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History and radiographic findings as predictors for esophageal coins versus button batteries. Int J Pediatr Otorhinolaryngol 2020; 137:110208. [PMID: 32896338 DOI: 10.1016/j.ijporl.2020.110208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine if clinical history and radiographic findings are reliable predictors for coin versus button battery in children presenting with esophageal foreign bodies to accurately guide decision making regarding the urgency of removal. METHODS A retrospective chart review was conducted in a single pediatric tertiary care center of all children who presented with suspected coin or button battery esophageal foreign body ingestion from 2017 to 2019. Patients with documented surgical removal, completed consultation notes, and available radiographic studies were included. Descriptive statistical analysis was performed and predictive characteristics of the diagnostic tests were calculated. RESULTS 139 patients met inclusion criteria for the study. Of 5 patients who had esophageal button batteries removed, clinical history was concerning for button battery in 2; accuracy of 12.35%. However, radiology reports suggested a battery in all 5. The negative predictive value for radiology alone for diagnosis of button battery was 97% with 81% accuracy. The clinical history for coin foreign body was accurate in 85.28% while radiography was 87% accurate. Wait time on average for all coin foreign body cases was 6.3 h. Day cases waited on average 5.5 h while after-hours cases waited a statistically significantly longer 7.5 h (p = 0.006). CONCLUSION Button batteries, while clinically important emergencies, are rare esophageal ingestions. Radiography has a strong negative predictive value for button battery. Children whose radiographic studies do not demonstrate concern for button battery could be considered for delayed elective removal. This could allow children to complete a period of observation at home, thereby reducing prolonged in-house wait times prior to operative removal.
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Making Heads or Tails of an Unexpected Colonoscopy Finding. ACG Case Rep J 2020; 7:e00328. [DOI: 10.14309/crj.0000000000000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/19/2019] [Indexed: 11/17/2022] Open
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Singh N, Chong J, Ho J, Jayachandra S, Cope D, Azimi F, Eslick GD, Wong E. Predictive factors associated with spontaneous passage of coins: A ten-year analysis of paediatric coin ingestion in Australia. Int J Pediatr Otorhinolaryngol 2018; 113:266-271. [PMID: 30173999 DOI: 10.1016/j.ijporl.2018.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Coins are the commonest foreign body ingested in paediatric populations. Although most ingested coins are either spontaneously passed or retrieved with medical intervention without serious consequence, there is potential for serious morbidity and mortality related to paediatric coin ingestion. We performed a 10-year retrospective review of Australian denomination coin ingestion at a tertiary paediatric hospital in Sydney, Australia. We attempted to determine whether a relationship exists between coin size, patient age, coin ingestion and spontaneous passage. METHODS Hospital records of all children presenting in a 10-year period to a paediatric tertiary care centre for coin ingestion were reviewed. Demographic information, coin denomination, previous history, symptoms, investigations, management, outcome and complications were recorded. RESULTS 241 cases were identified. The majority (55%) of cases occurred in children ≤3 years of age (range 7 months-11 years, mean 3.39 years). The most common location where coins were identified was in the proximal third of the oesophagus or at the cricopharyngeus (65%). Spontaneous passage occurred in 84 cases (34.9%) while 167 cases (69.3%) required intervention. Children ≤3 years were more likely to ingest small coins (<22 mm) (OR: 2.44; 1.39-4.17) and children >3 years were more likely to ingest larger coins (22-26 mm) (OR: 2.17; 1.39-4.35). CONCLUSIONS Coin size, coin weight and age of the child appear to be predictors for both likelihood of ingestion and spontaneous passage in paediatric coin ingestion cases. A child with minimal symptoms, witnessed ingestion and radiographic identification of the coin in the lower oesophagus or more distal can often be safety observed for up to 24 h in anticipation of spontaneous passage.
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Affiliation(s)
- Narinder Singh
- Department of Otolaryngology, Westmead Hospital, Mons Road, Westmead, Sydney, Australia; Sydney Medical School, University of Sydney, Australia
| | - Jessica Chong
- Department of Otolaryngology, Westmead Hospital, Mons Road, Westmead, Sydney, Australia
| | - Joyce Ho
- Department of Otolaryngology, Westmead Hospital, Mons Road, Westmead, Sydney, Australia
| | - Shruti Jayachandra
- Sydney Medical School, University of Sydney, Australia; Department of Cancer Epidemiology and Medical Statistics, Nepean Hospital, Derby Street, Kingswood, Sydney, Australia
| | - Daron Cope
- Department of Otolaryngology, Westmead Hospital, Mons Road, Westmead, Sydney, Australia
| | - Fred Azimi
- Department of Otolaryngology, Westmead Hospital, Mons Road, Westmead, Sydney, Australia
| | - Guy D Eslick
- Department of Cancer Epidemiology and Medical Statistics, Nepean Hospital, Derby Street, Kingswood, Sydney, Australia
| | - Eugene Wong
- Department of Otolaryngology, Westmead Hospital, Mons Road, Westmead, Sydney, Australia; Sydney Medical School, University of Sydney, Australia.
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Chouaib N, Rafai M, Belyamani L, Dimou M, El Koraichi A, El Haddoury M, Ech-Cherif El Kettani S. [Esophageal foreign body revealed by respiratory distress]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:245-247. [PMID: 24051189 DOI: 10.1016/j.pneumo.2013.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 05/08/2013] [Accepted: 05/24/2013] [Indexed: 06/02/2023]
Abstract
Ingestion of a foreign body is usually accidental in children. Respiratory symptoms, often favored by the persistence of the foreign body in the esophagus, can be revealing, but rarely respiratory distress as a method telling. We report a case of unrecognized esophageal foreign body revealed by respiratory distress.
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Affiliation(s)
- N Chouaib
- Service d'accueil des urgences médicochirurgicales, pôle des urgences médicochirurgicales, Hôpital militaire d'instruction Mohammed-V (HMIMV), Rabat, Maroc.
| | - M Rafai
- Service d'accueil des urgences médicochirurgicales, pôle des urgences médicochirurgicales, Hôpital militaire d'instruction Mohammed-V (HMIMV), Rabat, Maroc
| | - L Belyamani
- Service d'accueil des urgences médicochirurgicales, pôle des urgences médicochirurgicales, Hôpital militaire d'instruction Mohammed-V (HMIMV), Rabat, Maroc
| | - M Dimou
- Service d'accueil des urgences médicochirurgicales, pôle des urgences médicochirurgicales, Hôpital militaire d'instruction Mohammed-V (HMIMV), Rabat, Maroc
| | - A El Koraichi
- Service d'anesthésie-réanimation pédiatrique polyvalente, hôpital d'enfants de Rabat, Rabat, Maroc
| | - M El Haddoury
- Service d'anesthésie-réanimation pédiatrique polyvalente, hôpital d'enfants de Rabat, Rabat, Maroc
| | - S Ech-Cherif El Kettani
- Service d'anesthésie-réanimation pédiatrique polyvalente, hôpital d'enfants de Rabat, Rabat, Maroc
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Russell R, Lucas A, Johnson J, Yannam G, Griffin R, Beierle E, Anderson S, Chen M, Harmon C. Extraction of esophageal foreign bodies in children: rigid versus flexible endoscopy. Pediatr Surg Int 2014; 30:417-22. [PMID: 24549805 DOI: 10.1007/s00383-014-3481-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2014] [Indexed: 12/29/2022]
Abstract
PURPOSE Foreign body (FB) ingestion is a common and potentially serious problem in children. Both rigid (RE) and flexible (FE) endoscopic techniques are used for removal of esophageal FBs; however, there is no consensus amongst pediatric surgeons regarding the best method. This study reviewed our experience managing esophageal FBs using both techniques. METHODS A 12-year retrospective review of children admitted with an esophageal FB between 1999 and 2012 was undertaken. Clinical data, management techniques, and complications were abstracted. Differences between these two groups were compared with standard statistical methods. RESULTS 657 children were treated for esophageal FB ingestion, of which 366 (56%) were treated with FE. The most frequently ingested item was a coin (84%), and FBs were most commonly lodged in the upper third of the esophagus (78%). There was a slightly younger population in the FE group (4.0 vs. 3.3 years, p < 0.01), but otherwise no significant differences were found between the groups. The FB was successfully removed with the initially chosen technique in 97% of patients. CONCLUSIONS Esophageal FBs may be successfully removed with either RE or FE. Since treatment failures were managed with conversion to the other technique, both procedures should be included in the training curriculum.
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Affiliation(s)
- Robert Russell
- Division of Pediatric Surgery, Department of Surgery, Children's of Alabama, University of Alabama at Birmingham, 1600 7th Ave. S., Lowder Building Suite 300, Birmingham, AL, 35233, USA,
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Anderson KL, Dean AJ. Foreign Bodies in the Gastrointestinal Tract and Anorectal Emergencies. Emerg Med Clin North Am 2011; 29:369-400, ix. [DOI: 10.1016/j.emc.2011.01.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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7
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El Koraichi A, Lamkinsi T, Ghannam A, Tadili J, Benchekroun K, El Haddoury M, El Kettani SE. Extraction des pièces de monnaie à partir du tractus oesophagien supérieur chez les enfants par la pince de Magill sous sédation en ventilation spontanée. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s13546-011-0265-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Numismedica: Health Problems Caused by Coins. Am J Med Sci 2009; 337:445-50. [DOI: 10.1097/maj.0b013e31819e8791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Bowa K, Bvulani B, Mukonge L. The use of Foley's catheter in the removal of a coin in the oesophagus. Trop Doct 2009; 39:97-8. [PMID: 19299293 DOI: 10.1258/td.2008.070466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A coin in the oesophagus is a common paediatric emergency in Zambia. There are very few specialist surgeons and hospitals where endoscopic removal can be carried out in many resource-limited countries. The technique described here allows the removal of an ingested coin using an ordinary Foley's catheter. The use of this technique under fluoroscopic guidance has been described in literature. However, fluoroscopic facilities and trained radiologists are not commonly available in many parts of Africa. This technique is simple, safe and has a success rate close to that achieved by endoscopic removal.
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Affiliation(s)
- K Bowa
- University Teaching Hospital Lusaka, Lusaka, Zambia.
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10
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Diagnosis and Management of Upper Aerodigestive Tract Foreign Bodies. Otolaryngol Clin North Am 2008; 41:485-96, vii-viii. [DOI: 10.1016/j.otc.2008.01.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Safety and efficacy of a protocol using bougienage or endoscopy for the management of coins acutely lodged in the esophagus: a large case series. Ann Emerg Med 2007; 51:367-72. [PMID: 17933426 DOI: 10.1016/j.annemergmed.2007.09.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 08/29/2007] [Accepted: 09/06/2007] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE We report our experience using the bougienage procedure in the management of esophageal coins. METHODS Observational case series of all patients presenting to our emergency departments with coins acutely lodged in the esophagus between 1994 and 2006. All patients were treated according to our protocol with either endoscopy or bougienage. Patients are eligible for bougienage if they have had a witnessed coin ingestion less than 24 hours before presentation and if esophageal coin position is confirmed by chest radiograph and there is no history of esophageal disease, surgery, or foreign body. Primary outcomes measured were complications, efficacy of procedure, hospital charges, length of stay, and return to the hospital. Length of stay and hospital charges data were gathered for patients presenting in the final 24 months of the study. RESULTS Six hundred twenty patients were identified as having esophageal coins. Three hundred fifty-five patients had a successful bougienage, and 17 patients had unsuccessful bougienage. By comparison, 248 patients underwent endoscopy, and the coin was successfully removed in all but 1 of these patients. Of patients undergoing endoscopy, 89 were eligible for bougienage, but patient, parent, or physician preference was for endoscopic management. Eleven patients required reevaluation or readmission for complaints related to esophageal coin. The only complication was subglottic edema, causing respiratory distress in a single patient who had undergone endoscopy. Patients undergoing endoscopy had an average length of stay of 6.1 hours and average hospital charges were $6,087. Patients undergoing bougienage had an average length of stay of 2.2 hours and average hospital charges of $1,884. CONCLUSION In properly screened patients with coins acutely lodged in the esophagus, bougienage offers a safe and effective alternative to other methods of coin management.
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Abstract
PURPOSE OF REVIEW Coins are the most commonly ingested foreign body encountered in the pediatric population. Coins that are in the esophagus and are causing symptoms (cough, stridor, respiratory distress, drooling or pain) are managed with immediate removal via various methods. Asymptomatic coins have been a perplexing problem to the clinician for decades, with some advocating for immediate removal while others are proponents of "watchful waiting". RECENT FINDINGS This article will provide a review of the current literature on management options for symptomatic and asymptomatic esophageal coins. The article will discuss clinical decision-making strategies for the diagnosis of the unwitnessed ingestion, as well as diagnostic studies, such as plain radiographs, as well as novel modalities, such as metal detectors. Discussion of the anatomic issues related to esophageal foreign bodies will be addressed. Treatment options for asymptomatic patients will be reviewed utilizing data from retrospective studies as well as a prospective randomized trial. SUMMARY In the symptomatic patient with an esophageal coin, immediate removal via endoscopy is recommended. For the asymptomatic patient with an esophageal coin, current data support expectant management for a period of 12-24 h with the hope of spontaneous passage and avoidance of general anesthesia and surgical procedure.
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Affiliation(s)
- Mark L Waltzman
- Harvard Medical School, Division of Emergency Medicine, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
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Affiliation(s)
- Mark Waltzman
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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Cetinkursun S, Sayan A, Demirbag S, Surer I, Ozdemir T, Arikan A. Safe removal of upper esophageal coins by using Magill forceps: two centers' experience. Clin Pediatr (Phila) 2006; 45:71-3. [PMID: 16429219 DOI: 10.1177/000992280604500111] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Coin ingestion with subsequent esophageal coin impaction is common in children. Considerable debate surrounds the choice of technique for the removal of esophageal coins. This study demonstrates a minimally invasive technique for upper esophageal coin extraction. A retrospective review was conducted of 165 children who had upper esophageal coins extracted by using a Magill forceps. One hundred fifty-six coins (96.4%) were successfully removed without any complications. The average time taken to remove the coin was 33 seconds. Use of the Magill forceps technique minimizes instrumentation of the esophagus and is an easy, safe technique for removing coins from the upper end of the esophagus.
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Affiliation(s)
- Salih Cetinkursun
- Department of Pediatric Surgery, Gülhane Military Medical Academy, Ankara, Turkey
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Affiliation(s)
- Gregory P Conners
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA.
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Waltzman ML, Baskin M, Wypij D, Mooney D, Jones D, Fleisher G. A randomized clinical trial of the management of esophageal coins in children. Pediatrics 2005; 116:614-9. [PMID: 16140701 DOI: 10.1542/peds.2004-2555] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Children frequently ingest coins. When lodged in the esophagus, the coin may cause complications and must either be removed or observed to pass spontaneously. OBJECTIVES (1) To compare relatively immediate endoscopic removal to a period of observation followed by removal when necessary and (2) to evaluate the relationship between select clinical features and spontaneous passage. DESIGN/SETTING Randomized, prospective study of children <21 years old who presented to an emergency department with esophageal coins in the esophagus. Exclusion criteria were (1) history of tracheal or esophageal surgery, (2) showing symptoms, or (3) swallowing the coin >24 hours earlier. Children were randomized to either endoscopic removal (surgery) or admission for observation, with repeat radiographs approximately 16 hours after the initial image. OUTCOME MEASURES Proportion of patients requiring endoscopic removal, length of hospital stay, and the number of complications observed. RESULTS Among 168 children who presented with esophageal coins lodged in the esophagus, 81 were eligible. Of those eligible, 60 enrolled, 20 refused consent, and 1 was not approached. In the observation group, 23 of 30 (77%) children required endoscopy compared with 21 of 30 (70%) in the surgical group. Total hospital length of stay was longer in the randomized-to-observation group compared with the randomized-to-surgery group (mean: 19.4 [SD: +/-8.0] hours vs 10.7 [SD: +/-7.1] hours, respectively). There were no complications in either group. Spontaneous passage occurred at similar rates in both groups (23% vs 30%). Spontaneous passage was more likely in older patients (66 vs 46 months) and male patients (odds ratio: 3.7; 95% confidence interval: 0.98-13.99) and more likely to occur when the coin was in the distal one third of the esophagus (56% vs 27% [95% confidence interval: 1.07-5.57]). CONCLUSIONS Because 25% to 30% of esophageal coins in children will pass spontaneously without complications, treatment of these patients may reasonably include a period of observation, in the range of 8 to 16 hours, particularly among older children and those with distally located coins.
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Affiliation(s)
- Mark L Waltzman
- Division of Emergency Medicine, Department of Medicine, Children's Hospital Boston, Boston, MA 02115, USA.
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Vukmir RB. Abdominal pain in a child associated with dental amalgam ingestion. Am J Emerg Med 2005; 23:391-3. [PMID: 15915421 DOI: 10.1016/j.ajem.2005.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
We present the case of a child with abdominal cramping found to have radiopaque matter in his gastrointestinal tract on plain radiography. The parents denied ingestion of a foreign substance but specific questioning revealed a visit for dental care the previous day. This may serve to illustrate the benefits of taking a careful goal-directed history as opposed to the often recommended open-ended approach.
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Affiliation(s)
- Rade B Vukmir
- Department of Emergency Medicine, UPMC Northwest, Seneca, PA 16346, USA.
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Abstract
Toddlers commonly ingest coins. Studies of the evaluation and management of such ingestions have focused on the risk of complications from impaction in the esophagus. It is commonly assumed that coins that have passed through the esophagus present little or no risk for distal complications. We present the first report of cecal retention of a penny in a previously healthy 2 year old, ultimately resulting in surgical intervention.
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Sharieff GQ, Brousseau TJ, Bradshaw JA, Shad JA. Acute esophageal coin ingestions: is immediate removal necessary? Pediatr Radiol 2003; 33:859-63. [PMID: 14551754 DOI: 10.1007/s00247-003-1032-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2003] [Revised: 06/26/2003] [Accepted: 07/02/2003] [Indexed: 12/01/2022]
Abstract
AIMS Coins are the most commonly encountered foreign body ingestions presenting to the emergency department (ED). The purpose of our study was to retrospectively evaluate a new institutional protocol implemented in 1998, in which healthy patients with acute (less than 24 h) coin ingestions located below the thoracic inlet, were observed at home with next-day follow-up. If repeat radiographs revealed a persistent esophageal foreign body, then the coin was removed. METHODS The charts of all patients who presented to the ED with a complaint of esophageal foreign body were reviewed from 1 January 1998 until 31 December 2001. Patients were excluded if they had non-acute ingestions, known esophageal pathology, severe symptoms such as stridor or inability to tolerate oral fluids, or incomplete records. RESULTS Of 31 patients with esophageal coin ingestions, 16 had coins above the thoracic inlet. Three of these patients were asymptomatic and all experienced spontaneous coin passage into the stomach within 2 h of ED presentation while awaiting coin removal. There were eight eligible patients with coins located below the thoracic inlet. Three of five patients with mid-esophageal coins experienced spontaneous coin passage while the remaining two required coin removal on next-day follow-up for persistent esophageal coins. Three of three patients with distal-esophageal coin ingestions experienced spontaneous coin passage. There were no complications in any of the patients who underwent delayed coin removal either due to the procedure itself or to a delay in therapy. CONCLUSIONS Patients with acute esophageal coin ingestions may experience spontaneous coin passage and therefore, patients with coins located below the thoracic inlet with minor symptoms may be candidates for next-day follow-up. If repeat radiographs reveal a persistent esophageal coin, then the coin should be immediately removed. Furthermore, asymptomatic patients with coins above the thoracic inlet should undergo repeat radiographs in 2-5 h, as spontaneous coin passage may occur. Our protocol may also be more convenient and cost-effective as patients can be observed at home.
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Affiliation(s)
- Ghazala Q Sharieff
- Department of Emergency Medicine, University of Florida Health Science Center Shands, 655 W Eigth Street, Jacksonville, FL 32209, USA
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Abstract
BACKGROUND/PURPOSE This study demonstrates a minimally invasive technique for upper esophageal coin extraction. METHODS A retrospective review was conducted of 36 children who had upper esophageal coins extracted using a Magill forceps. RESULTS All coins were removed without complication in approximately 45 seconds (33 on the first attempt, 3 on the second attempt). CONCLUSIONS This technique minimizes instrumentation of the esophagus and is highly successful at removing coins lodged at or immediately below the level of the cricipharyngeus muscle.
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Affiliation(s)
- James E Janik
- Department of Pediatric Surgery, The Children's Hospital/University of Colorado Health Sciences Center, Denver, CO 80218, USA
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Hostetler MA, Barnard JA. Removal of esophageal foreign bodies in the pediatric ED: is ketamine an option? Am J Emerg Med 2002; 20:96-8. [PMID: 11880871 DOI: 10.1053/ajem.2002.31572] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The objective of the study was to evaluate our experience with esophageal foreign body (EFB) removal comparing the use of ketamine-midazolam (K-M) and fentanyl-midazolam (F-M) in the emergency department (ED), to admission and general anesthesia (GA) in the operating room (OR). A retrospective review of all children undergoing EFB removal at our institution during a 2-year period was conducted. A total of 93 patients were identified: K-M 57/93 (61.2%), F-M 28/93 (30.1%), GA 5/93 (5.4%), and 3/93 (3.2%) by other means. Mean procedure durations were 4.8 min for K-M and 7.0 min for F-M. Mean lengths of stay (LOS) for ED procedures were 3.6 hrs for K-M and 5.7 hrs for F-M, versus 17.7 hrs if admitted. Transient hypoxemia occurred in 10.7% of K-M and 15.4% of F-M. Removal of EFBs in the ED may obviate the need for admission. In our experience, the use of K-M is associated with fewer airway complications, shorter removal times, and an overall shorter LOS.
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Affiliation(s)
- Mark A Hostetler
- Department of Pediatrics, Division of Emergency Medicine, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA.
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