: PMC6039366 DOI: 10.15441/ceem.17.236] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/09/2017] [Indexed: 12/14/2022] Open
Abstract
A previously healthy 1-year-old boy suddenly began coughing while eating a dried sweet potato. Because he continued gagging after vomiting a piece of the dried sweet potato, his mother brought him to our emergency room. Upon arrival, despite normal pulmonary findings, he was drooling and gagging. Ultrasonography was performed because food impaction at the upper esophagus was suspected based on his medical history and physical examination, and results showed that a linear hyperechoic lesion was obstructing the posterior esophageal wall. Computed tomography was also considered for a detailed examination of the foreign body. However, the patient vomited the dried sweet potato before the test was performed. After vomiting the foreign body, the patient stopped gagging, and his ultrasonographic findings were normal. Therefore, the patient was discharged without any complications.
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Affiliation(s)
- Takaaki Mori
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Takateru Ihara
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yusuke Hagiwara
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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256
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Liu S, Li Q, Li Y, Lv Y, Niu J, Xu Q, Zhao J, Chen Y, Wang D, Bai R. Ileocecal junction perforation caused by a sewing needle in incarcerated inguinal hernia: An unusual case report. Medicine (Baltimore) 2018; 97:e10787. [PMID: 29851786 PMCID: PMC6393046 DOI: 10.1097/md.0000000000010787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION This case study is concerning the meticulous observation of the moving process and track of 2 ingested needles using interval x-ray radiography, trying to localize the foreign bodies and reduce unnecessary exploration of digestive tract. CASE PRESENTATION An unusual case of a 1-year, 9-month-old female baby, with incarcerated hernia perforation caused by sewing needles with sharp ends, was reported herein. The patient had swallowed 2 sewing needles. One needle was excreted uneventfully after 8 days. On the contrary, the other needle stabbed the ileocecal junction wall into the right side of inguinal hernia sac after 9 days, and the patient received successful operation management. Interval x-ray confirmed that 1 needle-like foreign body moving down in 8 days until excretion along with feces. However, the other pierced into the incarcerated hernia. Preoperative x-ray radiography successfully monitored the moving process and tract of the sewing needles. Considering the penetrating-migrating nature of the foreign bodies, once the sharp-pointed objects were located, they should be removed as the mortality and risk of related complications may be increased. CONCLUSION Interval x-ray radiography represents a meticulous preoperative monitoring method of the moving process and tract of needle-like foreign bodies. Interval x-ray with real-time images accurately detecting the moving foreign bodies could be help to reduce the unnecessary exploration of digestive tract and subsequently prevent possible complications. Based on the basic findings from the interval x-ray, treatment choices of endoscopic removal and surgical intervention may be attempted.
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Affiliation(s)
- Shiqi Liu
- Department of Pediatric Surgery, Northwest Women's and Children's Hospital, Xi’an, Shaanxi Province
| | - Qifeng Li
- Xinjiang Institute of Pediatrics, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, P.R. China
| | - Yumei Li
- The Interdisciplinary Centre for Security, Reliability and Trust (Sn T), University of Luxembourg, Luxembourg, Luxembourg
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shanxi Province
| | - Jianhua Niu
- Third Department of General Surgery, The First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang
| | - Quan Xu
- Department of Pediatric Surgery, Northwest Women's and Children's Hospital, Xi’an, Shaanxi Province
| | - Jingru Zhao
- Department of Pediatric Surgery, Northwest Women's and Children's Hospital, Xi’an, Shaanxi Province
| | - Yajun Chen
- Department of Basic Surgery, Beijing Children's Hospital, Capital Medical University, Beijing
| | - Dayong Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shanxi Province
| | - Ruimiao Bai
- Department of Neonatal Intensive Care Unit, Northwest Women's and Children's Hospital, Xi’an, Shaanxi Province, P.R. China
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Reeves PT, Nylund CM, Noel JM, Jones DS, Chumpitazi BP, Milczuk HA, Noel RA. Fidget Spinner Ingestions in Children-A Problem that Spun Out of Nowhere. J Pediatr 2018; 197:275-279. [PMID: 29571926 DOI: 10.1016/j.jpeds.2018.01.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 01/10/2018] [Accepted: 01/24/2018] [Indexed: 10/17/2022]
Abstract
The Consumer Product Safety Risk Management System's injury and potential injury database records 13 cases of fidget spinner ingestion since 2016. In addition to a database query, we report 3 additional cases of fidget spinner ingestion to describe patient presentations and subsequent management strategies.
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Affiliation(s)
- Patrick T Reeves
- Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - Cade M Nylund
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - James M Noel
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - David S Jones
- Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX
| | | | - Henry A Milczuk
- Department of Otolaryngology, Oregon Health & Science University, Portland, OR
| | - R Adam Noel
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
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258
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Management of Esophageal Food Impaction Varies Among Gastroenterologists and Affects Identification of Eosinophilic Esophagitis. Dig Dis Sci 2018; 63:1428-1437. [PMID: 29460159 PMCID: PMC5955857 DOI: 10.1007/s10620-018-4972-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/08/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Esophageal food impaction (EFI) is a gastrointestinal emergency requiring immediate evaluation in the emergency room (ER) and an esophagogastroduodenoscopy (EGD) for disimpaction. EFI is also a distinct presenting feature of eosinophilic esophagitis (EoE). This study aimed at understanding the management of EFI among gastroenterologists (GIs) and estimated its impact on identification of EoE in USA. METHODS GIs associated with three major gastroenterology societies based in USA were invited to participate in a web-based survey. Information on the resources available and utilized, and the clinical decision-making process related to management of EFI cases was collected and analyzed. RESULTS Of 428 responses, 49% were from pediatric GIs, 86% practiced in the USA, and 78% practiced in an academic setting. Compared to the pediatric GIs, adult GIs were more likely to perform EGD in the emergency room [OR 87.96 (25.43-304.16)] and advance the food bolus into stomach [5.58 (3.08-10.12)]. Only 34% of respondents obtained esophageal biopsies during EGD, and pediatric GIs were more likely to obtain esophageal biopsies [3.49 (1.12-10.84)] compared to adult GIs. In USA, by our conservative estimates, 10,494 patients presenting to ER with EFI and at risk of EoE are likely being missed each year. CONCLUSIONS EFI management varies substantially among GIs associated with three major gastroenterology societies in USA. Based on their practice patterns, the GIs in USA are likely to miss numerous EoE patients presenting to ER with EFI. Our findings highlight the need for developing and disseminating evidence-based EFI management practice guidelines.
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259
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Button Battery Powered Fidget Spinners: A Potentially Deadly New Ingestion Hazard for Children. J Pediatr Gastroenterol Nutr 2018; 66:595-597. [PMID: 29369847 DOI: 10.1097/mpg.0000000000001892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Toys entering the marketplace may have unrecognized hazard risks until data on injury become known. The fidget spinner is a new popular toy mass marketed to children and is primarily sold without warning labels. The US Consumer Product Safety Commission has recently issued a formal statement on potential safety concerns related to ingestion of the toy parts and other hazards. Button batteries within this toy pose the greatest danger to children as ingestion can lead to lethal injury. We report 2 cases of children who swallowed a button battery from a fidget spinner, causing severe esophageal injury. Various aspects of this type of ingestion important for clinicians to be aware of are reviewed.
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Abstract
Foreign body (FB) ingestion in children is common and most children are observed to be between 6 months and 3 years of age. Although most FBs in the gastrointestinal tract pass spontaneously without complications, endoscopic or surgical removal may be required in a few children. Thus, FB ingestion presents a significant clinical difficulty in pediatric gastroenterological practice. Parameters that need to be considered regarding the timing of endoscopic removal of ingested FBs in children are the children's age or body weight, the clinical presentation, time lapse since ingestion, time of last meal, type as well as size and shape of the FB, and its current location in the gastrointestinal tract. Esophageal button batteries require emergency removal regardless of the presence of symptoms because they can cause serious complications. Coins, magnets, or sharp FBs in the esophagus should be removed within 2 hours in symptomatic and within 24 hours in asymptomatic children. Among those presenting with a single or multiple magnets and a metallic FB that have advanced beyond the stomach, symptomatic children need a consultation with a pediatric surgeon for surgery, and asymptomatic children may be followed with serial X-rays to assess progression. Sharp or pointed, and long or large and wide FBs located in the esophagus or stomach require endoscopic removal.
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Affiliation(s)
- Ji Hyuk Lee
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
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263
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Piotto L, Gent R. The value of ultrasound in the investigation of ingested foreign bodies in children. SONOGRAPHY 2018. [DOI: 10.1002/sono.12139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Lino Piotto
- Division of Medical Imaging; Women's and Children's Hospital; South Australia Australia
| | - Roger Gent
- Division of Medical Imaging; Women's and Children's Hospital; South Australia Australia
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264
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Hur K, Angajala V, Maceri D, Hochstim C. Geographic health disparities in the Los Angeles pediatric esophageal foreign body population. Int J Pediatr Otorhinolaryngol 2018; 106:85-90. [PMID: 29447899 DOI: 10.1016/j.ijporl.2018.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/07/2018] [Accepted: 01/10/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess geographical sociodemographic differences in the pediatric esophageal foreign body population of Los Angeles. METHODS We retrospectively reviewed the medical records of 128 consecutive pediatric patients at Children's Hospital Los Angeles (CHLA) from 2014 to 2017 with a diagnosis of a retained foreign body in the esophagus removed by rigid or flexible esophagoscopy. Sociodemographic information including zip code of residence was extracted and analyzed with Chi-square, Fisher's exact test, and multivariable logistic regression. RESULTS The average age of patients with a retained esophageal foreign body in this study was 2.5 years old, 52.3% were male, 91.4% had no past medical history, 53.1% were Hispanic, 82.0% had public health insurance, and 63.3% were transfers from an outside hospital. The most common foreign body removed was a coin. There were no significant differences in gender, race, type of health insurance, or income between patients that lived within 10 miles of CHLA versus farther than 10 miles. On multivariable analysis, zip codes with a high volume of esophageal foreign bodies were more likely to be lower income neighborhoods. Gender, race, type of health insurance, and distance from CHLA were not risk factors for zip codes with a high volume of esophageal foreign bodies. CONCLUSION Geographic areas in the greater Los Angeles community with a high volume of retained esophageal foreign bodies requiring endoscopic removal at our institution are associated with lower income neighborhoods. Further studies should be performed to better understand health disparities within the U.S. pediatric esophageal foreign body population.
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Affiliation(s)
- Kevin Hur
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Varun Angajala
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dennis Maceri
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Otolaryngology - Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Christian Hochstim
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Otolaryngology - Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
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265
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Cole S, Lerner D. Caustic Ingestions in Children. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0156-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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266
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267
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Bowel obstruction due to ingestion of a water-absorbing bead. Arch Pediatr 2018; 25:136-138. [DOI: 10.1016/j.arcped.2017.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/12/2017] [Accepted: 12/10/2017] [Indexed: 01/08/2023]
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268
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Yeh HY, Chao HC, Chen SY, Chen CC, Lai MW. Analysis of Radiopaque Gastrointestinal Foreign Bodies Expelled by Spontaneous Passage in Children: A 15-Year Single-Center Study. Front Pediatr 2018; 6:172. [PMID: 29946536 PMCID: PMC6006757 DOI: 10.3389/fped.2018.00172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/24/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Most ingested foreign bodies (FBs) pass spontaneously through the gastrointestinal (GI) tract, but only limited data on transit time are available. We evaluated the relationship of FB size and shape with transit time. Methods: We retrospectively reviewed medical records collected over 15 years (January 2001 to December 2015) on pediatric patients with radiopaque FBs in the GI tract. We categorized the FBs as regularly (round or spherical) or irregularly shaped (ovoid, long, flake-like, or projecting) and measured their sizes radiographically. The diameter of regularly shaped FBs and the length of irregularly shaped FBs were correlated with transit time. Results: In total, 484 patients with GI FBs were surveyed, and 267 (55.1%) FBs were radiopaque. Among the 267 radiopaque FBs, 88 (33.1%) required endoscopic removal and 7 (2.6%) underwent surgical intervention. Eighty-seven patients with single FBs in the GI tract for whom precise details of transit time were enrolled into the analysis of transit time; their mean age was 3.48 ± 2.21 years. Of the 87 FBs, 61 (70.1%) were regularly shaped, and 26 (29.9%) were irregularly shaped. The diameter of regularly shaped FBs was positively associated with transit time, as revealed by Mann-Whitney U test; diameters >1.5 and >2 cm were significantly correlated with longer transit times (both p = 0.003). A trend toward an increased transit time for long irregularly shaped FBs was also apparent; the p-values for lengths of 1.5, 2, and 2.5 cm were 0.824, 0.153, and 0.055, respectively. Under receiver operating characteristic (ROC) curve analysis, the optimal cutoff diameter for regularly shaped FBs, and length for irregularly shaped FBs, to predict a transit time of longer than 72 h were 1.95 and 2.25 cm, respectively. Conclusions: The passage rate of ingested radiopaque FBs is 64.4%. Small FBs that have passed the duodenal curve should be managed conservatively via clinical observation and radiographic surveillance. Our results indicate that the larger an FB is, the longer the transit time will be.
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Affiliation(s)
- Hung-Yu Yeh
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Yen Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Chang Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Wei Lai
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Safety and Efficacy of the Push Endoscopic Technique in the Management of Esophageal Food Bolus Impactions in Children. J Pediatr Gastroenterol Nutr 2018; 66:e1-e5. [PMID: 28604510 DOI: 10.1097/mpg.0000000000001639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Adult-based guidelines support the use of the pull (extraction) endoscopic technique in managing esophageal food bolus impactions (FBIs) but allow the consideration of the push (advancement) technique with caution based on available published literature. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines mention the use of gentle endoscopic pushing for disimpaction but elaborate that this technique has not been studied in children. Our study aimed at assessing the safety and efficacy of the push technique in managing pediatric esophageal FBIs. METHODS This was a retrospective cohort study of all pediatric patients presenting with esophageal FBIs to a pediatric tertiary care center from 2003 to 2016. RESULTS Two hundred forty-two procedures for esophageal foreign body removal were reviewed. Thirty-nine procedures for managing esophageal FBIs were included in a total of 23 patients (1-4 procedures per patient). The most common underlying diagnoses were eosinophilic esophagitis and repaired tracheoesophageal fistula. The cohort had a median age of 8 years and median weight of 34.4 kg. Initial endoscopic disimpaction methods included 20 push and 19 pull technique attempts with success rates of 65% and 68%, respectively (P = 1.0). Unsuccessful attempts using 1 technique were successfully accomplished using the other technique. Patients initially managed by either of the 2 disimpaction techniques did not differ in age, weight, sex, or underlying diagnoses. No procedure-related complications were reported at our center. CONCLUSION The present study shows that the push technique is as safe and effective as the pull technique in managing esophageal FBIs in pediatric patients.
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270
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Krom H, Visser M, Hulst JM, Wolters VM, Van den Neucker AM, de Meij T, van der Doef HPJ, Norbruis OF, Benninga MA, Smit MJM, Kindermann A. Serious complications after button battery ingestion in children. Eur J Pediatr 2018; 177:1063-1070. [PMID: 29717359 PMCID: PMC5997112 DOI: 10.1007/s00431-018-3154-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 01/08/2023]
Abstract
UNLABELLED Serious and fatal complications after button battery ingestion are increasing worldwide. The aim of this study is to describe serious complications after battery ingestion in children in the Netherlands.All pediatric gastroenterologists in the Netherlands performing upper endoscopies were asked to report all serious complications after battery ingestion in children (0-18 years) between 2008 and 2016 retrospectively.Sixteen serious complications were reported: death after massive bleeding through esophageal-aortal fistula (n = 1), esophageal-tracheal fistula (n = 5), stenosis after (suspected) perforation and mediastinitis (n = 5), (suspected) perforation and mediastinitis (n = 3), vocal cord paralysis (n = 1), and required reintubation for dyspnea and stridor (n = 1). The median time interval between ingestion and presentation was 5 (IQR 2-258) h. All children were ≤ 5 (median 1.4; IQR 0.9-2.1) years. Vomiting (31.3%), swallowing/feeding problems (31.3%), and fever (31.3%) were the most common presenting symptoms; however, 18.8% of the patients were asymptomatic (n = 1 missing). All batteries were button batteries (75% ≥ 20 mm; 18.8% < 20 mm; n = 1 missing). The batteries were removed by esophagogastroduodenoscopy (50%) and rigid endoscopy (37.5%) or surgically (12.5%). CONCLUSION Sixteen serious complications occurred after small and large button batteries ingestion between 2008 and 2016 in both symptomatic and asymptomatic children in the Netherlands. Therefore, immediate intervention after (suspected) button battery ingestion is required. What is Known: • Button battery ingestion may result in serious and fatal complications. • Serious and fatal complications after button battery ingestion are increasing worldwide. What is New: • Sixteen serious complications after button battery ingestion occurred during 2008-2016 in children in the Netherlands. • Serious complications were also caused by small batteries (< 20 mm) in the Netherlands and also occurred in asymptomatic Dutch children.
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Affiliation(s)
- Hilde Krom
- Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands.
| | - Margot Visser
- Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Jessie M. Hulst
- Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Victorien M. Wolters
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Tim de Meij
- VU University Medical Center, Amsterdam, Netherlands
| | | | | | - Marc A. Benninga
- Emma Children’s Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - Margot J. M. Smit
- Juliana Children’s Hospital, Haga Teaching Hospital, Den Haag, Netherlands
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271
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Semple T, Calder AD, Ramaswamy M, McHugh K. Button battery ingestion in children-a potentially catastrophic event of which all radiologists must be aware. Br J Radiol 2018; 91:20160781. [PMID: 28830198 PMCID: PMC5966199 DOI: 10.1259/bjr.20160781] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 08/07/2017] [Accepted: 08/12/2017] [Indexed: 12/26/2022] Open
Abstract
Foreign body ingestion is common in infants and young children and can cause numerous complications, mainly if ingested and left in place for prolonged periods. In recent years, particular dangers, specifically from ingested button batteries, have become increasingly recognized as a public health issue. Of particular note is the rapid onset of full thickness burns and oesophageal perforation which may occur within as little as 2 h following the ingestion of button batteries. The aim of this review is twofold: (1) to increase awareness of the need for rapid action from radiologists, emergency care physicians and paediatricians on identifying a button battery impacted within the oesophagus, and (2) to review the imaging appearances that can distinguish button batteries from other similar appearing foreign bodies, most notably coins.
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Affiliation(s)
| | | | | | - Kieran McHugh
- Radiology Department, Great Ormond Street Hospital, London, UK
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272
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Abstract
Nonpharmaceutical household products are the most common substances involved in exploratory ingestions in young children. Fortunately, most of these products are not toxic if ingested in small volumes. However, there are several household products that have the potential to cause significant toxicity and, rarely, fatalities in young children. Key products reviewed in this article include alcohols, button batteries, corrosive cleaning products, laundry detergent pods, hydrocarbons, and magnets. [Pediatr Ann. 2017;46(12):e449-e453.].
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273
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Lee VR, Connolly M, Calello DP. Pediatric Poisoning by Ingestion: Developmental Overview and Synopsis of National Trends. Pediatr Ann 2017; 46:e443-e448. [PMID: 29227519 DOI: 10.3928/19382359-20171121-01] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The American Association of Poison Control Centers' National Poison Data Surveillance System provides real-time toxico-surveillance and epidemiologic trends, and pediatric ingestions comprise most of those reports. The sequences in social and physical developmental milestones from young childhood to adolescence reveal the vulnerability of these age groups to a wide variety of potential poisonous ingestions. Most pediatric ingestions are exploratory. Some common agents associated with pediatric fatalities include disc batteries, laundry detergent "pods," opioid analgesics, acetaminophen, benzodiazepines, and amphetamines. The pediatric provider can be a valuable resource at all points throughout a child's life, offering anticipatory guidance to caregivers targeting developmental changes associated with poisonous ingestions. [Pediatr Ann. 2017;46(12):e443-e448.].
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274
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275
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The anesthetic management of button battery ingestion in children. Can J Anaesth 2017; 65:309-318. [DOI: 10.1007/s12630-017-1023-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/25/2017] [Accepted: 10/02/2017] [Indexed: 01/08/2023] Open
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276
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Panuganti BA, Brigger MT. Foxtail Ingestion in an Asymptomatic Child: A True Emergency? Otolaryngol Head Neck Surg 2017; 158:395-396. [PMID: 29110568 DOI: 10.1177/0194599817742136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Bharat A Panuganti
- 1 Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
| | - Matthew T Brigger
- 2 Division of Pediatric Otolaryngology, Rady Children's Hospital-San Diego; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, USA
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277
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Haßkamp P, Blomeyer S, Mattheis S, Lang S, Lehnerdt G. Fremdkörperingestion: Knopfbatterien im Bereich der oberen Ösophagusenge. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0255-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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278
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Holland AJ, Soundappan SS. Trauma hazards in children: An update for the busy clinician. J Paediatr Child Health 2017; 53:1096-1100. [PMID: 28665528 DOI: 10.1111/jpc.13603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/17/2017] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Andrew Ja Holland
- Douglas Cohen Department of Paediatric Surgery, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Soundappan Sv Soundappan
- Douglas Cohen Department of Paediatric Surgery, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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279
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Shi WS, Su ZY, Wei CY, Chen XF, Liu SS, Fu X, Liu DL, Cui GH. Clinical features and standardized diagnosis and treatment of esophageal foreign bodies. Shijie Huaren Xiaohua Zazhi 2017; 25:2721-2730. [DOI: 10.11569/wcjd.v25.i30.2721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To summarize the clinical characteristics of esophageal foreign bodies and to explore their standardized diagnosis and treatment.
METHODS This retrospective study was conducted at our hospital from July 2011 to July 2017, and we reviewed the clinical data for 1190 patients with esophageal foreign bodies with regard to their sex, age, department patients first visited, treatment time, type, incarcerated site, treatment plan, and length of hospital stay.
RESULTS Of 1190 patients included, 568 were male and 622 were female, with a male-to-female ratio of 1.0:1.1. They aged from 2 mo to 99 years (mean, 45 years ± 28.44 years), with a median age of 54 years; 293 (24.6%) patients were under 15 years, 293 (24.6%) were between 15 and 55 years, and 604 (50.8%) over 55 years. Otolaryngology and head surgery department was the most first-visited department (966, 81.2%), followed by gastroenterology department (138, 11.6%), thoracic surgery department (46, 3.4%), and others (40, 3.4%). There were 716 (60.2%) patients who visited hospital within 24 h, 126 (10.6%) in 24 to 72 h, and 348 (29.2%) over 72 h. The foreign bodies were plant-based in 448 (37.6%) patients, animal-based in 403 (33.9%), metallic in 200 (16.8%), and composite material-based in 139 (11.7%), with jujube pits, chicken bones, and coins accounting for 62.9% (750 patients) of all cases. The foreign bodies were most commonly located in the upper orifice of the esophagus (827, 69.5%), followed by the upper part (245, 20.6%), the middle and lower parts (94, 7.8%), and others (25, 2.1%). We treated 1088 (91.4%) patients by endoscopy and 41 (3.4%) by surgery. The duration of hospitalization ranged from 1 to 71 d (median, 5 d; mean, 5.9 d ± 4.9 d).
CONCLUSION Esophageal foreign bodies most commonly occur in the upper orifice of the esophagus. Standardized diagnosis and treatment are important. Esophageal foreign bodies should be taken out within 24 h. Timely correction of water and electrolyte disturbance, effective antibiotic therapy, high nutrition support, and temporary esophageal, if necessary, are beneficial to the patient's recovery.
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Affiliation(s)
- Wen-Song Shi
- Dong-Lei Lie, Guang-Hui Cui, Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, He'nan Province, China
| | - Zheng-Yan Su
- Department of Gastroenterology, General Hospital of Tianjin Medical University, Tianjin 300000, China
| | - Chuang-Ye Wei
- Dong-Lei Lie, Guang-Hui Cui, Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, He'nan Province, China
| | - Xiao-Fang Chen
- Dong-Lei Lie, Guang-Hui Cui, Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, He'nan Province, China
| | - Shuai-Shuai Liu
- Dong-Lei Lie, Guang-Hui Cui, Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, He'nan Province, China
| | - Xiao Fu
- Dong-Lei Lie, Guang-Hui Cui, Department of Thoracic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, He'nan Province, China
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280
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Lee EJ, Yang HR, Cho JM, Ko JS, Moon JS. Two Cases of Colonoscopic Retrieval of a Foreign Body in Children: A Button Battery and an Open Safety Pin. Pediatr Gastroenterol Hepatol Nutr 2017; 20:204-209. [PMID: 29026738 PMCID: PMC5636938 DOI: 10.5223/pghn.2017.20.3.204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 12/15/2022] Open
Abstract
Ingestion of foreign body in children is a relatively common problem among paediatric population. The foreign bodies mostly pass spontaneously through the gastrointestinal tract. However, complications can occur according to its anatomical location, the characteristics of the foreign body, and delays in management. Although the cases of ingested button batteries or sharp objects impacted at the gastrointestinal tract can be very serious, there have been very only a few cases have reported colonoscopic removal of these dangerous foreign bodies in adults, and there have been no case reports in children. We report one case of a button battery and one case of an open safety pin, both impacted in the terminal ileum that had moved from the stomach within a few hours of ingestion and were eventually managed by colonoscopy without any complications.
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Affiliation(s)
- Eun Joo Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Min Cho
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Sung Ko
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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281
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Bradford V, Vadi M, Carter H. Diagnosis and Management of a Postpyloric Foreign Body Causing Small Bowel Obstruction in an Infant. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2017; 10:1179547617719249. [PMID: 35185346 PMCID: PMC8848043 DOI: 10.1177/1179547617719249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/04/2017] [Indexed: 12/27/2022]
Abstract
Foreign body ingestion is a common occurrence in the pediatric population and most ingestions resolve with little morbidity. Although radiopaque objects are easily identified on biplane radiographs, radiolucent objects may elude detection, delaying diagnosis. We report a case of a healthy 10-month-old infant who presented with a 5-day history of postprandial vomiting and imaging consistent with small bowel obstruction. On exploratory laparotomy, she was discovered to have a postpyloric foreign body requiring removal through an enterotomy.
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Affiliation(s)
- Victoria Bradford
- Division of Pediatric Anesthesiology, Department of Anesthesiology and Critical Care Medicine, University of New Mexico Children’s Hospital, Albuquerque, NM, USA
| | - Marissa Vadi
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
- Department of Anesthesiology, Loma Linda University, Loma Linda, CA, USA
| | - Harmony Carter
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
- Department of Anesthesiology, Loma Linda University, Loma Linda, CA, USA
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282
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Quality Improvement in Pediatric Endoscopy: A Clinical Report From the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr 2017. [PMID: 28644360 DOI: 10.1097/mpg.0000000000001592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The current era of healthcare reform emphasizes the provision of effective, safe, equitable, high-quality, and cost-effective care. Within the realm of gastrointestinal endoscopy in adults, renewed efforts are in place to accurately define and measure quality indicators across the spectrum of endoscopic care. In pediatrics, however, this movement has been less-defined and lacks much of the evidence-base that supports these initiatives in adult care. A need, therefore, exists to help define quality metrics tailored to pediatric practice and provide a toolbox for the development of robust quality improvement (QI) programs within pediatric endoscopy units. Use of uniform standards of quality reporting across centers will ensure that data can be compared and compiled on an international level to help guide QI initiatives and inform patients and their caregivers of the true risks and benefits of endoscopy. This report is intended to provide pediatric gastroenterologists with a framework for the development and implementation of endoscopy QI programs within their own centers, based on available evidence and expert opinion from the members of the NASPGHAN Endoscopy Committee. This clinical report will require expansion as further research pertaining to endoscopic quality in pediatrics is published.
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283
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Dalrymple RA, Berry K, Jester I. A Sharp Lesson: Duodenal Perforation 2 Months after Ingestion of a Pin. J Indian Assoc Pediatr Surg 2017; 22:179-180. [PMID: 28694580 PMCID: PMC5473309 DOI: 10.4103/jiaps.jiaps_250_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 11-year-old female child presented 2 months after accidentally swallowing her hijab pin, with right-sided abdominal pain. An X-ray showed that the pin was located in her right upper quadrant, and at laparoscopy, it was found to have eroded through her duodenum into her liver. Ingested pins should always be removed if not passed spontaneously within the first few days.
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Affiliation(s)
- Rebecca Amy Dalrymple
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow, G51 4TF, UK
| | - Kathleen Berry
- Department of Emergency, Birmingham Children's Hospital, Birmingham, B4 6NH, UK
| | - Ingo Jester
- Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, B4 6NH, UK
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284
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Pogorelić Z, Borić M, Markić J, Jukić M, Grandić L. A Case of 2-Year-Old Child with Entero-Enteric Fistula Following Ingestion of 25 Magnets. ACTA MEDICA (HRADEC KRÁLOVÉ) 2017; 59:140-142. [PMID: 28440218 DOI: 10.14712/18059694.2017.42] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Magnet ingestion usually does not cause serious complications, but in case of multiple magnet ingestion or ingestion of magnet with other metal it could cause intestinal obstruction, fistula formation or even perforation. CASE REPORT We report case of intestinal obstruction and fistula formation following ingestion of 25 magnets in a 2-year-old girl. Intraoperatively omega shaped intestinal loop with fistula caused by two magnetic balls was found. Intestine trapped with magnetic balls was edematous and inflamed. Resection of intestinal segment was performed, followed by entero-enteric anastomosis. A total of 25 magnets were removed from resected intestine. CONCLUSION Single magnet ingestion is treated as non-magnetic foreign body. Multiple magnet ingestion should be closely monitored and surgical approach could be the best option to prevent or to cure its complications.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, Split University Hospital and University of Split, School of Medicine, Split, Croatia.
| | - Matija Borić
- Department of Surgery, Split University Hospital and University of Split, School of Medicine, Split, Croatia
| | - Joško Markić
- Department of Pediatrics, Split University Hospital and University of Split, School of Medicine, Split, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, Split University Hospital and University of Split, School of Medicine, Split, Croatia
| | - Leo Grandić
- Department of Surgery, Split University Hospital and University of Split, School of Medicine, Split, Croatia
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285
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Abstract
Children inevitably swallow foreign material accidentally or intentionally. Each type of ingestion carries their own set of risks and complications, short and long term, some requiring immediate attention while others close monitoring. Alkalotic household cleaning products and lithium button batteries are increasingly common and damage the esophagus quickly. While many toys with rare-earth metals are banned, they are already present in many households and can cause necrosis of bowel that is between the magnets. This article reviews the incidence and assessment along with current literature to provide guidelines for management of pediatric patients with suspected caustic or foreign body ingestion.
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Affiliation(s)
- Jacob A Kurowski
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, 9500 Euclid Avenue, Dept A111, Cleveland, OH 44195-0001, USA.
| | - Marsha Kay
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, 9500 Euclid Avenue, Dept A111, Cleveland, OH 44195-0001, USA
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286
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Abstract
BACKGROUND AND STUDY AIMS Accidental swallowing of hijab (or turban) pin was reported mainly among adolescent girls. Current guidelines indicate emergent intervention endoscopy in case a long sharp object is found in the gastrointestinal tract. The aims of the current study are to present the results of an observational approach and to assess the need for intervention. PATIENTS AND METHODS A retrospective cohort study was conducted including all 5-18-year-old patients who presented with hijab-pin ingestion between 2003 and 2014. The need for intervention was assessed using both univariable and multivariable statistical analyses. RESULTS Two hundred three cases of hijab-pin ingestion were documented. In the majority of cases, the pin was observed in the stomach (137/203, 67.4%) upon arrival. Most pins that were located at the upper gastrointestinal tract (proximal to the ligament of Treitz) ejected spontaneously (120/169, 71%, Pv = 0.005). The absence of pin progression in an X-ray performed 12 h following presentation was significantly more frequent in the intervention group (46/51, 90%, Pv = 0.001). CONCLUSIONS In most cases, the outcome is spontaneous ejection from the digestive tract. However, if needle location remains unchanged on two consecutive X-rays, an endoscopic intervention is recommended.
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287
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Abstract
There is a broad clinical spectrum of gastrointestinal bleeding in children, ranging from subtle laboratory findings to dramatic clinical presentations. This review provides a framework for the evaluation and management of gastrointestinal hemorrhage for pediatricians. It outlines strategies for obtaining a tailored patient history and conducting a thorough physical examination that can shed light on the location, severity, and likely etiology of bleeding. It appraises blood tests, radiologic tools, and endoscopic modalities frequently used to identify and control a source of bleeding.
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Affiliation(s)
- Anita K Pai
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Victor L Fox
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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288
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Merchant S, Stringel G, Rosencrantz RA. Intragastric Fistula After Multiple Sphere Magnet Ingestion. Clin Gastroenterol Hepatol 2017; 15:e105-e106. [PMID: 27816757 DOI: 10.1016/j.cgh.2016.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Sana Merchant
- Section of Gastroenterology and Hepatobiliary Diseases, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York
| | - Gustavo Stringel
- Department of Pediatric Surgery, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York
| | - Richard A Rosencrantz
- Section of Gastroenterology and Hepatobiliary Diseases, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York
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289
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Open safety pin ingestion: A pediatric case: Can it be spontaneously eliminated or not? MARMARA MEDICAL JOURNAL 2017. [DOI: 10.5472/marumj.344831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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290
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Kodituwakku R, Palmer S, Prosad Paul S. Management of foreign body ingestions in children: button batteries and magnets. ACTA ACUST UNITED AC 2017; 26:456-461. [DOI: 10.12968/bjon.2017.26.8.456] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Ronan Kodituwakku
- Trainee Physician Associate, Peninsula College of Medicine and Dentistry, Plymouth
| | - Sarah Palmer
- Paediatric Sister in Emergency Department, Yeovil District Hospital, Yeovil
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291
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Shakir AK, Ramji F, El Halabi I. Penny for Your Thoughts; A Coin in the Stomach: Why Did It Get Stuck? Hosp Pediatr 2017; 7:294-296. [PMID: 28400420 DOI: 10.1542/hpeds.2016-0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Asiya K Shakir
- Section of Pediatric Gastroenterology, Department of Pediatrics, and
| | - Faridali Ramji
- Section of Pediatric Imaging, Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Issam El Halabi
- Section of Pediatric Gastroenterology, Department of Pediatrics, and
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292
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Chessman R, Verkerk M, Hewitt R, Eze N. Delayed presentation of button battery ingestion: a devastating complication. BMJ Case Rep 2017; 2017:bcr-2017-219331. [PMID: 28385909 DOI: 10.1136/bcr-2017-219331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 12-month-old child presented with a prolonged history of fever, cough and difficulty breathing, which was initially treated as bronchiolitis. She was discharged but presented again to Accident and Emergency department 4 days later with worsening symptom. Following deterioration in the Emergency department, a chest X-ray revealed a button battery in the upper oesophagus. Emergency oesophagoscopy was performed where a 20 mm button battery was removed and a tracheoesophageal fistula was seen 12 mm above the carina. Near total oesophagectomy, cervical oesophagostomy and gastrostomy were performed with a patch repair of the trachea, followed by a bioabsorbable tracheal stent. The patient spent a prolonged period of time in intensive care and was treated with intravenous antibiotics for mediastinitis. This case highlights the difficulty in diagnosis of button batteries when there is no clear history and the devastating consequences of prolonged exposure.
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Affiliation(s)
| | | | - Richard Hewitt
- ENT Head and Neck Surgery, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Nneka Eze
- Department of ENT, St George's Hospital London, London, UK
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293
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Akingbola O, Singh D, Blecker U. Movement Disorder Associated With Foreign Body Ingestion. Pediatrics 2017; 139:peds.2016-1967. [PMID: 28298482 DOI: 10.1542/peds.2016-1967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2016] [Indexed: 11/24/2022] Open
Abstract
We present a case of recurrent bouts of irritability with arching, head extension, and lethargy in a previously healthy 10-month-old girl admitted to the PICU for acute onset of a movement disorder. The patient's vital signs and physical examination were unremarkable but recurrent bouts of abnormal movements persisted for the first 10 hours of admission in the PICU. Possible diagnoses, such as meningitis, status epilepticus, space occupying lesions, and toxic ingestions, were ruled out because of negative cerebrospinal fluid analysis, normal EEG, and negative results of other ancillary tests. On the second day of admission, an abdominal radiograph was obtained because intussusception was considered a probable diagnosis due to recurrent episodes of arching and lethargy. The abdominal radiograph revealed the presence of a 15-mm radiopaque foreign body in the right lower quadrant corresponding to the anatomic location of the ileocecal valve. The patient made an uneventful recovery after she spontaneously passed a 1.5 cm by 1 cm rock (15 mm) in her stool on the third day of admission. This case highlights the need for a high index of suspicion for unwitnessed ingestion of a foreign body in a previously healthy preschool child with sudden onset of a movement disorder.
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Affiliation(s)
- Olugbenga Akingbola
- Department of Pediatrics, Tulane Lakeside Hospital for Women and Children, Metairie, Louisiana
| | - Dinesh Singh
- Department of Pediatrics, Tulane Lakeside Hospital for Women and Children, Metairie, Louisiana
| | - Uwe Blecker
- Department of Pediatrics, Tulane Lakeside Hospital for Women and Children, Metairie, Louisiana
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294
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Mason J, Sacchetti A, Herbert M, Jhun P. Just How Good Are Handheld Metal Detectors for Ingested Foreign Bodies? Ann Emerg Med 2017; 69:516-518. [DOI: 10.1016/j.annemergmed.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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295
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Abstract
RATIONALE FOR THIS CASE REPORT Many children are hospitalized because of foreign body ingestion. In such circumstances, the gastroenterologist must consider the timing of ingestion; the size, type, and location of the object ingested; and the patient's symptoms. But appendiceal foreign body in infant is very rare. PATIENT CONCERNS A 12-month-old boy visited because of swallowing small objects 2 weeks ago. Three small beads were found in the right lower quadrant on abdominal radiography. A 7-year-old boy was admitted for treatment of appendiceal foreign body, which was detected by accident 3 months ago. DIAGNOSES, INTERVENTIONS, AND OUTCOMES A 7-year-old boy had abdominal pain and underwent immediate appendectomy. However, the 12-month-old child was asymptomatic, which led to deliberation in regard to wait time for an appendectomy in younger children with asymptomatic appendiceal foreign body. He underwent prophylactic appendectomy after 2 months. MAIN LESSONS An appendiceal foreign body is very rare in infant and there are currently no treatment guidelines. We report 2 cases of appendiceal foreign body including infant who gave us difficult decisions.
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Affiliation(s)
- Min Lee
- Department of Pediatrics, Chonbuk National University Medical School and Hospital, Research Institute of Clinical Medicine of Chonbuk National University - Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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296
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Imaging button battery ingestions and insertions in children: a 15-year single-center review. Pediatr Radiol 2017; 47:178-185. [PMID: 27878583 DOI: 10.1007/s00247-016-3751-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/08/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Recent studies have shown an increase in morbidity associated with button battery ingestions in children. OBJECTIVE To perform a comprehensive, imaging-focused review of all patients with confirmed button battery ingestions/insertions imaged at our institution in the last 15 years. MATERIALS AND METHODS Radiology reports from Jan. 1, 2000, to July 12, 2015, were searched for the terms "battery" and "batteries." Confirmed cases of battery ingestion/insertion for which images were available were reviewed. Cases were reviewed for imaging studies performed, imaging findings, patient demographics, clinical history and management. Two pediatric gastroenterologists reviewed endoscopic images and graded mucosal injuries in selected cases. RESULTS Two hundred seventy-six cases were reviewed. All patients were imaged with radiography, 19 with fluoroscopy (6.8%), and 4 with CT (1.4%). Batteries retained in the esophagus (n = 27, 9.8%) were larger in diameter on average than those that had passed distally (22.1 ± 3.3 mm vs. 13.7 ± 1.6 mm, P<0.0001). Battery diameter ≥20 mm was associated with esophageal impaction (P<0.0001) and higher grade esophageal injury (P<0.0001). Mean battery diameter was greater for patients with grade 1 or higher mucosal injury than for patients with no mucosal injury (22.1 ± 2.1 mm vs. 14.7 ± 4.5 mm, P<0.0001). Sixteen percent (4/25) of patients with grade ≥1 esophageal injury had batteries in the stomach on initial imaging. Five patients (1.8%) had serious clinical complications (e.g., esophageal perforation, tracheoesophageal fistula). CONCLUSION Button batteries >20mm in diameter warrant increased clinical scrutiny due to higher likelihood and severity of injury. Implementation of recent pediatric gastroenterology societal guidelines will likely lead to a substantial increase in the number of CT and MRI examinations.
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297
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Airway Complications from an Esophageal Foreign Body. Case Rep Pulmonol 2017; 2016:3403952. [PMID: 28058124 PMCID: PMC5183758 DOI: 10.1155/2016/3403952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/20/2016] [Accepted: 11/06/2016] [Indexed: 02/05/2023] Open
Abstract
Introduction. Foreign body impaction (FBI) in the esophagus can be a serious condition, which can have a high mortality among children and adults, if appropriate diagnosis and treatment are not instituted urgently. 80–90% of all foreign bodies trapped in the esophagus usually pass spontaneously through the digestive tract, without any medical or surgical intervention. 10–20% of them will need an endoscopic intervention. Case Report. We hereby present a case of a large chicken piece foreign body impaction in the esophagus in a 25-year-old male with mental retardation. Patient developed hypoxemic respiratory failure requiring intubation. The removal required endoscopic intervention. Conclusions. Foreign bodies trapped in the upper gastrointestinal tract are a serious condition that can be fatal if they are not managed correctly. A correct diagnosis and treatment decrease the chances of complications. Endoscopic treatment remains the gold standard for extracting foreign body impaction.
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298
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Thomson M, Tringali A, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, Spaander M, Hassan C, Tzvinikos C, Ijsselstijn H, Viala J, Dall'Oglio L, Benninga M, Orel R, Vandenplas Y, Keil R, Romano C, Brownstone E, Hlava Š, Gerner P, Dolak W, Landi R, Huber WD, Everett S, Vecsei A, Aabakken L, Amil-Dias J, Zambelli A. Paediatric Gastrointestinal Endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy Guidelines. J Pediatr Gastroenterol Nutr 2017; 64:133-153. [PMID: 27622898 DOI: 10.1097/mpg.0000000000001408] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This guideline refers to infants, children, and adolescents ages 0 to 18 years. The areas covered include indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileocolonoscopy; endoscopy for foreign body ingestion; corrosive ingestion and stricture/stenosis endoscopic management; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangiopancreatography; and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease has been dealt with in other guidelines and are therefore not mentioned in this guideline. Training and ongoing skill maintenance are to be dealt with in an imminent sister publication to this.
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Affiliation(s)
- Mike Thomson
- *International Academy for Paediatric Endoscopy Training, Sheffield Children's Hospital, Weston Bank, Sheffield, UK †Digestive Endoscopy Unit, Catholic University, Rome, Italy ‡Gedyt Endoscopy Center, Buenos Aires, Argentina §Department of Pediatric Gastroenterology, Centro Hospitalar de São João, Porto, Portugal ||Department of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands ¶Department of Pediatric Gastroenterology and Nutrition, University Children's Hospital Basel, Basel, Switzerland #Department of Gastroenterology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands **Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy ††Department of Pediatric Gastroenterology, Alder Hey Children's Hospital, Liverpool, UK ‡‡Department of Pediatric Surgery and Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands §§Department of Pediatric Gastroenterology, Robert-Debré Hospital, Paris, France ||||Digestive Endoscopy and Surgery Unit, Bambino Gesù Children Hospital-IRCCS, Rome, Italy ¶¶Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia ##Pediatric Gastroenterology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium ***Department of Gastroenterology, Motol University Hospital, Prague, Czech Republic †††Department of Pediatrics, University of Messina, Messina, Italy ‡‡‡IV Medical Department, Rudolfstiftung Hospital, Vienna, Austria §§§Department of General Pediatrics, Children's Hospital Freiburg University, Freiburg, Germany ||||||Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria ¶¶¶Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK ###Department for Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Austria ****GI Endoscopy Unit, OUS, Rikshospitalet University Hospital, Oslo, Norway ††††Gastroenterology and Digestive Endoscopy Unit, Ospedale Nuovo Robbiani di Soresina, Soresina, Italy
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299
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Belsha D, Bremner R, Thomson M. Indications for gastrointestinal endoscopy in childhood. Arch Dis Child 2016; 101:1153-1160. [PMID: 27246069 DOI: 10.1136/archdischild-2014-306043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 04/18/2016] [Accepted: 05/02/2016] [Indexed: 12/11/2022]
Abstract
Endoscopic examination of the gastrointestinal tract (GIT) for diagnostics and therapy in children has evolved markedly over the last 20 or so years and is now usually undertaken by paediatric endoscopists. Updated diagnostic and management guidelines for common disorders including coeliac disease, gastro-oesophageal reflux disease, eosinophilic oesophagitis and inflammatory bowel disease highlight the central role of endoscopy. Therapeutic endoscopic approaches are also now widely available and further broaden the referral spectrum to include treatment of GIT bleeding, gastrostomy insertion, dilation of strictures and polypectomy. Lastly, the advent of newer technologies allows the examination of hitherto inaccessible areas of the GIT such as the mid-small bowel by wireless capsule video-endoscopy and enteroscopy. We summarise recent current practice and clinical guidelines, focussing on the key indications for referrals that are likely to require endoscopic assessment.
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Affiliation(s)
- D Belsha
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, UK
| | - R Bremner
- Centre for Paediatric Gastroenterology, Birmingham Children's Hospital, Birmingham, UK
| | - M Thomson
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, UK
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300
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Endoscopic Management of Foreign Bodies in the Gastrointestinal Tract: A Review of the Literature. Gastroenterol Res Pract 2016; 2016:8520767. [PMID: 27807447 PMCID: PMC5078654 DOI: 10.1155/2016/8520767] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/04/2016] [Indexed: 01/01/2023] Open
Abstract
Foreign body ingestion is a common diagnosis that presents in emergency departments throughout the world. Distinct foreign bodies predispose to particular locations of impaction in the gastrointestinal tract, commonly meat boluses in the esophagus above a preexisting esophageal stricture or ring in adults and coins in children. Several other groups are at high risk of foreign body impaction, mentally handicapped individuals or those with psychiatric illness, abusers of drugs or alcohol, and the geriatric population. Patients with foreign body ingestion typically present with odynophagia, dysphagia, sensation of having an object stuck, chest pain, and nausea/vomiting. The majority of foreign bodies pass through the digestive system spontaneously without causing any harm, symptoms, or necessitating any further intervention. A well-documented clinical history and thorough physical exam is critical in making the diagnosis, if additional modalities are needed, a CT scan and diagnostic endoscopy are generally the preferred modalities. Various tools can be used to remove foreign bodies, and endoscopic treatment is safe and effective if performed by a skilled endoscopist.
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