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Xu G, Jia D, Chen J, Pan H, Wu Z. Esophageal button battery impactions in children: an analysis of 89 cases. BMC Pediatr 2024; 24:388. [PMID: 38851720 PMCID: PMC11162056 DOI: 10.1186/s12887-024-04869-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024] Open
Abstract
OBJECTIVE To analyze the clinical characteristics of esophageal button battery impactions in children and explore safe and effective treatment methods. METHODS This retrospective cohort study was conducted at a single tertiary care center, Shenzhen Children's Hospital, encompassing 89 children diagnosed with esophageal button battery impactions between January 2013 and January 2023. To minimize esophageal mucosal corrosion, prompt removal of the button battery with a first-aid fast track rigid esophagoscopy under general anesthesia was performed within thirty minutes of diagnosis. The clinical features and complications were recorded and analyzed. RESULTS Button battery as esophageal foreign body was prevalent among children under 3 years old (79.8%), with boys exhibiting a higher incidence rate (56.2%) compared to girls (43.8%), and an average age of 25.8 months. The median duration from ingestion to hospital admission was 3 h (range: 0.5 h to 3 months). Common symptoms included vomiting and dysphagia, with early stage vomiting of brown foamy secretions being a characteristic presentation of esophageal button battery impactions. The majority (77.5%) of batteries were lodged in the upper esophagus. The larger batteries were verified to be more prone to complications. All 89 cases exhibited varying degrees of esophageal mucosal erosion, with 31 cases (34.8%) experiencing severe complications, including esophageal stenosis in 11 cases (35.5%), esophageal perforation in 9 cases (29%) with 4 cases of tracheoesophageal fistula, vocal cord paralysis in 6 cases (19.4%), hemorrhage in 2 cases (6.5%), mediastinitis in 2 cases (6.5%), and periesophageal abscess in 1 case (3.2%). Despite the severity of these complications, none of the patients died after emergency surgery. CONCLUSION Esophageal button battery impactions can lead to significant damage to the esophageal mucosa due to its strong corrosiveness. Prompt action is crucial to mitigate the risk of complications. For the first time, we implement a first-aid fast track surgical intervention following diagnosis is imperative to minimize the incidence of adverse outcomes.
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Affiliation(s)
- Guo Xu
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong, 518038, China
| | - Desheng Jia
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong, 518038, China
| | - Jing Chen
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong, 518038, China
| | - Hongguang Pan
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong, 518038, China
| | - Zebin Wu
- Department of Otorhinolaryngology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, Guangdong, 518038, China.
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Chen T, M Siu J, Madan Y, Ma GW, Gill PJ, Carman N, Propst EJ, Wolter NE. Pediatric Esophageal Foreign Bodies: The Role of Socioeconomic Status in Ingestion Patterns. Laryngoscope 2024; 134:2945-2953. [PMID: 38197507 DOI: 10.1002/lary.31274] [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: 11/12/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Pediatric esophageal foreign bodies (EFBs) are common and can result in serious complications. Little is known about the influence of socioeconomic status (SES) on EFB ingestion in children. The goal was to study SES as a risk factor for dangerous foreign body ingestion and in-hospital complications in children. METHODS This was a retrospective cohort study of children presenting to a tertiary care pediatric hospital with an esophageal foreign body from 2010 to 2021. SES was assessed for each patient by linking their postal code to the Ontario Marginalization Index to determine a quintile score across four dimensions of deprivation: residential instability, material deprivation, dependency, and ethnic concentration. Dangerous EFBs were defined as magnets, batteries, sharp objects, or bones. In-hospital complications included: intensive care unit admission, prolonged length of stay, and postoperative sequelae. RESULTS A total of 680 patients were included. Dangerous EFB ingestion was higher for children with increased residential instability (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.6) and increased material deprivation (OR, 2.2; CI, 1.9-2.8), which was similarly true for odds of complications. Odds of dangerous EFB ingestion were higher in older children (OR, 1.1; CI, 1.0-1.1) and odds of complications were higher in children with comorbidities (OR, 1.1; CI, 1.0-1.3). CONCLUSION Higher levels of housing instability and material deprivation are associated with dangerous EFB ingestion and complications related to EFB ingestion. These findings emphasize the role that SES plays on child health outcomes and the need for initiatives to mitigate these disparities. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2945-2953, 2024.
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Affiliation(s)
- Tanya Chen
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer M Siu
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Yasmine Madan
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gar-Way Ma
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Peter J Gill
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Carman
- Department of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Hashimi B, Shaffer AD, McCoy JL, Chi DH, Padia R. Resource Utilization and Risk Factors for Esophageal Injury in Pediatric Esophageal Foreign Bodies. Laryngoscope 2024. [PMID: 38682805 DOI: 10.1002/lary.31479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE While management protocols of pediatric esophageal foreign bodies (EFBs) are well-delineated, resource utilization can be improved. This study's objectives were to explore hospital charges/costs for pediatric patients who present with EFBs and to identify patient risk factors associated with esophageal injury. METHODS A retrospective chart review of patients undergoing aerodigestive foreign body removal at a tertiary-care children's hospital from 2018 to 2021 was conducted. Data collected included demographics, medical history, presenting symptoms, EFB type, surgical findings, and hospital visit charges/costs. RESULTS 203 patients were included. 178 of 203 (87.7%) patients were admitted prior to operation. Unwitnessed EFB ingestion (p < 0.001, OR = 15.1, 95% CI = 5.88-38.6), experiencing symptoms for longer than a week (p < 0.001, OR = 11.4, 95% CI = 3.66-38.6) and the following presenting symptoms increased the odds of esophageal injury: dysphagia (p = 0.04, OR = 2.45, 95% CI = 1.02-5.85), respiratory distress (p = 0.005, OR = 15.5, 95% CI = 2.09-181), coughing (p < 0.001, OR = 10.1, 95% CI = 3.73-28.2), decreased oral intake (p = 0.001, OR = 6.60, 95% CI = 2.49-17.7), fever (p = 0.001, OR = 5.52, 95% CI = 1.46-19.6), and congestion (p = 0.001, OR = 8.15, 95% CI = 2.42-27.3). None of the 51 asymptomatic patients had esophageal injury. The median total charges during the encounter was $20,808 (interquartile range: $18,636-$24,252), with operating room (OR) (median: $5,396; 28.2%) and inpatient admission (median: $5,520; 26.0%) contributing the greatest percentage. CONCLUSIONS Asymptomatic patients with EFBs did not experience esophageal injury. The OR and inpatient observation accounted for the greatest percentage of the hospital charges. These results support developing a potential algorithm to triage asymptomatic patients to be managed on a same-day outpatient basis to improve the value of care. LEVEL OF EVIDENCE Level 3 Laryngoscope, 2024.
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Affiliation(s)
- Basil Hashimi
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Amber D Shaffer
- Division of Pediatric Otolaryngology, Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Jennifer L McCoy
- Office of Research and Development, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, U.S.A
| | - David H Chi
- Division of Pediatric Otolaryngology, Department of Otolaryngology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Reema Padia
- Division of Pediatric Otolaryngology, Department of Otolaryngology, University of Utah, Salt Lake City, Utah, U.S.A
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Oftring ZS, Mehrtens DM, Mollin J, Hamelmann E, Gaus S. Chronic stridor in a toddler after ingestion of a discharged button battery: a case report. BMC Pediatr 2024; 24:246. [PMID: 38582899 PMCID: PMC10998317 DOI: 10.1186/s12887-024-04730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/30/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Button battery (BB) ingestions (BBI) are increasingly prevalent in children and constitute a significant, potentially life-threatening health hazard, and thus a pediatric emergency. Ingested BBs are usually charged and can cause severe symptom within 2 h. Discharged BBs ingestion is very rare and protracted symptom trajectories complicate diagnosis. Timely imaging is all the more important. Discharged BBs pose specific hazards, such as impaction, and necessitate additional interventions. CASE PRESENTATION We present the case of a previously healthy 19-month-old girl who was admitted to our pediatric university clinic in Germany for assessment of a three-month history of intermittent, mainly inspiratory stridor, snoring and feeding problems (swallowing, crying at the sight of food). The child's physical examination and vital signs were normal. Common infectious causes, such as bronchitis, were ruled out by normal lab results including normal infection parameters, negative serology for common respiratory viruses, and normal blood gas analysis, the absence of fever or pathological auscultation findings. The patient's history contained no evidence of an ingestion or aspiration event, no other red flags (e.g., traveling, contact to TBC). Considering this and with bronchoscopy being the gold standard for foreign body (FB) detection, an x-ray was initially deferred. A diagnostic bronchoscopy, performed to check for airway pathologies, revealed normal mucosal and anatomic findings, but a non-pulsatile bulge in the trachea. Subsequent esophagoscopy showed an undefined FB, lodged in the upper third of the otherwise intact esophagus. The FB was identified as a BB by a chest X-ray. Retrieval of the battery proved extremely difficult due to its wedged position and prolonged ingestion and required a two-stage procedure with consultation of Ear Nose Throat colleagues. Recurring stenosis and regurgitation required one-time esophageal bougienage during follow-up examinations. Since then, the child has been asymptomatic in the biannual endoscopic controls and is thriving satisfactorily. CONCLUSION This case describes the rare and unusual case of a long-term ingested, discharged BB. It underscores the need for heightened vigilance among healthcare providers regarding the potential hazards posed by discharged BBIs in otherwise healthy children with newly, unexplained stridor and feeding problems. This case emphasizes the critical role of early diagnostic imaging and interdisciplinary interventions in ensuring timely management and preventing long-term complications associated even to discharged BBs.
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Affiliation(s)
- Zoe S Oftring
- Department of Paediatrics, University Clinic Giessen & Marburg, Marburg, Germany
- Philipps University Marburg and University Clinic Giessen & Marburg, Institute of Digital Medicine, Marburg, Germany
- Department of Paediatrics, Bielefeld University, University Hospital OWL, Children's Center Bethel, Bielefeld, Germany
| | - Doortje M Mehrtens
- Department of Paediatrics, Bielefeld University, University Hospital OWL, Children's Center Bethel, Bielefeld, Germany
| | - Julian Mollin
- Department of Paediatrics, Bielefeld University, University Hospital OWL, Children's Center Bethel, Bielefeld, Germany
- Clinic Westbrandenburg GmbH, Children's Hospital, Potsdam, Germany
| | - Eckard Hamelmann
- Department of Paediatrics, Bielefeld University, University Hospital OWL, Children's Center Bethel, Bielefeld, Germany
| | - Sebastian Gaus
- Pediatric Emergency Department, Bielefeld University, University Hospital OWL, Children's Center Bethel, Bielefeld, Germany.
- Notaufnahme Kinderzentrum Bethel (NoKi), Evangelisches Klinikum Bethel (EvKB), Universitätsklinik für Kinder-und Jugendmedizin, Grenzweg 10, Bielefeld, 33617, Germany.
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Mao R, Ruan W, Zhu J, Jiang G. Spontaneous extrusion of an ingested plum pit through the umbilicus in a child: A case report. Asian J Surg 2024; 47:1522-1523. [PMID: 38057222 DOI: 10.1016/j.asjsur.2023.11.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Renping Mao
- Department of Neonatal Intensive Care Unit, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, 315012, China
| | - Weiwei Ruan
- Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, 315012, China.
| | - Jianming Zhu
- Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, 315012, China
| | - Guoping Jiang
- Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, 315012, China
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Dursun A, Öztaş T. Management of Foreign Bodies Crossing the Gastroesophageal Junction in Children. Turk Arch Pediatr 2023; 58:607-611. [PMID: 37850664 PMCID: PMC10724748 DOI: 10.5152/turkarchpediatr.2023.23023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/17/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Foreign body (FB) ingestion is a common problem in children and is an important public health problem in terms of causing serious complications. This study aims to evaluate the complication management and intervention rates of FBs crossing the gastroesophageal junction. MATERIALS AND METHODS The hospital records of all children who presented to our clinic because of ingestion of FB between August 2019 and August 2021 were retrospectively reviewed. Patients who had an FB crossing the esophagogastric junction on plain radiographs showing the entire gastrointestinal tract taken at the time of admission were included in this study. Patients who had an FB removed from the esophagus by endoscopy were excluded from this study. RESULTS Of the 127 patients included in this study, 66 (52%) were male and 61 (48%) were female, with a mean age of 4.94 ± 3.15 years (3 months-17 years), and 59% (n = 75) of the patients were under 5 years of age. The most common type of FB was a coin (47%). The first pediatric cases in the literature were a clothespin discovered in the stomach and a Meckel's diverticulum perforated by a sunflower seed shell. Management included spontaneous passing (89%), endoscopy (7%), and open surgery (4%). CONCLUSION Although FBs passing through the esophagogastric junction may be asymptomatic in most cases, the need for close monitoring and surgical intervention should be kept in mind in these patients.
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Affiliation(s)
- Ahmet Dursun
- Department of Pediatric Surgery, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Tülin Öztaş
- Department of Pediatric Surgery, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
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Maggi G, Tessadori M, Marenzoni ML, Porciello F, Caivano D, Marchesi MC. Endoscopic Retrieval of Esophageal and Gastric Foreign Bodies in Cats and Dogs: A Retrospective Study of 92 Cases. Vet Sci 2023; 10:560. [PMID: 37756082 PMCID: PMC10538072 DOI: 10.3390/vetsci10090560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/26/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
Esophageal and gastric foreign bodies (FBs) commonly occur in small animal practices, and their endoscopic removal has been previously reported. However, few studies reported the endoscopic instruments used for the retrieval attempt and the time spent for endoscopic removal. Therefore, the aim of this study is to evaluate the factors that can influence the success rate and timing of the endoscopic retrieval of FBs. The medical records of 92 animals undergoing endoscopic removal of esophageal (n = 12) and gastric (n = 84) FBs have been reviewed. Two dogs had FBs in both the esophagus and stomach. From medical records and video recordings, there were extrapolated data on signalment, clinical signs, endoscopic devices used, success of retrieval, and duration of endoscopy. Endoscopic removal of FBs was successful in 88% cases, and the mean time spent for the extraction was 59.74 min (range, 10-120 min). The success rate and timing for the removal of endoscopic foreign bodies (EFBs) are influenced by several factors in our population: medium-breed dogs, adult animals, and localization of FBs in the body of the stomach increased the probability of failure during the endoscopic retrieval attempt. Conversely, the success and timing of the retrieval of EFBs were higher in puppies and with increasing operator's experience. Moreover, the use of combination devices such as polypectomy snare and grasping forceps negatively influenced the success of extraction of FBs. Further prospective and comparative studies in a large and multicentric population of patients can be useful to create interventional endoscopic guidelines, as in human medicine.
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Affiliation(s)
- Giulia Maggi
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy; (G.M.); (M.L.M.); (F.P.)
| | - Mattia Tessadori
- “Ponte Felcino” Veterinary Clinic, Via della Ghisa 3, 06134 Perugia, Italy;
| | - Maria Luisa Marenzoni
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy; (G.M.); (M.L.M.); (F.P.)
| | - Francesco Porciello
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy; (G.M.); (M.L.M.); (F.P.)
| | - Domenico Caivano
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy; (G.M.); (M.L.M.); (F.P.)
| | - Maria Chiara Marchesi
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy; (G.M.); (M.L.M.); (F.P.)
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Ekim A, Altun A. Foreign body aspirations in childhood: A retrospective review. J Pediatr Nurs 2023; 72:e174-e178. [PMID: 37355460 DOI: 10.1016/j.pedn.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/15/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE The aim of this study was to examine the childhood-age foreign body aspiration (FBA) retrospectively by focusing on symptoms, types, home interventions, hospitalization and complications. METHOD All patients between 0-18 years admitted to pediatric surgical clinic and diagnosed with FBA were examined retrospectively from January 2021 to January 2022. RESULTS The study group consisted of 163 patients and their mean age was 17.8±12.7 months (1 months to 6 years). FBA events included aspiration of food (78%), coins (10%), batteries (3.7%), parts of toys (4%), buttons (2.4%) and other (2%). First aid treatment to children was performed at home by mothers (61%). Types of first aid treatment performed by mothers included tapping the back (31%); cleaning inside the mouth (24%); trying to remove the foreign body with fingers (12%), pushing the foreign body forward (5.9%) and forcing the child to vomit (9.5%) respectively. CONCLUSIONS FBA is a potential life-threatening health problem during childhood. When the age of majority of patients being under one year old and prevalence of food in FBA types are taken into consideration, safe-feeding practices of mothers, feeding position and training about the safe-environment are the basic steps of prevention strategies. PRACTICE IMPLICATIONS One of the most useful ways of preventing FBA cases is to provide planned and continuing education to parents, care givers and all the individuals responsible for the care of the child in order to increase their knowledge and practice levels.
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Affiliation(s)
- Ayfer Ekim
- Faculty of Health Sciences, Department of Pediatric Nursing, Istanbul Arel University, Istanbul, Turkey..
| | - Aslıhan Altun
- Graduate Education Institute, Istanbul Arel University, Istanbul, Turkey
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Almoffarreh H, Alawni O, Mustafa A, Aljaafari A. Unwitnessed Foreign Body Ingestion Causing Significant Morbidity in a Pediatric Patient Who Died During Resuscitation Secondary to Acute Upper Gastrointestinal Bleeding. Cureus 2023; 15:e38752. [PMID: 37180547 PMCID: PMC10171877 DOI: 10.7759/cureus.38752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 05/16/2023] Open
Abstract
Foreign body (FB) ingestion is a common presenting complaint to the emergency department in the pediatric age group; however, management and intervention vary based on the object ingested, location, time since ingestion, and clinical presentation. One of the rare presentations of foreign body ingestion is extreme complications such as upper gastrointestinal (GI) bleeding that requires urgent resuscitation and might need surgical intervention. We urge critical healthcare providers to consider foreign body ingestion in the differential diagnosis of acute unexplained upper gastrointestinal bleeding and maintain a high index of suspicion, and they must endeavor to obtain a complete history.
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Affiliation(s)
- Haitam Almoffarreh
- Pediatric Emergency Medicine, King Abdullah Specialist Children's Hospital, King Abdulaziz Medical City, Riyadh, SAU
| | - Omar Alawni
- Pediatric Emergency Medicine, King Abdullah Specialist Children's Hospital, King Abdulaziz Medical City, Riyadh, SAU
| | - Ahmad Mustafa
- Pediatric Emergency Medicine, King Abdullah Specialist Children's Hospital, King Abdulaziz Medical City, Riyadh, SAU
| | - Azzam Aljaafari
- Pediatric Gastroenterology, King Abdullah Specialist Children's Hospital, King Abdulaziz Medical City, Riyadh, SAU
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An unusual case of gastric ulcers. Asian J Surg 2022; 46:2100-2101. [PMID: 36411167 DOI: 10.1016/j.asjsur.2022.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022] Open
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