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Emeka CK, Chukwuebuka NO, Tochukwu EJ. Foreign body in the gastrointestinal tract in children: A tertiary hospital experience. Afr J Paediatr Surg 2023; 20:224-228. [PMID: 37470560 PMCID: PMC10450112 DOI: 10.4103/ajps.ajps_148_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 08/13/2021] [Accepted: 11/20/2021] [Indexed: 07/21/2023] Open
Abstract
Background Foreign body (FB) ingestion in the gastrointestinal tract (GIT) in children is common. Although most foreign bodies will pass spontaneously, surgical intervention is required when they fail to pass. Aims and Objectives The aim of this study was to evaluate our experience in the management of children who presented with FB in the GIT. Materials and Methods This was a retrospective study of children that underwent laparotomy for the removal of FB in the GIT at the paediatric surgery unit of Enugu State University Teaching Hospital, Enugu over a 10-year period. Results A total of 272 children presented with FB in the GIT during the study period, out of which 30 patients had laparotomy. This gave an operative incidence rate of 11%. There was a slight male predominance and the ages of the patients ranged from 6 months to 5 years (median 3 years). About half of the patients had no symptoms and all the patients were investigated with an abdominal radiograph. Only one-third of the patients had a predisposing factor that could have led to FB impaction. FB impaction was the most common indication for surgery, and enterotomy with FB removal was the most performed surgical procedure. The most common FB removed were tiny parts of toys, and the most common post-operative complication was surgical site infection. There was no mortality. Conclusion FB in GIT in children could be associated with complications that require surgical treatment. FB ingestion is preventable. Focus should be placed on caregivers preventing children from ingesting FB.
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Affiliation(s)
- Chukwubuike Kevin Emeka
- Department of Surgery, Paediatric Surgery Unit, Enugu State University Teaching Hospital, Enugu, Enugu State, Nigeria
| | | | - Enebe Joseph Tochukwu
- Department of Obstetrics and Gynecology, Enugu State University Teaching Hospital, Enugu, Enugu State, Nigeria
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Hu T, Zhang J, Liu Y, Chen L, Cen W, Wu W, Huang Q, Sun X, Stock S, Zippi M, Zimmer V, Basharat Z, Hong W. Evaluation of the risk factors for severe complications and surgery of intestinal foreign bodies in adults: a single-center experience with 180 cases. Gastroenterol Rep (Oxf) 2022; 10:goac036. [PMID: 35966628 PMCID: PMC9366183 DOI: 10.1093/gastro/goac036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/17/2022] [Accepted: 05/20/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Foreign bodies (FBs) lodged in the intestine or causing intestinal complications are uncommon in clinical practice but may pose diagnostic difficulties and prove life-threatening. This study aimed to evaluate the risk factors for severe complications and surgery to aid clinicians in the diagnosis and management of intestinal FBs. METHODS We performed a retrospective analysis of patients in whom FBs were lodged in the intestine or caused complications from 2010 to 2020 in the First Affiliated Hospital of Wenzhou Medical University (Zhejiang, China). The characteristics of the patients and FBs, symptoms, imaging findings, diagnostics, treatment strategies, and clinical outcomes were analysed. Furthermore, the risk factors for complications and surgery were investigated. RESULTS In total, 180 patients were included in our study. Most patients (76.1%) were unable to provide a history of ingestion. Bezoars were the most common FBs (35.6%). The FBs were mainly located in the duodenum (32.8%) and the ileum (27.8%). Surgical removal of FBs was successful in 89 (49.4%) patients and endoscopic removal in 54 (30.0%) patients. Eleven with perforations were treated conservatively. FBs located in the jejunum or ileum were more likely to cause severe complications than those located in the duodenum. FBs located in the jejunum, ileum, or sigmoid colon were more likely to undergo surgery, and severe complications were an independent risk factor for surgery. CONCLUSION Intestinal FBs, often localized in angulation, are likely to be misdiagnosed because most patients do not provide a history of FB ingestion. Surgery and endoscopic therapy are the most commonly used treatment modalities. Surgery is not mandatory in clinically stable patients with small and contained perforations. FBs located in the jejunum or ileum are risk factors for both complications and surgery.
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Affiliation(s)
| | | | | | - Lifang Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Wei Cen
- The First Clinical College, Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Wenzhi Wu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Qingke Huang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Xuecheng Sun
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P. R. China
| | - Simon Stock
- Department of Surgery, World Mate Emergency Hospital, Battambang, Cambodia
| | - Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
| | - Vincent Zimmer
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Zarrin Basharat
- Jamil-ur-Rahman Center for Genome Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Wandong Hong
- Corresponding author. Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325025, Zhejiang, P. R. China. Tel: +86-577-88069817; Fax: +86-577-88069555; ;
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Duodenal dislodgement of an ingested sharp foreign body by mucosal unfolding "Gilan maneuver"; A novel surgical approach. Int J Surg Case Rep 2021; 90:106721. [PMID: 34968984 PMCID: PMC8717244 DOI: 10.1016/j.ijscr.2021.106721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/15/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance Foreign body (FB) ingestion is a common challenge for pediatric health care providers globally. Although endoscopic approach for FB extraction is recommended, surgery remains life giving specifically in developing countries. We presented a novel surgical approach called ‘Gilan maneuver’ for removal of FB which lodged in duodenal loop. Case presentation An eighteen months old male infant referred to emergency department while he lied on his mother's arm. Parents stated their son has ingested a sharp metallic pointy thick needle which applies for cattle injection. On examination mid epigastric tenderness was remarkable. Laboratory finding was normal. Plain thoracoabdominal radiologic study confirmed the diagnosis. Patient underwent explorative laparotomy and the needle was removed through ‘Gilan maneuver’ in which mucosal unfolding of duodenal loop facilitated dislodgement of the FB and it was extracted on the jujenal side. Clinical discussion Duodenal lodge of sharp FB is rare and could be masked by gastric deposition diagnosis. Mucosal folding, narrow luminal diameter, retroperitoneal adherence, and hard surgical anatomy of the duodenal loop make both sharp and large FBs spontaneous dislodgement and favorable surgical outcome relatively unanticipated. Conclusion Despite rarity of duodenal deposition of FB it is possible and could be harmful due to adjacent unforgiving organs. Although endoscopic extraction of FB is generally recommended in guidelines, surgical approach is safe and could be considered. Thick metazlic sharp needle ingestion although is rare, could lodge in duodenal mucosal fold. Mucosal unfolding of duodenum could safely dislodge foreign body and prevent major complication. Gilan maneuver facilitates intraluminal passage of foreign body by pyloric valve extraction and jujenal pulling gently.
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Gatto A, Capossela L, Ferretti S, Orlandi M, Pansini V, Curatola A, Chiaretti A. Foreign Body Ingestion in Children: Epidemiological, Clinical Features and Outcome in a Third Level Emergency Department. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121182. [PMID: 34943378 PMCID: PMC8700598 DOI: 10.3390/children8121182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/16/2022]
Abstract
Ingestion of foreign bodies is a frequent pediatric cause of access to the Emergency Department (ED). The aim of this study was to determine the epidemiological and clinical features of pediatric patients with a diagnosis of foreign body ingestion and to identify the factors associated with an urgent invasive procedure or hospitalization. This is a retrospective study conducted on a population of 286 pediatric patients (0-17 years) evaluated for foreign body ingestion at the Pediatric ED of "Fondazione Policlinico Universitario A. Gemelli, IRCSS" between October 2014 and June 2019. Data concerning age and gender, underlying diseases, type of foreign body, symptoms and signs, instrumental tests, specialist visits, treatment and outcome were analyzed. The majority of foreign bodies were coins (23%). Symptoms recurred in 50% of the foreign bodies with esophageal localization and between the 92 (32%) patients with symptoms the most common was vomiting (7%). X-rays was performed in 61% of patients. Among all patients, 253 patients (88.8%) had been discharged, 21 (7%) had been hospitalized, and four (1.4%) were sent to an outpatient facility. Besides, 17 (5.9%) patients had been transferred to the Observation Unit. Of the hospitalized patients (21 (7.3%)), clinical observation was performed for 57% and endoscopic procedure for 45%. Our data confirm that the ESPGHAN-ESGE guidelines application prevents interventions that are not necessary, avoiding diagnostic and therapeutic delays.
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Affiliation(s)
- Antonio Gatto
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Correspondence:
| | - Lavinia Capossela
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Serena Ferretti
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Michela Orlandi
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Valeria Pansini
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Antonietta Curatola
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Antonio Chiaretti
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
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Zhang S, Zhang L, Chen Q, Zhang Y, Cai D, Luo W, Chen K, Pan T, Gao Z. Management of magnetic foreign body ingestion in children. Medicine (Baltimore) 2021; 100:e24055. [PMID: 33466161 PMCID: PMC7808496 DOI: 10.1097/md.0000000000024055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
Magnetic foreign bodies ingestion is a special cause for attending emergency department. Here, we aim to analyze the characteristics and treatments of children who ingested magnetic foreign bodies (Buckyballs). Data were collected from children who ingested Buckyballs between February 2017 and October 2019. A retrospective analysis was performed to summarize the experiences of conservative treatment, gastroscopy and surgery when dealing with Buckyballs ingestion.A total of 49 patients with buckyballs ingestion were identified, of whom 11 underwent conservative treatments, 6 underwent gastroscopy, and 32 underwent surgery. Among such individuals, eight patients (72.7%) had a successful conservative treatment (number of Buckyballs [NB]: 3.5[IQR: 2.0-4.0]); four patients (66.7%) had Buckyballs successfully removed by gastroscopy (NB: 3.5[IQR: 3.0-5.5]); 16 asymptomatic (50%) patients (NB: 4.0[IQR: 3.0-8.0]) and 16 symptomatic (50%) patients (NB: 8.5 [IQR: 6.25-11.75]) received emergency surgery. Compared to patients who received conservative treatment, the number of ingested Buckyballs was significantly higher in patients who received surgery or gastroscopy (7.0 [IQR: 3.0-10.75] vs 3.5 [IQR: 2.0-4.0], P < .05). The risk of intestinal perforation was significantly higher in symptomatic patients (P < .05) compared to asymptomatic patients.Gastroscopy is recommended when Buckyballs are in the stomach or esophagus. In asymptomatic patients, conservative treatment can be considered for 4 to 6 days. Patients failing conservative treatment, or those who are symptomatic should undergo emergency surgery.
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Multiple magnet ingestion: Ring-like configuration with multiple intestinal fistulae. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Dias DDM, Amorim WWS, Rodriguez JER, Cauduro JF, Pena SP, Dias DS, Dias DI, Dias DL, Lima CSC, Cardoso TM. Bowel obstruction in entero-colic fistula associated with magnet ingestion in children at the Amazonas countryside. AME Case Rep 2019; 3:44. [PMID: 31872179 DOI: 10.21037/acr.2019.09.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/16/2019] [Indexed: 11/06/2022]
Abstract
Ingestion of small objects by children became worrisome as the number of cases increased over the years. Consequences such as intestinal obstruction or even infection of the gastrointestinal tract are becoming more frequent since even in majority cases there is having only an expectant conduct, complications can occur. Also, the combination of two elements such as punctiform metallic materials and imams cause fistula formation in loops with greater ease, granulomas in the intestines, perforation, and can progress to peritonitis or abscesses, as well as having considerable morbidity.
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Affiliation(s)
| | - Wolfram W S Amorim
- General Surgery Service at Getúlio Vargas Teaching Hospital (HUGV), Manaus, Amazonas, Brazil
| | - Juan E R Rodriguez
- Medical School of Federal University of Amazonas (UFAM), Manaus, Amazonas, Brazil
| | - Júlia F Cauduro
- Medical School of Federal University of Amazonas (UFAM), Manaus, Amazonas, Brazil
| | - Samuel P Pena
- Medical School of Federal University of Amazonas (UFAM), Manaus, Amazonas, Brazil
| | - Darlla S Dias
- Nilton Lins University (UNL), Manaus, Amazonas, Brazil
| | - Didney I Dias
- Nilton Lins University (UNL), Manaus, Amazonas, Brazil
| | - David L Dias
- Nilton Lins University (UNL), Manaus, Amazonas, Brazil
| | - Cinira S C Lima
- Pediatric Surgery Service of Institute of Children's Health of Amazonas (ICAM)-Avenina Codajás, Manaus, Amazonas, Brazil
| | - Tiago M Cardoso
- College of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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