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Paladin I, Mizdrak I, Gabelica M, Golec Parčina N, Mimica I, Batinović F. Foreign Bodies in Pediatric Otorhinolaryngology: A Review. Pediatr Rep 2024; 16:504-518. [PMID: 38921707 PMCID: PMC11207020 DOI: 10.3390/pediatric16020042] [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] [Received: 04/09/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024] Open
Abstract
Foreign bodies (FBs) in pediatric otorhinolaryngology represent up to 10% of cases in emergency departments (ED) and are primarily present in children under five years old. They are probably the result of children's curiosity and tendency to explore the environment. Aural and nasal FBs are the most common and accessible, and the removal methods differ depending on the exact location and type of FB, which can be organic or inorganic. A fish bone stuck in one of the palatine tonsils is the most common pharyngeal FB. Laryngopharyngeal FBs can obstruct the upper respiratory tract and thus become acutely life-threatening, requiring an urgent response. Aspiration of FBs is common in children between 1 and 4 years old. A history of coughing and choking is an indication of diagnostic and therapeutic methods to rule out or confirm a tracheobronchial FB. Regardless of the availability of radiological diagnostics, rigid bronchoscopy is the diagnostic and therapeutic method of choice in symptomatic cases. Radiological diagnostics are more significant in treating esophageal FBs since most are radiopaque. Flexible or rigid esophagoscopy is a successful method of removal. A delayed diagnosis, as with tracheobronchial FBs, can lead to fatal consequences.
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Affiliation(s)
- Ivan Paladin
- Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (I.M.); (M.G.); (N.G.P.); (F.B.)
| | - Ivan Mizdrak
- Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (I.M.); (M.G.); (N.G.P.); (F.B.)
| | - Mirko Gabelica
- Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (I.M.); (M.G.); (N.G.P.); (F.B.)
| | - Nikolina Golec Parčina
- Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (I.M.); (M.G.); (N.G.P.); (F.B.)
| | - Ivan Mimica
- Department of ENT, General Hospital Sibenik, 22000 Sibenik, Croatia;
| | - Franko Batinović
- Department of ENT and Head and Neck Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (I.M.); (M.G.); (N.G.P.); (F.B.)
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Jiang G, Wu L, Ruan W, Shao Q, Zhu J. Case Report: Perianal infection in children caused by ingested jujube pits: a report of two cases. Front Pediatr 2024; 12:1379689. [PMID: 38665377 PMCID: PMC11044676 DOI: 10.3389/fped.2024.1379689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Background The ingestion of jujube pits by children is a rare cause of perianal infection.This article aimed to report two cases of perianal infection in children resulting from the ingestion of jujube pits. Methods We reviewed the clinical records of perianal infection caused by jujube pits at our hospital. Details of the patients' presentation, imaging studies, complications and treatment were recorded. Results Both pediatric patients presented with perianal swelling and pain. The caregivers of both patients denied a history of jujube consumption. Magnetic resonance imaging (MRI) indicated the presence of jujube pits, which were subsequently removed during surgery. Postoperatively, both patients recovered well, and follow-up showed no recurrence or the formation of anal fistulas. Conclusion The ingestion of jujube pits leading to perianal infection is rare and inconspicuous. Early diagnosis and treatment are beneficial in preventing the occurrence of serious complications.
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Affiliation(s)
- Guoping Jiang
- Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, China
- School of Medicine, Ningbo University, Ningbo, China
| | - Lixu Wu
- Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, China
| | - Weiwei Ruan
- Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, China
| | - Qian Shao
- Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, China
| | - JianMing Zhu
- Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, China
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Marshall RD, Bailey J, Lin A, Sheridan DC, Hendrickson RG, Hughes A, Horowitz BZ. Impact of social media "challenges" on poison center case volume for intentional ingestions among school-aged children: an observational study. Clin Toxicol (Phila) 2024; 62:183-189. [PMID: 38587109 DOI: 10.1080/15563650.2024.2331064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Mental health problems among youth have escalated over the past decade, with increased rates of self-harm, including suicide attempts by ingestion. Social media use has been linked to youth mental health, including "challenges" urging youth to ingest substances for recreational and other purposes. We hypothesized that social media challenges for particular substances would temporally correspond with increased ingestions of these substances. METHODS We identified peak Google Trends search times for social media ingestion challenges involving diphenhydramine, laundry pods, nutmeg, and cinnamon, and used data from America's Poison Centers National Poison Data System to plot reported ingestions 3 months before and after peak searches in school-aged children. RESULTS There were 2,169 individuals in the analysis. Diphenhydramine was the most frequently reported ingestion for misuse/abuse and suicidal purposes (n = 266 and 1,609, respectively). For all ingestions together, 45 percent (n = 979) had a moderate health effect, and 6.35 percent (n = 137) had a major health effect. Time of peak searches corresponded with increased ingestions for each substance. DISCUSSION We found a temporal relationship between peak Google Trends searches for ingestion challenges and ingestions of that substance reported to United States poison centers. Compared to misuse/abuse ingestions, most suicidal ingestions peaked 1-2 months later, suggesting a public health opportunity for intervention. LIMITATIONS This retrospective observational study does not establish causal effect. All data are a result of self-reporting of the exposures, which may lead to a reporting bias. Google Trends is not the only search engine and likely underestimates the true incidence of social media posts. CONCLUSIONS Additional research is needed on the relationship between social media and youth mental health, particularly around "challenges" that place youths' health at risk. There may be opportunities for intervention to decrease medical and mental health sequelae of these challenges.
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Affiliation(s)
- Rebecca D Marshall
- Department of Psychiatry, OR Health & Science University, Portland, OR, USA
| | - Jessica Bailey
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Amber Lin
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - David C Sheridan
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Robert G Hendrickson
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Poison Center, Portland, OR, USA
| | - Adrienne Hughes
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Poison Center, Portland, OR, USA
| | - B Zane Horowitz
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Poison Center, Portland, OR, USA
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Kiefer A, Duppel U, Schützenmeier A, Lang T, Kittel J, Kabesch M, Kerzel S. Button Battery Ingestions cause the Majority of Severe Complications. KLINISCHE PADIATRIE 2023; 235:90-97. [PMID: 36758576 DOI: 10.1055/a-2007-1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Foreign body ingestion in children is a clinically important reason for presentation to the emergency department. The individual outcome ranges from benign spontaneous courses to severe complications. Fatal outcomes occur rarely and complications are related to patient's age as well as type and location of the foreign body. The aim of our present study was to evaluate the outcome of children and adolescents with foreign body ingestion with a focus on complications, which mainly occurred after button battery ingestion. METHODS We reviewed medical records of patients between 0 and 18 years of age who had presented to the paediatric emergency department of our hospital with suspected foreign body ingestion between January 2011 and March 2021 (123 months). Clinical, imaging, and endoscopic data as well as treatment modalities were analysed. RESULTS In the ten10 year period under review, a total of 1,162 children and adolescents (6 months - 18 years) presented to our emergency room with suspected foreign body ingestion. Among those, 398 ingestions (34%) could be verified radiologically and/or endoscopically, while in the remaining 764 cases (66%) the suspicion could not be confirmed. The majority of patients with verified ingestion (n=324; 81%) presented with ingestion of a metallic foreign body. We observed 55 cases with verified ingestion of a button battery. Five of these cases had severe complications, with a near-fatal course in two patients who developed an oesophageal-tracheal fistula. CONCLUSION In contrast to all other ingestions of foreign bodies in children, button battery ingestions lead to mucosal damage and severe complications in a significant number of children.
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Affiliation(s)
- Alexander Kiefer
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Uta Duppel
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Alexander Schützenmeier
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Thomas Lang
- Department of Paediatrics, Pediatric Gastroenterology, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Jochen Kittel
- Department of Paediatrics, Pediatric Gastroenterology, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Michael Kabesch
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Sebastian Kerzel
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
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Üner Ç, Tokur O, Aydın S, Gökharman FD. A Pediatric Right Lower Quadrant Pain Case. J Med Ultrasound 2023; 31:74-75. [PMID: 37180630 PMCID: PMC10173823 DOI: 10.4103/jmu.jmu_41_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/08/2021] [Accepted: 06/04/2021] [Indexed: 05/16/2023] Open
Affiliation(s)
- Çiğdem Üner
- Department of Radiology, Dr. Sami Ulus Training and Research Hospital, Ankara, Turkey
| | - Oğuzhan Tokur
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
- Address for correspondence: Dr. Oğuzhan Tokur, Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey. E-mail:
| | - Sonay Aydın
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
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Xu G, Chen YC, Chen J, Jia DS, Wu ZB, Li L. Management of oesophageal foreign bodies in children: a 10-year retrospective analysis from a tertiary care center. BMC Emerg Med 2022; 22:166. [PMID: 36195854 PMCID: PMC9533606 DOI: 10.1186/s12873-022-00723-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Oesophageal foreign bodies (EFBs) are a common emergency issue in paediatrics, and few studies have revealed its clinical features and treatment methods. We conducted this retrospective study to provide our 10-year clinical evidence for the diagnosis and treatment of EFB and reduce the incidence of complications. METHODS We retrospectively reviewed all paediatric cases diagnosed with EFB from January 2012 to December 2021 at Shenzhen Children's Hospital. The age and sex of the patients, types of foreign bodies (FBs), preoperative examination, location and duration of FB impaction, clinical symptoms, surgical methods, therapeutic effects and complications were analysed. RESULTS Among the 1355 cases, 759 were boys and 596 were girls, with a median age of 2.9 years (4 months to 16 years). The shortest FB lodged time was 1 hour, while the longest time was 3 months. The types of foreign bodies included coins and blunt objects (812,59.9%), bones and sharp objects (278,20.5%), button batteries (86,6.3%), food impactions (84,6.2%), toys (51,3.8%) and plastic objects (44,3.2%). A total of 720 of 812 cases impacted by coins and blunt subjects were successfully treated with a Foley catheter without any complications. A total of 558 patients underwent rigid oesophageal endoscopy under general anaesthesia, and foreign bodies were successfully removed in 525 cases. No FB was found in 33 cases, and FBs pushed into the lower digestive tract during operation in 5 cases. Oesophageal injury was found in 130 cases (23.3%). Our study showed that the age of the patient, time of foreign body incarceration, type of foreign body, location of the lodged foreign body, and fever or cough were risk factors leading to oesophageal foreign body complications, and the differences were statistically significant (P < 0.05). CONCLUSION Children with EFB have a risk of complications, especially if the FB is a button battery. The appropriate surgical method should be selected through the analysis of the clinical characteristics of the foreign body in the oesophagus and the risk factors for complications to reduce the incidence of complications. Health education and effective care are the keys to the prevention of EFB.
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Affiliation(s)
- Guo Xu
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, Guangdong, China
| | - Yong-Chao Chen
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, Guangdong, China.,Department of Otorhinolaryngology, Shenzhen Children's Hospital, China Medical University, Shenzhen, 518038, Guangdong, China
| | - Jing Chen
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, Guangdong, China
| | - De-Sheng Jia
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, Guangdong, China.,Department of Otorhinolaryngology, Shenzhen Children's Hospital, China Medical University, Shenzhen, 518038, Guangdong, China
| | - Ze-Bin Wu
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, Guangdong, China.
| | - Lan Li
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, 518038, Guangdong, China.
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Holtestaul T, Franko J, Escobar MA, Barlow M. Pediatric Ingestions. Surg Clin North Am 2022; 102:779-795. [DOI: 10.1016/j.suc.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Ohns MJ. Button Battery Ingestion: A Case Report. J Pediatr Health Care 2022; 36:465-469. [PMID: 35843853 DOI: 10.1016/j.pedhc.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 10/17/2022]
Abstract
This case report describes a 17-month-old child with ingestion of a button battery. The clinical presentation, diagnostic reasoning, national guidelines, hospital course, and follow-up are discussed. Between 1995 and 2015, an estimated 759,074 children aged < 6 years were seen in emergency departments for suspected or confirmed foreign body ingestions, representing a 93.3% increase in cases . The most common objects ingested were coins, toys, jewelry, and batteries. The most common battery ingested was a button battery. Although 80% to 90% of ingested foreign objects pass without intervention, a button battery positioned in the esophagus is an emergency requiring immediate removal.
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Affiliation(s)
- Mary Jean Ohns
- Mary Jean Ohns, Pediatric Nurse Practitioner, Emergency Department, Russel J. Ebeid Children's Hospital, and Tenured Assistant Professor, College of Nursing, University of Toledo, Toledo, OH.
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Xing H, Tan B, Yang C, Zhang M. A sewing needle in the liver in children: A case report and literature review. Medicine (Baltimore) 2022; 101:e29339. [PMID: 35801787 PMCID: PMC9259108 DOI: 10.1097/md.0000000000029339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE In clinical practice, foreign bodies (FBs) in the digestive tract are more common in children, but intrahepatic FBs are rare, especially those that can cause infection, bleeding, bile leakage, and other complications. However, there is no consensus on its diagnosis and treatment due to the lack of large-scale cohort studies. PATIENT CONCERNS Case 1 is a 4-years 8-months-old girl, who at the age of 10 months, showed an X-ray finding of a striped FB in her liver, with no symptoms. However, the patient's parents refused surgery. After nearly 4 years of active surveillance, the patient visited our hospital for surgery. Case 2, a 2-year-old male, reported a sewing needle that completely pierced into the right upper abdomen due to an accidental fall that took place half-a-day before admission. He only had right upper abdominal pain. CT showed a striped FB in the liver. DIAGNOSIS FB in the liver (sewing needle). INTERVENTIONS Both the patients were injected with human tetanus immunoglobulin and underwent surgical removal. OUTCOMES Both patients recovered smoothly and had no complications during follow-up. LESSONS Active surveillance might be considered for cases with no symptoms or complications and no displacement of the FB, but surgery should be the first choice. If the patient's condition is complicated, it is recommended to use ultrasound or X-ray to help decision-making during the operation. Additionally, tetanus, child safety, and family education are important supportive measures.
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Affiliation(s)
- Huiwu Xing
- Department of Hepatobiliary Surgery, Children’s Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Bingqian Tan
- Department of Hepatobiliary Surgery, Children’s Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Chenyu Yang
- Department of Hepatobiliary Surgery, Children’s Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Mingman Zhang
- Department of Hepatobiliary Surgery, Children’s Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- *Correspondence: Mingman Zhang, Department of Hepatobiliary Surgery, Children’s Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China (e-mail: )
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Deniz MA, Turmak M. CT Evaluation of Swallowed Foreign Bodies Located in the Gastrointestinal System. Cureus 2022; 14:e26355. [PMID: 35770182 PMCID: PMC9234383 DOI: 10.7759/cureus.26355] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background and objective CT imaging is important in detecting the location and the structure of swallowed foreign bodies and assessing their complications, due to its features such as the ability to show the detailed anatomical structure and enable multiplanar examination. In this study, we aimed to analyze the CT findings of swallowed foreign bodies located in the gastrointestinal tract and compare them with the data in the existing literature. Materials and methods We conducted a retrospective archive study to achieve our goals. Patients who presented to our radiology department with the preliminary diagnosis of foreign body ingestion, abdominal pain, or acute abdomen and were found to have a foreign body in the gastrointestinal tract on CT between April 2018 and April 2021, especially those in whom the presence of a foreign body was confirmed by endoscopy or surgery, were included in our study. The patients were evaluated in terms of age, gender, foreign body type, foreign body localization, and complications. Results A total of 31 patients (15 males and 16 females) were included in the study. The patients’ age ranged from 1 to 67 years, and the mean age was 28.5 ±5.4 years. The most common foreign bodies found were metallic toy parts (n=11, 35%), and most of the foreign bodies were located in the ileum (n=9, 29%) of the patients. Complications were observed in nine patients (29%). In patients with complications, the most common finding was perforation (n=3, 38%). Conclusion When a CT exam is performed on patients with abdominal pain, the gastrointestinal tract should be carefully evaluated to determine if a foreign body is involved and to analyze the complications caused by the foreign body.
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Shi H, Lv Z, Xu W, Sheng Q, Huang X, Xu T. Case report and literature review: An intrahepatic sewing needle in a child. Front Pediatr 2022; 10:1101163. [PMID: 36699312 PMCID: PMC9870669 DOI: 10.3389/fped.2022.1101163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/07/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The presence of intrahepatic foreign bodies is a rare occurrence at the emergency department. Normally, foreign bodies reach the liver through migration. Incidence is lower among children than among adults, and the circumstances of children are often different. We report a 19-month-old boy with a sewing needle in the liver and review the previous reports of intrahepatic sewing needle in the PubMed database from the last three decades. CASE PRESENTATION A 19-month-old boy was transferred to our center from a local hospital presenting intermittent cough and rhinorrhea. A chest radiograph to exclude pulmonary disease revealed an incidental finding of a high-density shadow in the hepatic region. On admission, the boy had no gastrointestinal symptoms. Abdominal physical examinations were unremarkable. His mother, a worker in a textile factory, denied any history of trauma. Abuse was excluded based on investigation. Preoperative routine test results were normal. Contrast-enhanced computed tomography (CT) revealed that the sewing needle was located in hepatic segment IV and the tip had close relationship with intrahepatic portal vein. Initially, laparoscopy was performed without success. We eventually converted to laparotomy to completely remove the rusty sewing needle. The patient resumed feeding soon after the operation and was discharged in a few days. CONCLUSIONS Intrahepatic sewing needle has high incidence among boys and developing countries. Combined with contrast-enhanced CT, knowledge of the pediatric patient's family background and medical history would help judge the route of entry and determine the management and surgical strategy. Laparoscopic procedure is not suitable for rusty sewing needles.
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Affiliation(s)
- Hao Shi
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhibao Lv
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weijue Xu
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qingfeng Sheng
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiong Huang
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Xu
- Department of General Surgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Survival of Toddler with Aortoesophageal Fistula after Button Battery Ingestion. Case Rep Otolaryngol 2021; 2021:5557054. [PMID: 34650821 PMCID: PMC8510820 DOI: 10.1155/2021/5557054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/29/2022] Open
Abstract
Button batteries (BBs) are found in many households and are a source of esophageal foreign body in the pediatric population. Upon ingestion, significant caustic injury can occur within 2 hours leading to tissue damage and severe, potentially fatal sequelae. Aortoesophageal fistula (AEF) is a rare complication that nearly always results in mortality. We report a rare case of a toddler who developed an AEF after BB ingestion and survived following staged aortic repair. There should be a high index of suspicion for this complication with the history of BB ingestion and presence of hematemesis, hemoptysis, or melena.
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Foreign body ingestion and associated factors in pediatric patients at a tertiary care center. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 87:20-28. [PMID: 34635446 DOI: 10.1016/j.rgmxen.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND AIMS Foreign body (FB) ingestion is a common problem in children under 5 years of age and is one of the main indications for endoscopy. The aim of the present study was to describe the clinical, radiographic, and endoscopic characteristics of patients with FB ingestion, as well as the factors associated with the anatomic location and the type of object ingested. MATERIALS AND METHODS An analytic cross-sectional study was conducted on all patients with FB ingestion seen at the gastroenterology service from January 2013 to December 2018. The data were analyzed using the SPSS program, obtaining frequencies, percentages, medians, and interquartile ranges. Associations were assessed through the chi-square test. RESULTS Eighty-five patients (52 males and 33 females) were included, with a median age of 4 years. The most common symptom was vomiting (29.4%). Two radiographic projections were carried out in 72.9% of the cases and the stomach was the site where the FB was most frequently visualized (32.9%). The objects most commonly ingested were coins (36%), with esophageal location (p<0.05), as well as objects with a diameter larger than 2cm (p<0.05). An endoscopic procedure was performed on 76 patients (89.4%) for FB extraction, with findings of erythema (28.9%), erosion (48.6%), ulcer (10.5%) and perforation (1.3%). CONCLUSIONS Numerous factors should be taken into account in the approach to FB ingestion in pediatric patients, including type and size of the FB, time interval from ingestion to hospital arrival, and patient clinical status and age.
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Au A, Goldman RD. Management of gastric metallic foreign bodies in children. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:503-505. [PMID: 34261710 DOI: 10.46747/cfp.6707503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
QUESTION A 2-year-old boy presented to my clinic after a caregiver witnessed him swallow a foreign body. The caregiver recalls seeing a small metallic object but is unsure exactly what was ingested. The child was asymptomatic upon examination. How should I identify and localize the foreign body? Do metal foreign bodies need to be removed endoscopically? ANSWER Foreign body ingestion is very common in children. Considerations must be made for the type of foreign body and site of impaction. A clear patient history and radiographs should be used to localize and identify the object. Handheld metal detectors can also be used to localize known metallic foreign bodies. Most metallic objects that pass the esophagus and reach the stomach will continue to pass without complication. Bowel perforation, sepsis, and even death have been documented in extremely rare cases of multiple magnets, button batteries, and long, angular, or 2-pointed sharp objects. These objects must be removed. Other metallic foreign bodies including coins and single magnets can be managed conservatively with stool monitoring.
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Crain MA, Lakhani DA, Kuhnlein R, Balar AB, Neptune S, Parrish D, Shorter N, Adelanwa A, Nguyen TP, Hailemichael E. Small bowel obstruction from hollow foreign body ingestion: A case report and brief review of literature. Radiol Case Rep 2021; 16:1628-1632. [PMID: 33995754 PMCID: PMC8105595 DOI: 10.1016/j.radcr.2021.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/10/2021] [Accepted: 04/11/2021] [Indexed: 11/22/2022] Open
Abstract
While ingestion of a foreign body by children is common, diagnosis is often challenging, especially when the consumption by a young child is unwitnessed and presenting symptoms mimic other medical conditions. If the foreign body does not pass spontaneously, radiological imaging studies are typically performed, but visualization and identification of the ingested foreign object can be inconclusive, especially when an unidentified mass is radio translucent. Under this circumstance, physicians often have to go on a "fishing expedition", using exploratory endoscopy and/or surgery to identify and extract the object that became lodged. In this report we discuss a case of a 3 year-old boy who presented with abdominal pain and signs of bowel obstruction. Imaging revealed an ingested "radiolucent" foreign body, masqueraded as soft-tissue mass and enteric duplication cyst, delaying the diagnosis. Systematic shape and density reanalysis of CT and US imaging suggested a hollow object lodged at the terminal ileum. The patient underwent exploratory laparotomy with extraction of a hollow toy "fish". There is a dearth of literature regarding hollow ingested objects. This case report highlights the importance of systematic density and shape imaging analyses in order to identify and locate hollow ingested objects.
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Affiliation(s)
| | - Dhairya A. Lakhani
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| | - Ryan Kuhnlein
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| | - Aneri B Balar
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| | - Susan Neptune
- Department of Surgery, West Virginia University, Morgantown, West Virginia
| | - Dan Parrish
- Department of Surgery, West Virginia University, Morgantown, West Virginia
| | - Nicholas Shorter
- Department of Surgery, West Virginia University, Morgantown, West Virginia
| | - Ayodele Adelanwa
- Department of Pathology, West Virginia University, Morgantown, West Virginia
| | - Thuan-Phuong Nguyen
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| | - Eyassu Hailemichael
- Department of Radiology, West Virginia University, Morgantown, West Virginia
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17
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Sethia R, Gibbs H, Jacobs IN, Reilly JS, Rhoades K, Jatana KR. Current management of button battery injuries. Laryngoscope Investig Otolaryngol 2021; 6:549-563. [PMID: 34195377 PMCID: PMC8223456 DOI: 10.1002/lio2.535] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/07/2021] [Indexed: 01/08/2023] Open
Abstract
Button batteries (BB) are found in common household items and can lead to significant morbidity and mortality in the pediatric population when ingested. BBs are made of various chemistries and have a unique size and shape that yield significant injury when lodged in the pediatric esophagus. BBs create a local tissue pH environment of 10 to 13 and can induce liquefactive necrosis at the negative pole. This initial injury can progress with further tissue breakdown even after removal. Unfortunately, patients may present with vague symptoms similar to viral illnesses and there is not always a known history of ingestion. Plain film X-ray can be diagnostic. Exposure can lead to caustic injury within 2 hours. Thus, timely endoscopic removal is the mainstay of treatment. Novel mitigation and neutralization strategies have been implemented into treatment guidelines. These include the preremoval ingestion of honey or sucralfate and intraoperative irrigation with acetic acid. Depending on the severity of injury following removal, careful consideration should be given for potential delayed complications including fistulization into major vessels which often leads to death. The National Button Battery Taskforce and several industry members have implemented prevention strategies such as educational safety outreach campaigns, child-resistant packaging changes, and warning labels. Governmental regulation and industry changes are key to limit not only the amount of BB ingestions, but also the devastating consequences that can result. Anonymous reporting of BB injuries through the Global Injury Research Collaborative has been made convenient and centralized through the advent of a user-friendly smartphone iOS/App Store and Android/GooglePlay application called the "GIRC App"; all specialists who manage foreign body cases should contribute their cases to help prevent future injuries. BB ingestion must be recognized and treated promptly using a multidisciplinary approach to optimize outcomes for these patients. Ultimately, a safer BB technology is critically needed to reduce or eliminate the severe and life-threatening injuries in children. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Rishabh Sethia
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA
| | - Hannah Gibbs
- College of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Ian N. Jacobs
- Division of OtolaryngologyThe Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Otorhinolaryngology—Head and Neck SurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - James S. Reilly
- Division of Pediatric OtolaryngologyNemours/Alfred I. DuPont Hospital for ChildrenWilmingtonDelawareUSA
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
- Global Injury Research Collaborative (GIRC)ColumbusOhioUSA
| | - Keith Rhoades
- Global Injury Research Collaborative (GIRC)ColumbusOhioUSA
| | - Kris R. Jatana
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State University Wexner Medical CenterColumbusOhioUSA
- College of MedicineThe Ohio State UniversityColumbusOhioUSA
- Global Injury Research Collaborative (GIRC)ColumbusOhioUSA
- Department of Pediatric OtolaryngologyNationwide Children's Hospital, Wexner Medical Center at Ohio StateColumbusOhioUSA
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Kaufmann J, Grozeva B, Laschat M, Brackhahn M, Rudolph D, Neuhaus N, Hubertus J, Wappler F, Eich C. Rapid and safe removal of foreign bodies in the upper esophagus in children using an optimized Miller size 3 video laryngoscope blade. Paediatr Anaesth 2021; 31:587-593. [PMID: 33583069 DOI: 10.1111/pan.14158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Foreign bodies lodged in the upper esophagus in children may result in life-threatening complications, especially with button batteries. Rapid removal is essential to prevent complications. Experts report that extraction with a suitable laryngoscope and a forceps is feasible under general anesthesia, but no further data had been available so far. AIMS To study foreign body visualization and removal from the upper esophagus in children using a new optimized Miller size 3 blade video laryngoscope. METHODS This prospective observational study was performed in three pediatric hospitals. The clinical observations were reported anonymously on an electronic spreadsheet after obtaining the informed consent from the parents or guardians. During the observational period from January 2019 to October 2020, all children with a foreign body lodged into the upper esophagus were eligible for participation and 22 cases were included. Main outcome measures were rates of successful removal and complications as well as duration of the procedure. Secondary outcome was subjective assessment regarding the quality of the visualization and the feasibility of the procedure. RESULTS Success rate was 100% with no complications. Mean intervention and anesthesia times were 5 ± 4 minutes and 26 ± 25 minutes. Quality of visualization of the foreign body was judged as 'excellent' or 'good' in all cases and the feasibility of the procedure as 'without' or 'with little' effort in 95% of all cases. CONCLUSION The new Miller size 3 video laryngoscope enables rapid, easy, and reliable extraction of foreign bodies when they are located in the upper part of the esophagus. As early removal of esophageal foreign bodies, especially with button batteries, prevents life-threatening complications, we suggest this technique as the first choice of treatment.
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Affiliation(s)
- Jost Kaufmann
- Department for Paediatric Anaesthesia, Children's Hospital Cologne, Cologne, Germany.,Faculty for Health, University Witten/Herdecke, Witten, Germany
| | - Boyana Grozeva
- Department for Paediatric Anaesthesia, Children's Hospital Cologne, Cologne, Germany.,Faculty for Health, University Witten/Herdecke, Witten, Germany
| | - Michael Laschat
- Department for Paediatric Anaesthesia, Children's Hospital Cologne, Cologne, Germany
| | - Michael Brackhahn
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hanover, Germany
| | - Diana Rudolph
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hanover, Germany
| | - Nikolas Neuhaus
- Department of Paediatric Surgery, Dr. von, Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jochen Hubertus
- Department of Paediatric Surgery, Dr. von, Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Frank Wappler
- Department for Paediatric Anaesthesia, Children's Hospital Cologne, Cologne, Germany.,Faculty for Health, University Witten/Herdecke, Witten, Germany
| | - Christoph Eich
- Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hanover, Germany
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19
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Paediatric chemical burns: a clinical review. Eur J Pediatr 2021; 180:1359-1369. [PMID: 33403450 DOI: 10.1007/s00431-020-03905-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/05/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
Although they account for a small proportion of burns in paediatrics, injuries from chemicals can be just as devastating as other mechanisms of burn injury. At least 25,000 chemicals exist which can cause burns: in children, they are often caused by household chemicals via accidental exposure. The mechanism by which corrosive substances produce chemical burns highlights the importance of early and plentiful irrigation of the burn area, removal of contaminated clothes and careful clinical assessment. Surgical intervention is uncommon but often follows the principles for thermal burns. This article reviews the aetiology, incidence, clinical presentation, management, complications and prevention of chemical burns. What is Known • Chemical burns in paediatrics are often caused by accidental exposure to chemicals available at home • Differences in the pathophysiology of chemical burns reinforces the need for early irrigation What is New • New irrigation fluids show promise in adults and need further study in children • The nature of chemical cutaneous burns can make assessment of wound depth difficult. Laser Doppler Imaging (LDI) is an accurate technique that can be used clinically to determine burn depth in thermal burns and is an area of future interest in the assessment of chemical burns.
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20
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Navia-López LA, Cadena-León JF, Ignorosa-Arellano KR, E M Toro-Monjaraz, Zárate-Mondragón F, Loredo-Mayer A, Cervantes-Bustamante R, Ramírez-Mayans JA. Foreign body ingestion and associated factors in pediatric patients at a tertiary care center. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2021; 87:S0375-0906(21)00032-X. [PMID: 33892985 DOI: 10.1016/j.rgmx.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/09/2020] [Accepted: 09/16/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND AIMS Foreign body (FB) ingestion is a common problem in children under 5 years of age and is one of the main indications for endoscopy. The aim of the present study was to describe the clinical, radiographic, and endoscopic characteristics of patients with FB ingestion, as well as the factors associated with the anatomic location and the type of object ingested. MATERIALS AND METHODS An analytic cross-sectional study was conducted on all patients with FB ingestion seen at the gastroenterology service from January 2013 to December 2018. The data were analyzed using the SPSS program, obtaining frequencies, percentages, medians, and interquartile ranges. Associations were assessed through the chi-square test. RESULTS Eighty-five patients (52 males and 33 females) were included, with a median age of 4 years. The most common symptom was vomiting (29.4%). Two radiographic projections were carried out in 72.9% of the cases and the stomach was the site where the FB was most frequently visualized (32.9%). The objects most commonly ingested were coins (36%), with esophageal location (p <0.05), as well as objects with a diameter larger than 2cm (p <0.05). An endoscopic procedure was performed on 76 patients (89.4%) for FB extraction, with findings of erythema (28.9%), erosion (48.6%), ulcer (10.5%) and perforation (1.3%). CONCLUSIONS Numerous factors should be taken into account in the approach to FB ingestion in pediatric patients, including type and size of the FB, time interval from ingestion to hospital arrival, and patient clinical status and age.
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Affiliation(s)
- L A Navia-López
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México.
| | - J F Cadena-León
- Departamento de Gastroenterología y Nutrición Pediátrica, Unidad de Diagnóstico en Gastroenterología Pediátrica Integral (UDIGAPI), Instituto Nacional de Pediatría, Ciudad de México, México
| | - K R Ignorosa-Arellano
- Departamento de Gastroenterología y Nutrición Pediátrica, Unidad de Diagnóstico en Gastroenterología Pediátrica Integral (UDIGAPI), Instituto Nacional de Pediatría, Ciudad de México, México
| | - E M Toro-Monjaraz
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - F Zárate-Mondragón
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - A Loredo-Mayer
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - R Cervantes-Bustamante
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - J A Ramírez-Mayans
- Servicio de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
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21
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Mathew RP, Liang TIH, Kabeer A, Patel V, Low G. Clinical presentation, diagnosis and management of aerodigestive tract foreign bodies in the paediatric population: Part 2. SA J Radiol 2021; 25:2027. [PMID: 33936796 PMCID: PMC8063769 DOI: 10.4102/sajr.v25i1.2027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/22/2020] [Indexed: 01/08/2023] Open
Abstract
Children, especially toddlers, because of their behaviour, physiology and anatomical characteristics such as oral exploration of their surroundings, have a tendency to place objects in their mouth. Therefore, ingestion or aspiration of foreign bodies (FBs) in children is a potentially life-threatening and common problem seen across the world. In this second part of our pictorial review on ingested and aspirated FBs, we focus on the paediatric population, reviewing the current literature and examining the epidemiology, clinical presentation, anatomic considerations, appropriate imaging modalities, key imaging characteristics associated with clinically relevant FBs in the emergency department (ED) and current management protocols.
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Affiliation(s)
- Rishi P Mathew
- Department of Radiology, Rajagiri Hospital, Aluva, India
| | - Teresa I-Han Liang
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
| | - Ahamed Kabeer
- Department of Pediatric Surgery, Rajagiri Hospital, Aluva, India
| | - Vimal Patel
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Canada
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22
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Gatto A, Angelici S, Di Pangrazio C, Nanni L, Buonsenso D, Paradiso FV, Chiaretti A. The Fakir Child: Clinical Observation or Invasive Treatment? Pediatr Rep 2020; 12:103-107. [PMID: 33137885 PMCID: PMC7717650 DOI: 10.3390/pediatric12030023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/25/2020] [Indexed: 01/08/2023] Open
Abstract
Accidental swallowing of foreign bodies is a common problem among the pediatric population (6 months to 3 years), especially if the foreign body (FB) presents a sharp end that could potentially lead to perforation of the gastrointestinal (GI) tract, resulting in infection and complications. We report the case of a 2-year-old, admitted to the Emergency Department of our hospital after ingesting two FBs classifiable as sharp objects, specifically two metal nails, both approximately 4-cm long, which had been swallowed in one go, as reported by the parents. The patient had been previously admitted to another hospital in the same region, where the Emergency Department (ED) doctors took an X-ray to confirm the ingestion. The foreign bodies ingestion was thus confirmed, and they were, according to their report, located in the GI tract over the stomach. The patient has been monitored through all of his stay in the hospital and the progression of the foreign bodies has been documented with serial X-rays. Since neither clinical nor radiological signs of perforation were present, putting the FBs in the small bowel, a non-operative expectant management was followed. After 4 days of admission, the patient had passed one of the two FBS and later on the second one, without any complication. Thereafter the patient was discharged. The management of sharp gastrointestinal foreign objects ingestion is still debated, and the data of the current literature are poor. A number of case reports and small case series describe successful conservative management for the majority of ingested sharp objects. According to the literature data, our report confirms that the ingestion of sharp objects and relatively big objects in a baby can be successfully non-operatively managed, even despite the age of the patient and though the FBs are multiple.
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Affiliation(s)
- Antonio Gatto
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Correspondence:
| | - Serenella Angelici
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (S.A.); (C.D.P.); (A.C.)
| | - Claudia Di Pangrazio
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (S.A.); (C.D.P.); (A.C.)
| | - Lorenzo Nanni
- Division of Pediatric Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.N.); (F.V.P.)
| | - Danilo Buonsenso
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Filomena Valentina Paradiso
- Division of Pediatric Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.N.); (F.V.P.)
| | - Antonio Chiaretti
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (S.A.); (C.D.P.); (A.C.)
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Liu YH, Lv ZB, Liu JB, Sheng QF. Perianorectal abscesses and fistula due to ingested jujube pit in infant: Two case reports. World J Clin Cases 2020; 8:4930-4937. [PMID: 33195663 PMCID: PMC7642569 DOI: 10.12998/wjcc.v8.i20.4930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/11/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND About 90% of perianal infection is caused by cryptoglandular infection. Only a few cases of peritonitis or intra-abdominal abscesses secondary to perforation of the digestive tract by an ingested foreign body have been reported. The most common sites of impaction and perforation include the appendix, cecum and the terminal ileum. The rectum is an unusual site of foreign body impaction. This report intends to highlight that ingested foreign body impacted in the rectum is an extremely rare cause of perianal abscess and subsequent fistula in infants.
CASE SUMMARY Two cases of perianal abscess and fistula due to ingested jujube pit impacted in the rectum are reported. Both cases are infants with free previous medical history suffered from recurrent perianal infection. The caregivers of the two patients denied ingestion of a foreign body or any history of trauma. Physical examination combined with ultrasound or computed tomography scan established the diagnosis. Both of the patients underwent operation under general anesthesia. In case 1, a jujube pit with sharp ends was discovered embedded within a subcutaneous fistula. The jujube pit was then removed intact along with fistula resection. The wound was successfully laid open to allow healing by secondary intention. In case 2, a jujube pit was found with its sharp end puncturing the rectum, surrounded by pus and necrotic tissue. Subsequent incision and adequate drainage were performed. The whole jujube pit was then removed from the abscess cavity at the same time. Both patients received colonoscopy to rule out inflammatory bowel disease or other potential damages by the ingested jujube pit. The postoperative period was uneventful. At 1.5 year follow-up, no recurrent abscess or fistula were found in either patient.
CONCLUSION An impacted foreign body must not be overlooked as an unusual cause of perianal abscess and fistula, especially in young children.
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Affiliation(s)
- Ying-Hua Liu
- Department of General Surgery, Children’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai 200333, China
| | - Zhi-Bao Lv
- Department of General Surgery, Children’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai 200333, China
| | - Jiang-Bin Liu
- Department of General Surgery, Children’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai 200333, China
| | - Qing-Feng Sheng
- Department of General Surgery, Children’s Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai 200333, China
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Langham J, Sulton C, Holmes S. A 3-Year-Old Male Presenting With Sore Throat and Torticollis. Glob Pediatr Health 2020; 7:2333794X20953304. [PMID: 33062807 PMCID: PMC7536469 DOI: 10.1177/2333794x20953304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Carmen Sulton
- Emory University School of Medicine, Atlanta, GA, USA
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25
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Saltiel J, Molinsky R, Lebwohl B. Predictors of Outcomes in Endoscopies for Foreign Body Ingestion: A Cross-Sectional Study. Dig Dis Sci 2020; 65:2637-2643. [PMID: 31907772 DOI: 10.1007/s10620-019-06033-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/24/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND As foreign body ingestion/food impaction is one of the less common indications for upper endoscopy in adults, few studies have investigated outcomes. We aimed to determine the distribution of ingested items warranting endoscopy and to identify factors associated with successful endoscopic retrieval. METHODS We conducted a retrospective, cross-sectional study, identifying all endoscopies performed between June 2006 and June 2018 for foreign body ingestion or food impaction. We performed univariate and multivariate analyses to identify variables associated with endoscopic foreign body visualization and successful removal from the mouth. RESULTS Of the 168 endoscopies identified, the ingested item was visualized in 131 (78%) and was removed from the mouth in 88 (52.4%). 6.5% of cases required surgery and 2.4% of cases had a perforation noted. The two most common foreign bodies were food boluses (51.2%) and bones (28.6%). Older patients were more likely to have their ingested foreign body visualized during endoscopy (age ≥ 70 compared to 18-29 adjusted odds ratio [aOR] 8.78; 95% CI 1.62-47.70) and more likely to have it removed from the mouth (aOR 5.57; 95% CI 1.34-22.85). Bones were less likely to be visualized on endoscopy (aOR 0.16; 95% CI 0.04-0.57) but not less likely to be removed successfully (aOR 0.85; 95% CI 0.42-1.72). Foreign bodies visible on radiography were more likely to be identified on endoscopy (aOR 9.07; 95% CI 2.71-30.37) and more likely to be successfully removed (aOR 2.82; 95% CI 1.26-6.32). CONCLUSIONS Factors such as age, radiographic visibility, and the suspected foreign body may affect the likelihood that it can be visualized and removed. Future studies should focus on further characterizing complications of foreign body ingestions and the types of patients and objects most at risk.
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Affiliation(s)
- Jason Saltiel
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA.
| | - Rebecca Molinsky
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA
| | - Benjamin Lebwohl
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY, 10032, USA
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26
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Pediatric button battery ingestion: Publication trends in the literature. Am J Otolaryngol 2020; 41:102401. [PMID: 32033802 DOI: 10.1016/j.amjoto.2020.102401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/15/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Examine literature for evidence of changes in button battery (BB) research over time including: amount and rate of literature output, levels of evidence, and the location of the research. METHODS Literature review of all peer-reviewed button battery literature available online through Pubmed and Embase was performed. Inclusion criteria were applied to ensure relevance. Publications were grouped into 4 time periods. Various study characteristics were compared between groups. RESULTS A total of 255 original research studies were reviewed. A significant increase in study number was found with a 664% increase comparing 2009-2018 and 1977-1988 (p < 0.001) and a 187% increase comparing 2009-2018 and all previous years. Average author number significantly increased over the study period (range: 2.8 to 4.4; p < 0.001). Case report or case series were consistently the most common type of study design (range: 56.5% to 84.0%). Level of evidence has remained at 4-5 for the majority of studies (range: 87% to 92.1%). First author specialty remained stable over time, with non-otolaryngologist surgeons being the most common authors, followed by pediatricians and otolaryngologists (28.8%, 18.9%, 18.5%, respectively). Location of research has diversified, with US publications falling from 50% to 29.5% of all studies when comparing 1977-1988 to 2009-2018 time periods. CONCLUSIONS Button battery ingestion in the pediatric population has been an important topic of discussion among various medical specialties due to a rise in morbidity and mortality surrounding these ingestions. Despite the increase in number of studies and authors, the strength of these studies has remained largely unchanged.
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Buonsenso D, Chiaretti A, Curatola A, Morello R, Giacalone M, Parri N. Pediatrician performed point-of-care ultrasound for the detection of ingested foreign bodies: case series and review of the literature. J Ultrasound 2020; 24:107-114. [PMID: 32212088 DOI: 10.1007/s40477-020-00452-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/11/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Foreign body (FB) ingestions represent a common problem in children. History and physical examination are commonly not enough to diagnose a foreign body ingestion; therefore, conventional radiography is routinely used to detect them. Point-of-care ultrasound is widely used in the emergency department for several diagnostic applications but there are few articles describing the possibility to use point-of-care ultrasound to detect ingested foreign bodies, and the necessary training to get competent in this application. The main objective of this paper is to illustrate the use of point-of-care ultrasound (POCUS) to detect ingested foreign bodies. The secondary objective is to describe a limited training, necessary for emergency pediatricians, to obtain this skill. METHODS This is a case series of eight pediatric patients who presented to the pediatric Emergency Department (ED), with suspected ingestion of FB, and were assessed with POCUS. Physician sonographers were two pediatricians and three residents in pediatrics working in two Italian Pediatric EDs. All sonographers participated in a 2-day POCUS workshop which included the most common pediatric POCUS applications. RESULTS POCUS, performed by emergency pediatricians who participated to a limited training, allowed to always identify the foreign bodies ingested. CONCLUSIONS We demonstrate that an appropriate and limited training allows pediatric emergency physicians to correctly identify foreign body in the esophagus or stomach. Point-of-care ultrasound in foreign body ingestion in the Emergency Department may allow to prioritize the escalation of care in children and it can contribute to reduce the time to endoscopic management when needed.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Child Health Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Roma, RM, Italy
| | - Antonio Chiaretti
- Department of Woman and Child Health and Public Health, Child Health Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Roma, RM, Italy
| | - Antonietta Curatola
- Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Roma, RM, Italy.
| | - Rosa Morello
- Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Roma, RM, Italy
| | - Martina Giacalone
- Emergency Department and Trauma Center, Meyer University Childrens' Hospital, Florence, Italy
| | - Niccolò Parri
- Emergency Department and Trauma Center, Meyer University Childrens' Hospital, Florence, Italy
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Simunic M, Zaja I, Ardalic Z, Stipic R, Maras-Simunic M. Case report: successful endoscopic treatment of a large bowel perforation caused by chicken bone ingestion. Medicine (Baltimore) 2019; 98:e18111. [PMID: 31852071 PMCID: PMC6922534 DOI: 10.1097/md.0000000000018111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE Large bowel perforations by a foreign body are rarely diagnosed pre-operatively due to non-specific clinical symptoms. The safety and efficacy of foreign body removal via upper endoscopy is well-established and strongly recommended. There is far less experience of endoscopic treatment of sharp foreign bodies impacted in lower parts of gastrointestinal tract. PATIENT CONCERNS The patient was 78-year-old female with abdominal pain and nausea. Symptoms had begun 48 hours prior to hospital admission. She had lost over 10 kg of body weight in the previous couple of months DIAGNOSIS:: A multidetector-row computed tomography (MDCT) examination of the abdomen revealed mural thickening and enhancement of the cecum with haziness and linear areas of high attenuation in the pericecal fat tissue. A colonoscopy showed, the clear presence of a sharp 5.5-cm-long chicken bone perforating the cecal wall at the antemesenteric site close to the Bauchini valve. INTERVENTIONS A quarter of the bone that had penetrated the cecal wall was pulled out with a flexible colonoscopy using a polypectomy snare. Due to the form and length of the bone, it was withdrawn through the entire colon, using pointed end trailing. OUTCOMES The patient was discharged three days after colonoscopy with normal laboratory results and without any pain. LESSONS In cases where sharp foreign bodies stuck into the large bowel, it is highly advisable to try to remove them via colonoscopy, before deciding to resolve the issue through a surgical intervention.
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Day R, Bradberry SM, Thomas SHL, Vale JA. Liquid laundry detergent capsules (PODS): a review of their composition and mechanisms of toxicity, and of the circumstances, routes, features, and management of exposure. Clin Toxicol (Phila) 2019; 57:1053-1063. [DOI: 10.1080/15563650.2019.1618466] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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