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Powers K, Baldassari C, Lucas J. Pediatric Esophageal Foreign Bodies and Caustic Ingestions. Otolaryngol Clin North Am 2024; 57:623-633. [PMID: 38519292 DOI: 10.1016/j.otc.2024.02.016] [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] [Indexed: 03/24/2024]
Abstract
Foreign body ingestions commonly occur in children aged under 6 years. While serious complications of ingestions are rare, sharp objects, caustics, multiple magnets, and button batteries can be associated with poorer outcomes including gastrointestinal (GI) obstruction, perforation, necrosis, and fistula formation. Initial workup should include history, physical examination, and plain film radiographs that will identify radiopaque objects. Removal of the foreign body is typically warranted if the object is high risk, it is located higher up in the GI tract, the patient is symptomatic, or the object is retained for a prolonged amount of time.
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Affiliation(s)
- Kristina Powers
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Cristina Baldassari
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, VA, USA
| | - Jordyn Lucas
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, VA, USA.
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2
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Al Ghadeer HA, AlKadhem SM, Albisher AM, AlAli NH, Al Hassan AS, Alrashed MH, Alali MH, Alturaifi RT, Alabdullah MB, Buzaid AH, Aldandan ZA, Alnasser MH, Aldandan NS, Aljaziri AA. Foreign Body Ingestion: A Common Presentation Among Pediatric Age Group in the City of AlAhsa Eastern Province, Saudi Arabia. Cureus 2022; 14:e31494. [DOI: 10.7759/cureus.31494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
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3
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Esophageal Bougienage for Management of Lodged Esophageal Coins: Safe, Effective, Efficient, and Underused. Pediatr Emerg Care 2022; 38:589-597. [PMID: 36173343 DOI: 10.1097/pec.0000000000002849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aims of the study are to evaluate outcomes of esophageal bougienage for management of lodged esophageal coins and to assess the extent of bougienage usage and barriers among emergency providers. METHODS We performed a retrospective chart review of pediatric patients with single lodged esophageal coins presenting to our single academic pediatric emergency department between November 2012 and December 2018. We compared procedural outcomes, complications, length of stay (LOS), and cost between those managed with bougienage and with endoscopy. We further surveyed emergency physicians to assess the extent of bougienage usage and barriers to utilization across different institutions. RESULTS We identified 205 patients with single lodged esophageal coins presenting during our study window. One hundred forty-seven patients ultimately underwent bougienage with 97% success and no major complications. Fifty-six patients were managed by endoscopy with 100% success and one major complication. Bougienage had significantly lower LOS (median 2.18 vs 11.92 hours, P < 0.001) and hospital charges (median $3533 vs $12,679, P < 0.001) compared with endoscopy. We received 242 completed surveys representing 38 states from primarily academic pediatric emergency physicians. The majority of respondents (90%) used specialist consult with only 4.5% performing bougienage. A total of 36.4% of respondents had never heard of the procedure and only 16.1% had ever performed it. Barriers to usage included lack of provider training (95.6%), perceived risk of complications (94.4%), and perceived lack of success (80.5%). CONCLUSIONS Bougienage is safe and effective with significant LOS and cost benefits compared with endoscopy. Despite these advantages, the procedure is underused, because of lack of provider education and concerns regarding safety, efficacy, and both family and specialist preference, which are not supported by current literature. These data support the need for broader education regarding the bougienage technique, as well as larger prospective studies of its safety and outcomes.
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4
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Rostad BS, Richer EJ, Riedesel EL, Alazraki AL. Esophageal discoid foreign body detection and classification using artificial intelligence. Pediatr Radiol 2022; 52:477-482. [PMID: 34850259 DOI: 10.1007/s00247-021-05240-3] [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: 07/11/2021] [Revised: 10/05/2021] [Accepted: 10/31/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Early and accurate radiographic diagnosis is required for the management of children with radio-opaque esophageal foreign bodies. Button batteries are some of the most dangerous esophageal foreign bodies and coins are among the most common. We hypothesized that artificial intelligence could be used to triage radiographs with esophageal button batteries and coins. OBJECTIVE Our primary objective was to train an object detector to detect esophageal foreign bodies, whether button battery or coin. Our secondary objective was to train an image classifier to classify the detected foreign body as either a button battery or a coin. MATERIALS AND METHODS We trained an object detector to detect button batteries and coins. The training data set for the object detector was 57 radiographs, consisting of 3 groups of 19 images each with either an esophageal button battery, esophageal coin or no foreign body. The foreign bodies were endoscopically confirmed, and the groups were age and gender matched. We then trained an image classifier to classify the detected foreign body as either a button battery or a coin. The training data set for the image classifier consisted of 19 radiographs of button batteries and 19 of coins, cropped from the object detector training data set. The object detector and image classifier were then tested on 103 radiographs with an esophageal foreign body, and 103 radiographs without a foreign body. RESULTS The object detector was 100% sensitive and specific for detecting an esophageal foreign body. The image classifier accurately classified all 6/6 (100%) button batteries in the testing data set and 93/95 (97.9%) of the coins. The remaining two coins were incorrectly classified as button batteries. In addition to these images with a single button battery or coin, there were two unique cases in the testing data set: a stacked button battery and coin, and two stacked coins, both of which were classified as coins. CONCLUSION Artificial intelligence models show promise in detecting and classifying esophageal discoid foreign bodies and could potentially be used to triage radiographs for radiologist interpretation.
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Affiliation(s)
- Bradley S Rostad
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA, 30322, USA. .,Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Edward J Richer
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA, 30322, USA.,Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Erica L Riedesel
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA, 30322, USA.,Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Adina L Alazraki
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA, 30322, USA.,Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta, Atlanta, GA, USA
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5
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Gatto A, Capossela L, Ferretti S, Orlandi M, Pansini V, Curatola A, Chiaretti A. Foreign Body Ingestion in Children: Epidemiological, Clinical Features and Outcome in a Third Level Emergency Department. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121182. [PMID: 34943378 PMCID: PMC8700598 DOI: 10.3390/children8121182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/16/2022]
Abstract
Ingestion of foreign bodies is a frequent pediatric cause of access to the Emergency Department (ED). The aim of this study was to determine the epidemiological and clinical features of pediatric patients with a diagnosis of foreign body ingestion and to identify the factors associated with an urgent invasive procedure or hospitalization. This is a retrospective study conducted on a population of 286 pediatric patients (0-17 years) evaluated for foreign body ingestion at the Pediatric ED of "Fondazione Policlinico Universitario A. Gemelli, IRCSS" between October 2014 and June 2019. Data concerning age and gender, underlying diseases, type of foreign body, symptoms and signs, instrumental tests, specialist visits, treatment and outcome were analyzed. The majority of foreign bodies were coins (23%). Symptoms recurred in 50% of the foreign bodies with esophageal localization and between the 92 (32%) patients with symptoms the most common was vomiting (7%). X-rays was performed in 61% of patients. Among all patients, 253 patients (88.8%) had been discharged, 21 (7%) had been hospitalized, and four (1.4%) were sent to an outpatient facility. Besides, 17 (5.9%) patients had been transferred to the Observation Unit. Of the hospitalized patients (21 (7.3%)), clinical observation was performed for 57% and endoscopic procedure for 45%. Our data confirm that the ESPGHAN-ESGE guidelines application prevents interventions that are not necessary, avoiding diagnostic and therapeutic delays.
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Affiliation(s)
- Antonio Gatto
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Correspondence:
| | - Lavinia Capossela
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Serena Ferretti
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Michela Orlandi
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Valeria Pansini
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Antonietta Curatola
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
| | - Antonio Chiaretti
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS—Università Cattolica Sacro Cuore, 00168 Rome, Italy; (L.C.); (S.F.); (M.O.); (A.C.); (A.C.)
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6
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Ibrahim AH, Andijani A, Abdulshakour M, Algain S, Thamrah AA, Ali MM, Marwah H, Aldaher A, Bashir S, Alsaleem B, Asery A, Al-Hussaini A. What Do Saudi Children Ingest?: A 10-Year Retrospective Analysis of Ingested Foreign Bodies From a Tertiary Care Center. Pediatr Emerg Care 2021; 37:e1044-e1050. [PMID: 31348207 PMCID: PMC8667801 DOI: 10.1097/pec.0000000000001894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Few studies investigated the correlation between foreign body (FB) ingestion and occurrence of complications. The local literature is limited to case reports and small case series on esophageal FBs. We conducted this study to identify the high-risk factors predisposing to complications among Saudi children ingesting FBs. METHODS The medical records of 436 children (boys, 59.6%; mean age, 4.4 ± 2.7 years) presenting to the emergency department (ED) between 2007 and 2016 were retrospectively reviewed. Relative risk analysis of clinical variables was performed between 2 groups: The first group constituted children without FB-related complications (n = 389), and the second group included those with major complications (n = 14). Major complication was defined as any event associated with significant morbidity such as esophageal stricture, esophageal perforation, esophageal fistula, and intestinal perforation or fistula formation. RESULTS Most of the 436 cases presented between ages 2 and 4 years (35.1%). Coin was the most commonly ingested FB (22.9%) followed by button battery (19.5%). Most of the ingested FBs passed spontaneously without intervention (69%). Upper endoscopy was performed in 121 cases (27.7%). By multivariate analysis, the variables that were significantly associated with major complications included the following: very young age group (0-2 years; odds ratio [OR], 11.5), button battery (OR, 4), FB impacted at upper esophagus (OR, 8.7), and longer time duration to visit the ED (OR, 14.7). CONCLUSION Button battery impaction at upper esophagus in very young children and delayed presentation to the ED were the most significant risk factors of FB-related complications.
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Affiliation(s)
- Ahmed H. Ibrahim
- From the Children’s Specialized Hospital, King Fahad Medical City
| | | | | | - Sulwan Algain
- From the Children’s Specialized Hospital, King Fahad Medical City
| | - Asma Abu Thamrah
- From the Children’s Specialized Hospital, King Fahad Medical City
| | - Mariam M. Ali
- From the Children’s Specialized Hospital, King Fahad Medical City
| | - Haifa Marwah
- From the Children’s Specialized Hospital, King Fahad Medical City
| | - Anwaar Aldaher
- From the Children’s Specialized Hospital, King Fahad Medical City
| | - Salman Bashir
- Department of Biostatistics, Research Services Administration, Research Center, King Fahad Medical City
| | - Badr Alsaleem
- Division of Pediatric Gastroenterology, Children’s Specialized Hospital, King Fahad Medical City
| | - Ali Asery
- Division of Pediatric Gastroenterology, Children’s Specialized Hospital, King Fahad Medical City
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7
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Safavi AR, Brook CD, Sakai O, Setty BN, Zumwalt A, Gonzalez Md M, Platt MP. Urgency of Esophageal Foreign Body Removal: Differentiation Between Coins and Button Cell Batteries. Otolaryngol Head Neck Surg 2021; 166:80-85. [PMID: 33940963 DOI: 10.1177/01945998211008384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Coin-shaped button battery foreign bodies have a similar initial presentation to coin ingestion, but delayed retrieval of a battery from the esophagus can have devastating consequences. Variations in timing of retrieval for children with ingestion of coin foreign bodies have been reported. The study assesses the sensitivity and specificity of conventional and digital radiographs to differentiate button batteries from coin foreign bodies. STUDY DESIGN 3B case control study. STUDY SETTING Tertiary academic medical center. METHODS A radiographic study of the 12 most common commercially available button batteries and 66 coins of varying international origins was performed. Foreign bodies were placed at the cervical esophagus of a cadaver, and anteroposterior (AP) and lateral conventional radiographs of the neck were obtained. Digital AP and lateral radiographs of standalone coins and batteries were also obtained. Images were blindly read by 2 otolaryngologists and 2 radiologists. Statistical analysis was performed to determine accuracy in identifying coins vs batteries. RESULTS Using conventional radiographs to identify button batteries yielded a sensitivity of 0.88 and a specificity of 0.92 (positive predictive value [PPV] = 0.75, negative predictive value [NPV] = 0.97). Digital radiography yielded an overall sensitivity of 0.98 and specificity of 0.97 (PPV = 0.87, NPV = 0.99). Features of button batteries were only seen on AP conventional radiographs using reverse contrast. CONCLUSIONS Neither conventional nor digital radiographic imaging had perfect accuracy in identifying coins vs batteries. Features of common disc batteries were identified, which may aid in diagnosis. With potential devastating consequences from retained battery in the esophagus, emergent removal of any possible disc battery foreign body should be considered.
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Affiliation(s)
- Arash R Safavi
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Christopher D Brook
- Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Osamu Sakai
- Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Bindu N Setty
- Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Ann Zumwalt
- Boston Medical Center, Boston, Massachusetts, USA
| | - Mauricio Gonzalez Md
- Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - Michael P Platt
- Boston University School of Medicine, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
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8
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Pugh A, Schunk J, Ryan S. A 3-year-old boy with rapid obstructive symptoms secondary to coin ingestion and gastric impaction. J Am Coll Emerg Physicians Open 2021; 2:e12382. [PMID: 33532762 PMCID: PMC7831616 DOI: 10.1002/emp2.12382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/02/2021] [Accepted: 01/14/2021] [Indexed: 11/06/2022] Open
Abstract
Foreign body ingestion is a common problem in children; blunt objects occur most frequently, and coins are the most common culprit. Rarely does coin ingestion lead to serious consequences other than esophageal impaction. In this report, we present the case of a healthy 3-year-old boy who developed rapid obstructive symptoms after the ingestion of a coin that required endoscopic retrieval from the stomach. Obstruction attributed to an ingested coin once post-esophageal is a rare complication of a relatively common presenting complaint.
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Affiliation(s)
- Andrew Pugh
- Division of Emergency Medicine, Department of SurgeryUniversity of UtahSalt LakeUtahUSA
| | - Jeff Schunk
- Division of Pediatric Emergency Medicine, Department of PediatricsPrimary Children's HospitalSalt LakeUtahUSA
| | - Sydney Ryan
- Division of Pediatric Emergency Medicine, Department of PediatricsPrimary Children's HospitalSalt LakeUtahUSA
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9
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Dorterler ME, Günendi T. Foreign Body and Caustic Substance Ingestion in Childhood. Open Access Emerg Med 2020; 12:341-352. [PMID: 33177894 PMCID: PMC7649222 DOI: 10.2147/oaem.s241190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 07/14/2020] [Indexed: 01/08/2023] Open
Abstract
Foreign body and caustic substance ingestion in childhood are common and require accurate and timely diagnosis to provide appropriate management consistent with the ingested substance/foreign body and clinical presentation as well as the associated risk status to prevent significant complications and morbidity. The aim of this paper was to present foreign body and caustic ingestion in childhood in terms of epidemiology, pathophysiology, diagnostic work-up and appropriate management and potential complications in accordance with clinical presentation and the type of ingested substance/foreign body.
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Affiliation(s)
| | - Tansel Günendi
- Harran University Faculty of Medicine, Department of Pediatric Surgery, Sanliurfa, Turkey
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10
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Oliva S, Romano C, De Angelis P, Isoldi S, Mantegazza C, Felici E, Dabizzi E, Fava G, Renzo S, Strisciuglio C, Quitadamo P, Saccomani MD, Bramuzzo M, Orizio P, Nardo GD, Bortoluzzi F, Pellegrino M, Illiceto MT, Torroni F, Cisarò F, Zullo A, Macchini F, Gaiani F, Raffaele A, Bizzarri B, Arrigo S, De' Angelis GL, Martinelli M, Norsa L. Foreign body and caustic ingestions in children: A clinical practice guideline. Dig Liver Dis 2020; 52:1266-1281. [PMID: 32782094 DOI: 10.1016/j.dld.2020.07.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022]
Abstract
Foreign body and caustic ingestions in children are usually the most common clinical challenges for emergency physicians, general pediatricians and pediatric gastroenterologists. Management of these conditions often requires different levels of expertise and competence. Endoscopy is often necessary but there is a high risk of misusing this tool with incorrect timing and indications. The imprecise clinical history frequently leaves clinicians uncertain about timing and nature of the ingestion. Few clinical guidelines regarding management of these ingestions in children have been published, none of which from the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). An expert panel of Italian endoscopists was convened by the SIGENP Endoscopy Working Group to produce the present article that outlines practical clinical approaches to the pediatric patient with a variety of foreign body and caustic ingestions. The Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) has also endorsed the project since many adult endoscopists usually manage children with these conditions. Differently from the other published guidelines, the proposed one focuses on the role of the endoscopists (regardless of whether they are adult or pediatric gastroenterologists) in the diagnostic process of children with foreign body and caustic ingestions.
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Affiliation(s)
- Salvatore Oliva
- Maternal and Child Health Department, Pediatric Gastroenterology and Liver Unit, Sapienza - University of Rome, Rome, Italy.
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology and Pediatrics, University of Messina, Italy
| | - Paola De Angelis
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Isoldi
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Cecilia Mantegazza
- Pediatric Gastroenterology and Digestive Endoscopic Unit, Department of Pediatrics and Pediatric Surgery, University of Milan, Buzzi Children's hospital, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Emanuele Dabizzi
- Gastrointestinal and Interventional Endoscopy Unit, Surgical Department, AUSL Bologna, Bologna, Italy
| | - Giorgio Fava
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Renzo
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Florence, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | | | - Matteo Bramuzzo
- Pediatric Gastroenterology, Digestive Endoscopy and Clinical Nutrition Unit, Department of Pediatric, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Paolo Orizio
- Department of Pediatric Surgery, Spedali Civili Children's Hospital, Brescia, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Sapienza University of Rome, Sant'Andrea University Hospital
| | | | - Maristella Pellegrino
- Pediatric Surgery Unit, Maternal and Child Department, ASST GOM of Niguarda, Milan, Italy
| | - Maria Teresa Illiceto
- Pediatric Gastroenterology and Digestive Endoscopic Unit, Department of Pediatrics, "Santo Spirito" Hospital of Pescara, Italy
| | - Filippo Torroni
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Cisarò
- Pediatric Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera-Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Alessandro Raffaele
- Pediatric Surgery Unit, Department of Maternal and Child health, IRCCS Policlinico San Matteo Pavia and Department of Clinical-Surgical, Diagnostic and Pediatric Science, University of Pavia, Italy
| | - Barbara Bizzarri
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Unit, Institute Giannina Gaslini, Genoa, Italy
| | - Gian Luigi De' Angelis
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Massimo Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Norsa
- Pediatric Hepatology Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
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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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12
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Fujisawa J, Mutoh T, Kawamura K, Yonezawa R, Hirai M, Morioka I. Age-Specific Differences in Foreign Bodies Ingested by Children: A Cohort Study of 252 Japanese Cases. ACTA ACUST UNITED AC 2020; 56:medicina56010039. [PMID: 31963841 PMCID: PMC7023417 DOI: 10.3390/medicina56010039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 12/23/2022]
Abstract
Background and Objectives: When children accidentally ingest foreign bodies, they may be unable to communicate adequately; it is often difficult to identify the causative foreign body unless someone is watching over them. In such instances, to identify the causative foreign body during clinical practice, we aimed to determine if it varies according to age. Materials and Methods: From April 2013 to June 2018, 252 records of pediatric patients with a confirmed diagnosis of foreign-body ingestion were retrospectively examined in a Japanese university hospital. Comparisons among multiple age groups, according to type of ingested foreign body, were analyzed using Kruskal‒Wallis tests. The differences between the individual data were tested using the Steel‒Dwass test. Results: The median age of the patients was 15 months, and of the total patients, 140 were boys (55.5%). The types of foreign bodies ingested were as follows, in order of frequency: cigarettes (n = 44, 17%, median age: 12 months), plastics (n = 43, 17%, median age: 11 months), chemicals (n = 27, 11%, median age: 13 months), internal medicines (n = 26, 10%, median age: 33 months), and metals (n = 26, 10%, median age: 35 months). The median age was significantly different among the types of causative foreign bodies (p < 0.01). The patient age for the ingestion of cigarettes was significantly younger than that for ingesting metals or coins. The age for ingesting internal medicines was significantly older than that for ingesting plastics, cigarettes, paper, or chemicals (p < 0.01). Conclusions: The causative foreign body ingested differed according to age. This will be valuable information for physicians that encounter pediatric patients who may have ingested an unknown foreign body in Japanese pediatric emergency or general practice settings.
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Endoscopic management of foreign body ingestion in children. GASTROENTEROLOGY REVIEW 2020; 15:349-353. [PMID: 33777276 PMCID: PMC7988830 DOI: 10.5114/pg.2020.101563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/29/2019] [Indexed: 11/17/2022]
Abstract
Introduction Foreign body ingestion is common in children. Most accidental ingestions are passed spontaneously without intervention. Some cases of ingestion require intervention in a timely fashion to reduce risks and morbidities. Aim To analyse the clinical presentation, aetiology, and outcome of children presenting with foreign body ingestion, who required endoscopic intervention at a tertiary hospital (King Abdullah University Hospital, Irbid, Jordan). Material and methods Records of all patients with ingested foreign bodies requiring endoscopic retrieval over a 3-year period were reviewed retrospectively. Data on age, sex, type of ingested foreign body, presentation, type of intervention, stuck and retrieval location, outcome, and complications were collected. Results Of the sixty-three patients identified, 32 (50.8%) were male. Mean patient age was 7.7 ±3.4 years (range: 1 month-17.4 years). Most patients (74.6%) presented asymptomatically after the family or the child reported ingestion. Coins were the most commonly retrieved foreign bodies (37, 58.7%). The oesophagus was the most common site of retrieval (45, 71%). A rat tooth forceps was most commonly used to retrieve coins, followed by a net basket. Endoscopy was effective in managing the foreign body in 57 (90.5%) cases. Surgery was needed in 1 (1.6%) patient, a 1-month-old infant with a plastic tube in his stomach. All patients tolerated the procedure well with no complications. Interestingly, 7 (11.1%) male patients showed endoscopic features of eosinophilic oesophagitis; eosinophilic oesophagitis was confirmed histopathologically in three of them. Conclusions Endoscopic intervention is effective and well tolerated in the management of ingested foreign bodies in the upper gastrointestinal system. Parents and children should be cautioned against playing with coins, to reduce the incidence of foreign body ingestion.
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14
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Shen XF, Li Q. Which coin is easier to pass esophagus spontaneously? Int J Pediatr Otorhinolaryngol 2019; 126:109596. [PMID: 31357144 DOI: 10.1016/j.ijporl.2019.109596] [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: 06/09/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the factors associated with the spontaneous passage (SP) of coins lodged in the esophagus in children. SUBJECTS AND METHODS A total of 351 pediatric patients with coin ingestion admitted to our hospital from March 2016 to March 2019 were included in the study. The patients underwent a period of overnight watch with a repeated chest x-ray within 24 h after the commencement of hospitalization. The influencing factors (sex, age, types of coin, time in the esophagus, and location) were analyzed. RESULTS The repeated chest x-ray showed coins that had passed into the stomach or intestine in 68 patients. Sex, age, time in the esophagus, location in the esophagus or the types of coins were not associated with SP, but the distribution of the esophageal coins varied statistically significantly in the different ages. CONCLUSION Coins pass spontaneously through the esophagus (19.4%) within 24 h, unrelated to sex, age, time of esophagus lodging, coin location in the esophagus, or coin types. Children approximately two years old were more likely to ingest small coins (10 or 50 cents), whereas children approximately five years old were more likely to ingest a large coin (1 Yuan).
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Affiliation(s)
- Xiao-Fei Shen
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Jiangsu, PR China
| | - Qi Li
- Department of Otorhinolaryngology, Children's Hospital of Nanjing Medical University, Jiangsu, PR China; Department of Otorhinolaryngology, Nanjing Children's Hospital, Affiliated to Medical School of Nanjing University, Jiangsu, PR China.
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15
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Xiong Y, Yu J, Luo Q, Jiang H, Zhang J. Novel Bougie for the Management of Esophageal Coins in Children: An Observational Study. Ann Otol Rhinol Laryngol 2019; 128:503-507. [PMID: 30758230 DOI: 10.1177/0003489419828764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To determine the efficacy and safety of a novel bougie for the removal of esophageal coins lodged in the proximal esophagus. SUBJECTS AND METHODS This was an observational study. Medical records were reviewed of patients who were confirmed with esophageal coins between July 2015 and October 2016 in our department. Sixty-three patients, upper esophageal coins were confirmed by radiographs, were treated by using this novel bougie to remove esophageal coins. RESULTS A total of 63 children were enrolled in this study. Sixty coins (95%) were removed successfully. The coin was extracted on the first attempt in 56 cases (89%), the second attempt in 3 cases (5%), and the third attempt in 1 case (2%). Two coins retained in the esophagus underwent endoscopy. In the remaining patient, the coin passed into the stomach and was confirmed to be passed in the stool within 48 hours. No serious complications occurred in any subject. CONCLUSIONS Our novel bougie procedure is likely a safe, highly efficient approach to managing esophageal coins given that no serious complications of the 63 patients were reported. This simple technique may provide another valuable option to physicians.
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Affiliation(s)
- Yuanping Xiong
- 1 First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jieqing Yu
- 1 First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qing Luo
- 1 First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hongqun Jiang
- 1 First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jian Zhang
- 1 First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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16
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Tursunov KT, Mendigaliev EK, Sagymbayeva AA, Sagymbayeva AA. [Common foreign bodies of the intestine in the child]. Khirurgiia (Mosk) 2019:77-79. [PMID: 31120452 DOI: 10.17116/hirurgia201904177] [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] [Indexed: 06/09/2023]
Abstract
It is presented case report of diagnosis and treatment of foreign body of the intestine (magnets) in the 5-year-old child.
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Affiliation(s)
- K T Tursunov
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - E K Mendigaliev
- Kazakh Medical University of Continuing Education, Almaty, Kazakhstan
| | | | - A A Sagymbayeva
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
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17
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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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18
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Huyett P, Shaffer A, Flom L, Simons JP, Jabbour N. Accuracy of chest X-Ray measurements of pediatric esophageal coins. Int J Pediatr Otorhinolaryngol 2018; 113:1-3. [PMID: 30173964 DOI: 10.1016/j.ijporl.2018.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/05/2018] [Accepted: 07/07/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the accuracy of chest x-ray measurements in children using ingested radiopaque foreign bodies of known size. METHODS A database of foreign body ingestions at a tertiary care children's hospital was queried from 2013 to 2016 for children who had ingested a US coin, had a pre-operative chest x-ray and documentation of coin type at the time of endoscopic removal. Four blinded research subjects measured the coin diameter on chest x-ray using iSite PACS software and based on the measurement, predicted the coin type. Measurements were compared to the known coin diameters published by the US Mint. RESULTS A total of 51 patients with sixteen esophageal quarters (diameter 24.26 mm), fourteen nickels (21.21 mm), fourteen pennies (19.05 mm) and seven dimes (17.91 mm) were included in the study. The four subjects had a mean accuracy of 60.3% (range 49.0%-72.5%) in predicting the correct coin type. Across all raters, there was poor agreement for pennies (kappa = 0.161) and dimes (kappa = 0.131), fair agreement for nickels (kappa = 0.259), good agreement for quarters (kappa = 0.687), and fair agreement overall (kappa = 0.371). The study measurements overestimated the coin size in 203 of the 204 measurements by a mean of 1.84 mm (range -0.31-3.85 mm). The mean size discrepancy was larger (2.40 vs. 1.30 mm, p < 0.001) and accuracy of coin type identification was worse (44.6% vs. 74.1%, p = 0.001) in children <4 years old. CONCLUSIONS Measurement of esophageal coins on chest x-ray is relatively inaccurate and overestimates the size in the majority of cases. Clinicians should use caution when performing fine measurements on chest x-rays, especially in children younger than 4 years old.
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Affiliation(s)
- Phillip Huyett
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Amber Shaffer
- Department of Otolaryngology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Linda Flom
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey P Simons
- Department of Otolaryngology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Noel Jabbour
- Department of Otolaryngology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Utilization of a handheld metal detector protocol to reduce radiation exposure in pediatric patients with esophageal coins. Int J Pediatr Otorhinolaryngol 2018; 112:104-108. [PMID: 30055717 DOI: 10.1016/j.ijporl.2018.06.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/25/2018] [Accepted: 06/25/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The primary objective of this study is to assess the utility of a handheld metal detector for identification and surveillance of patients with known esophageal coin ingestion to reduce repeat x-rays and associated radiation exposure. METHODS Prospective study of children presented to the emergency department with esophageal coins confirmed by an initial x-ray were enrolled. The otolaryngology team used the handheld metal detector to detect and localize the coin on patient. If admitted for observation, the metal detector was used to ensure coin persistence prior to going to operating room for removal. No further x-rays were done if same location is confirmed. RESULTS A total of 19 patients (10 months-14 years) with 20 esophageal coins were enrolled. 14 patients (73.7%) were initially detected in the emergency department by the metal detector. 11 (58%) asymptomatic patients admitted for period of observation, repeat x-rays were avoided in 10 (90.9%) patients prior to removal in the OR. All proximal esophageal coins were detected with the metal detector. There were 5 (26.3%) patients who failed initial detection of coin, and all of these were in the mid-distal esophageal location with depth from skin >7 cm. CONCLUSION A handheld metal detector is rapid, cost-effective surveillance tool to reduce exposure to radiation from repeated x-rays in patients with esophageal coins. In contrast to all prior published studies, which did not objectively examine depth, the distance of the coin from skin surface appears to be a major limitation. Parents have provided positive feedback on the protocol.
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20
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Saadeh C, Ulualp SO. An uncommon source for oesophageal foreign body: Fidget spinner. SAGE Open Med Case Rep 2018; 6:2050313X18781229. [PMID: 29977556 PMCID: PMC6024347 DOI: 10.1177/2050313x18781229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/15/2018] [Indexed: 01/21/2023] Open
Abstract
Fidget spinner is a new handheld toy with potential choking and ingestion hazard. Our objectives are to describe clinical presentation of a child with fidget spinner ingestion and draw attention to danger associated with fidget spinner. A 3-year-old boy presented with painful swallowing and feeling of something stuck in the throat. A chest radiograph revealed a radiopaque foreign body with a disc-like component. Rigid oesophagoscopy revealed a foreign object with disc battery and battery holder circuit board. Clinicians should consider the fidget spinner as one of many varieties of toys that has potential for button battery ingestion or aspiration.
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Affiliation(s)
- Charles Saadeh
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Seckin O Ulualp
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Pediatric Otolaryngology, Children's Health, Dallas, TX, USA
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21
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Govindarajan KK. Esophageal perforation in children: etiology and management, with special reference to endoscopic esophageal perforation. KOREAN JOURNAL OF PEDIATRICS 2018; 61:175-179. [PMID: 29963100 PMCID: PMC6021361 DOI: 10.3345/kjp.2018.61.6.175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/06/2018] [Accepted: 04/29/2018] [Indexed: 01/08/2023]
Abstract
Perforation of the esophagus is an uncommon problem with significant morbidity and mortality. In children undergoing endoscopy, the risk of perforation is higher when interventional endoscopy is performed. The clinical features depend upon the site of esophageal perforation. Opinions vary regarding the optimal treatment protocol, and the role of conservative management in this context is not well established. Esophageal perforation that occurs as a consequence of endoscopy in children requires careful evaluation and management, as outlined in this article.
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Affiliation(s)
- Krishna Kumar Govindarajan
- Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
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22
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Abstract
Unintentional foreign body ingestion is common among children. Normally, these ingested foreign bodies pass spontaneously and the rest can be removed endoscopically; only few ingested foreign bodies lead to complications and need surgical intervention. We are reporting a case of accidental nail ingestion in a 10-year-old child which led to a sealed perforation of duodenum. Operative management included primary duodenal repair after removal of nail. Post operative recovery was smooth and oral was started on day 5. We recommend that all ingested sharp and large foreign bodies should be removed endoscopically, if not passed spontaneously.
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Affiliation(s)
- Fatima Naumeri
- Dr. Fatima Naumeri, MCPS. FCPS. Department of Pediatric Surgery, King Edward Medical University, Lahore, Pakistan
| | - Bilal Qayyum
- Dr. Bilal Qayyum, Department of Pediatric Surgery, King Edward Medical University, Lahore, Pakistan
| | - Muhammad Sohaib Yousaf
- Dr. Muhammad Sohaib Yousaf, Department of Pediatric Surgery, King Edward Medical University, Lahore, Pakistan
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23
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Chang CS, Wallace CG, Hsiao YC, Huang JJ, Chen ZC, Chang CJ, Lo LJ, Chen PKT, Chen JP, Chen YR. Clinical evaluation of silicone gel in the treatment of cleft lip scars. Sci Rep 2018; 8:7422. [PMID: 29743500 PMCID: PMC5943303 DOI: 10.1038/s41598-018-25697-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/26/2018] [Indexed: 01/22/2023] Open
Abstract
Upper lip scars are at risk of hypertrophy. Our center therefore uses microporous tape and silicone sheeting for postoperative scar care following cleft lip repair. However, some babies have previously ingested their silicone sheeting, which has the potential for respiratory compromise or gastrointestinal obstruction. Self-dry silicone gel is reportedly also effective for preventing hypertrophic scars. Hence, we sought to test whether silicone gel, which cannot be ingested whole, might be non-inferior to silicone sheeting for controlling against upper lip scar hypertrophy. This was a mixed prospective and retrospective case-controlled clinical trial involving patients undergoing unilateral cleft lip repair, 29 of whom received standard postoperative silicone sheeting (control group) and another 33 age-matched consecutive patients who received self-dry silicone instead. The Vancouver scar scale, visual analogue scale and photographically assessed scar width assessments were the same in both groups at six months after surgery. In conclusion, silicone gel appears to be non-inferior to silicone sheeting for postoperative care of upper lip scars as judged by scar quality at six months, but silicone sheeting has the safety disadvantage that it can be swallowed whole by babies. It is thus recommended that silicone gel be used for upper lip scar management in babies.
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Affiliation(s)
- Chun-Shin Chang
- Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan.,Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery and Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Plastic Surgery, Xiamen Chang Gung Hospital, Xiamen, China
| | - Christopher Glenn Wallace
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery and Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Plastic Surgery, Royal Devon & Exeter Hospital, Exeter, EX1 1AP, United Kingdom
| | - Yen-Chang Hsiao
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery and Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jung-Ju Huang
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery and Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Plastic Surgery, Xiamen Chang Gung Hospital, Xiamen, China
| | - Zung-Chung Chen
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery and Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Plastic Surgery, Xiamen Chang Gung Hospital, Xiamen, China
| | - Chee-Jen Chang
- Graduate Institute of Clinical Medical Sciences, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lun-Jou Lo
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery and Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Philip Kuo-Ting Chen
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery and Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Jyh-Ping Chen
- Department of Chemical and Materials Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ray Chen
- Craniofacial Research Center, Department of Medical Research, Department of Plastic & Reconstructive Surgery and Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Abstract
Foreign body (FB) ingestion in children is common and most children are observed to be between 6 months and 3 years of age. Although most FBs in the gastrointestinal tract pass spontaneously without complications, endoscopic or surgical removal may be required in a few children. Thus, FB ingestion presents a significant clinical difficulty in pediatric gastroenterological practice. Parameters that need to be considered regarding the timing of endoscopic removal of ingested FBs in children are the children's age or body weight, the clinical presentation, time lapse since ingestion, time of last meal, type as well as size and shape of the FB, and its current location in the gastrointestinal tract. Esophageal button batteries require emergency removal regardless of the presence of symptoms because they can cause serious complications. Coins, magnets, or sharp FBs in the esophagus should be removed within 2 hours in symptomatic and within 24 hours in asymptomatic children. Among those presenting with a single or multiple magnets and a metallic FB that have advanced beyond the stomach, symptomatic children need a consultation with a pediatric surgeon for surgery, and asymptomatic children may be followed with serial X-rays to assess progression. Sharp or pointed, and long or large and wide FBs located in the esophagus or stomach require endoscopic removal.
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Affiliation(s)
- Ji Hyuk Lee
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
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25
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Affiliation(s)
| | | | - Jyoti Ramakrishna
- Division of Pediatric Gastroenterology and Nutrition, Tufts Floating Hospital for Children, Boston, MA
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26
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Esophageal foreign bodies in children: Emphasis on complicated cases. Asian J Surg 2017; 40:362-366. [DOI: 10.1016/j.asjsur.2015.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/18/2015] [Accepted: 12/28/2015] [Indexed: 11/21/2022] Open
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Abstract
Most otolaryngology-related complaints are straightforward and easily recognized and treated. However, given the proximity of the ears, nose, and throat to numerous vital structures in the head and neck, the potential for serious consequences exists if disease processes go unrecognized and untreated. This article serves to familiarize the primary care provider with the clinical presentation of various complications associated with common otolaryngologic complaints. Clinicians who care for patients presenting with otolaryngologic complaints should keep these entities in mind and attempt to rule out any serious complication.
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28
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Shakir AK, Ramji F, El Halabi I. Penny for Your Thoughts; A Coin in the Stomach: Why Did It Get Stuck? Hosp Pediatr 2017; 7:294-296. [PMID: 28400420 DOI: 10.1542/hpeds.2016-0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Asiya K Shakir
- Section of Pediatric Gastroenterology, Department of Pediatrics, and
| | - Faridali Ramji
- Section of Pediatric Imaging, Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Issam El Halabi
- Section of Pediatric Gastroenterology, Department of Pediatrics, and
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29
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The utility of a handheld metal detector in detection and localization of pediatric metallic foreign body ingestion. Int J Pediatr Otorhinolaryngol 2017; 92:1-6. [PMID: 28012507 DOI: 10.1016/j.ijporl.2016.10.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 10/27/2016] [Accepted: 10/29/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To test the ability of a handheld metal detector (HHMD) to identify the presence and location of ingested metallic foreign bodies (MFBs) in children. METHODS Prospective case series enrolling children suspected of metallic foreign body ingestion presenting to the Emergency Department. Thirty-eight children were enrolled and the HHMD was used to detect the presence and location of a MFB. Results were compared to standard radiographic studies. RESULTS Thirty-seven of the 38 ingested foreign bodies were MFBs. Of the 37 MFBs, the HHMD positively identified 33, and 4 were missed by HHMD but identified on radiography. When positive, the location indicated by HHMD correlated 100% with radiograph. There were 33 true positives, 0 false positives, 4 false negatives, and 1 true negative. This resulted in a sensitivity of 89% (95% CI of 75%-96%) and specificity of 100% (95% CI of 2.5%-100%). CONCLUSION Our study demonstrates the accuracy of HHMD in the identification and localization of metallic foreign bodies. We propose an emergency room foreign body protocol that uses HHMD as an early screening tool in triage in order to expedite the process of obtaining Otolaryngology consultation and potentially shorten the wait time to the operating room or discharge. In instances were outside films are previously performed, HHMD use may be able to minimize the overall radiation exposure to children by obviating the need for repeat radiographs. As the sensitivity is not 100%, a negative HHMD screening does not negate the need for a standard radiograph in order to avoid missed MFBs. HHMD is best suited for detection of coins, which accounts for the majority of the MFB ingestions, and may not be suitable for all metallic objects since the amount of metal may decrease its sensitivity.
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Thomson M, Tringali A, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, Spaander M, Hassan C, Tzvinikos C, Ijsselstijn H, Viala J, Dall'Oglio L, Benninga M, Orel R, Vandenplas Y, Keil R, Romano C, Brownstone E, Hlava Š, Gerner P, Dolak W, Landi R, Huber WD, Everett S, Vecsei A, Aabakken L, Amil-Dias J, Zambelli A. Paediatric Gastrointestinal Endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy Guidelines. J Pediatr Gastroenterol Nutr 2017; 64:133-153. [PMID: 27622898 DOI: 10.1097/mpg.0000000000001408] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This guideline refers to infants, children, and adolescents ages 0 to 18 years. The areas covered include indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileocolonoscopy; endoscopy for foreign body ingestion; corrosive ingestion and stricture/stenosis endoscopic management; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangiopancreatography; and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease has been dealt with in other guidelines and are therefore not mentioned in this guideline. Training and ongoing skill maintenance are to be dealt with in an imminent sister publication to this.
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Affiliation(s)
- Mike Thomson
- *International Academy for Paediatric Endoscopy Training, Sheffield Children's Hospital, Weston Bank, Sheffield, UK †Digestive Endoscopy Unit, Catholic University, Rome, Italy ‡Gedyt Endoscopy Center, Buenos Aires, Argentina §Department of Pediatric Gastroenterology, Centro Hospitalar de São João, Porto, Portugal ||Department of Pediatric Gastroenterology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands ¶Department of Pediatric Gastroenterology and Nutrition, University Children's Hospital Basel, Basel, Switzerland #Department of Gastroenterology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands **Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy ††Department of Pediatric Gastroenterology, Alder Hey Children's Hospital, Liverpool, UK ‡‡Department of Pediatric Surgery and Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands §§Department of Pediatric Gastroenterology, Robert-Debré Hospital, Paris, France ||||Digestive Endoscopy and Surgery Unit, Bambino Gesù Children Hospital-IRCCS, Rome, Italy ¶¶Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia ##Pediatric Gastroenterology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium ***Department of Gastroenterology, Motol University Hospital, Prague, Czech Republic †††Department of Pediatrics, University of Messina, Messina, Italy ‡‡‡IV Medical Department, Rudolfstiftung Hospital, Vienna, Austria §§§Department of General Pediatrics, Children's Hospital Freiburg University, Freiburg, Germany ||||||Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria ¶¶¶Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK ###Department for Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Austria ****GI Endoscopy Unit, OUS, Rikshospitalet University Hospital, Oslo, Norway ††††Gastroenterology and Digestive Endoscopy Unit, Ospedale Nuovo Robbiani di Soresina, Soresina, Italy
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Dedhia K, Chang YF, Leonardis R, Chi DH. Is There a Need for Repeat Radiologic Examination of Children with Esophageal Coin Foreign Body? Otolaryngol Head Neck Surg 2016; 156:173-179. [PMID: 27576682 DOI: 10.1177/0194599816667039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To determine factors associated with the passage of coins. To determine the need for repeat preoperative chest x-ray (CXR) for esophageal coin foreign body. Setting Academic tertiary care center. Design Case series with chart review. Subjects and Methods Patient information was retrieved from an Institutional Review Board-approved database. We identified 1359 children with esophageal coin foreign bodies from 2001 to 2013. Patients with both initial diagnostic and immediate preoperative CXR were included. Results A total of 406 patients met inclusion criteria. The average age was 47 months (range, 1.8-194 months). On preoperative CXR, the position changed in 29 patients (7%). Age, type of coin, and location of coin were all statistically significant factors affecting the passage of the coin ( P < .0001). Coins in the distal esophagus were 9.3 times more likely to pass than coins in the proximal esophagus. The longer the object was in the esophagus, the less likely it was to pass. Conclusions This study characterizes when esophageal coins may pass. Age, type of coin, location of coin at initial x-ray, and length of time are all important considerations to determine if the coin will pass. This information may be used to counsel families about the likelihood of coins to pass and whether repeat x-ray is necessary prior to surgical removal. Additionally, it may be more cost-effective to obtain repeat films in select patients and prevent those from going to the operating theater who are more likely to pass the coin spontaneously.
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Affiliation(s)
- Kavita Dedhia
- 1 Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Yue-Fang Chang
- 2 Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rachel Leonardis
- 1 Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA.,3 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - David H Chi
- 1 Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
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Eskander AE, Sawires HK, Ebeid BA. Foreign body ingestion in Egyptian children: a 10-year experience of endoscopic intervention in a tertiary hospital. Minerva Pediatr 2016; 71:443-448. [PMID: 27441491 DOI: 10.23736/s0026-4946.16.04350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is paucity of data regarding foreign body (FB) ingestion among Middle-Eastern children. We conducted a retrospective analysis of FB ingestion among Egyptian children and determined the predictors that affect the occurrence of complications. METHODS This retrospective study was carried out on 1546 patients aged 13 years or younger presenting with FB ingestion and in need of endoscopic FB removal. RESULTS There were 711 males (46%) and 835 females (54%) (mean age 4.56±2.26 years). Symptoms were present in 1414 patients (91.5%) while complications were present in 137 patients (8.9%). There was a significant difference between complicated and non-complicated cases with regard to higher age group, duration of impaction, site of impaction and type of FB (P=0.001, P=0.001, P=0.001, and P<0.001, respectively). CONCLUSIONS The highest rate of complications was observed in FB impacted in duodenum and those without symptoms while symptomatic cases and impaction in upper esophagus were associated with higher success rate of removal.
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Affiliation(s)
- Ayman E Eskander
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Happy K Sawires
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt -
| | - Basel A Ebeid
- Department of Tropical Medicine, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt
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Lin JH, Fang J, Wang D, Chen HZ, Guo Q, Guo XG, Han ST, He LP, He SX, Jiang HQ, Jin ZD, Li X, Liao Z, Mei B, Ren X, Tang YJ, Wang BM, Wang L, Xu H, Xu LM, Xue XC, Yang YX, Zhang XF, Zhang ZQ, Zheng HL, Zhi FC, Zhong L, Zou DW, Zou XP, Li ZS. Chinese expert consensus on the endoscopic management of foreign bodies in the upper gastrointestinal tract (2015, Shanghai, China). J Dig Dis 2016; 17:65-78. [PMID: 26805028 DOI: 10.1111/1751-2980.12318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 01/06/2016] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Dong Wang
- Department of Gastroenterology.,Digestive Endoscopy Center
| | - He Zhong Chen
- Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai
| | - Qiang Guo
- Department of Gastroenterology, First People's Hospital of Yunnan Province, Kunming, Yunnan Province
| | - Xue Gang Guo
- Department of Gastroenterology, Xijing Hospital, Xi'an, Shaanxi Province
| | - Shu Tang Han
- Digestive Endoscopy Center, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu Province
| | - Li Ping He
- Digestive Endoscopy Center, Fujian Provincial Hospital, Fuzhou, Fujian Province
| | - Shui Xiang He
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province
| | - Hui Qing Jiang
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province
| | - Zhen Dong Jin
- Department of Gastroenterology.,Digestive Endoscopy Center
| | - Xun Li
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu Province
| | - Zhuan Liao
- Department of Gastroenterology.,Digestive Endoscopy Center
| | - Bing Mei
- Department of Emergency Medicine, Changhai Hospital, Second Military Medical University, Shanghai
| | - Xu Ren
- Department of Gastroenterology, Heilongjiang Provincial Hospital, Harbin, Heilongjiang Province
| | - Yong Jin Tang
- Editorial Department of Chinese Journal of Digestive Endoscopy, Nanjing, Jiangsu Province
| | - Bang Mao Wang
- Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin
| | - Li Wang
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai
| | - Hong Xu
- Department of Gastrointestinal Surgery, The First Hospital of Jilin University, Changchun, Jilin Province
| | - Lei Ming Xu
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai
| | - Xu Chao Xue
- Department of Gastrointestinal Surgery, Changhai Hospital, Second Military Medical University, Shanghai
| | - Yu Xiu Yang
- Department of Gastroenterology, Henan Provincial People's Hospital, Zhengzhou, Henan Province
| | - Xiao Feng Zhang
- Department of Gastroenterology, Hangzhou First People's Hospital, Hangzhou, Zhejiang Province
| | - Zi Qi Zhang
- Digestive Endoscopy Center, PLA General Hospital, Beijing
| | - Hong Liang Zheng
- Department of ENT, Changhai Hospital, Second Military Medical University, Shanghai
| | - Fa Chao Zhi
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province
| | - Liang Zhong
- Department of Gastroenterology, Huashan Hospital, Fudan University, Shanghai
| | - Duo Wu Zou
- Department of Gastroenterology.,Digestive Endoscopy Center
| | - Xiao Ping Zou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province, China
| | - Zhao Shen Li
- Department of Gastroenterology.,Digestive Endoscopy Center
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Foreign Bodies Ingestion in Children: Experience of 61 Cases in a Pediatric Gastroenterology Unit from Romania. Gastroenterol Res Pract 2016; 2016:1982567. [PMID: 26949384 PMCID: PMC4753337 DOI: 10.1155/2016/1982567] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/05/2016] [Accepted: 01/10/2016] [Indexed: 12/15/2022] Open
Abstract
The ingestion of foreign bodies is a worldwide pediatric pathology. We assessed the clinical, endoscopic, and therapeutic aspects of this condition in a pediatric gastroenterology unit. We reviewed 61 patients (median age of 3.25 ± 4.7 years). The most frequently ingested objects were coins (26.23%), unidentified metal objects (13.11%), bones (8.19%), batteries, and buttons (6.55%). The clinical features we encountered included abdominal pain (55.73%), vomiting (34.42%), and asymptomatic children (29.5%). Routine X-ray examination enabled finding the foreign body in 42 of the cases. An esophagogastroduodenoscopy was performed within 24–72 hours. 25 cases resulted in a negative endoscopy (40.98%), 19 objects (31.14%) were removed using a polypectomy snare, and extraction failure occurred in 17 patients (27.86%). 28 foreign bodies were passed without incidents; in 14 cases, the swallowed objects were never found. In one case, a battery was stuck in the esophageal folds and led to tracheal-esophageal fistula and bronchopneumonia and later to esophageal stenosis. We report a large proportion of foreign bodies that could not be identified or removed due to lack of early endoscopy and poor technical settings. Batteries and sharp objects lead to severe complications and preschool-age children are at high risk for such events.
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Dereci S, Koca T, Serdaroğlu F, Akçam M. Foreign body ingestion in children. Turk Arch Pediatr 2015; 50:234-40. [PMID: 26884693 DOI: 10.5152/turkpediatriars.2015.3164] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/05/2015] [Indexed: 01/12/2023]
Abstract
AIM Foreign bodies ingested by the oral route enter into the gastrointestinal tract and are considered a significant health problem in the childhood. In this study, we evaluated the pediatric patients who presented to our hospital with the complaint of ingestion of foreign body. MATERIAL AND METHODS The hospital records of all children who presented to our clinic because of ingestion of foreign body between January 2008 and January 2015 were examined retrospectively. The complaints at admission, the types of foreign bodies ingested, the localization of the foreign body in the gastrointestinal tract and the approaches and treatment methods used were examined. RESULTS Thirty-six (56%) of 64 patients included in the study were male and 28 (44%) were female and the mean age was 5.7±4.6 years (10 months-17 years). Thirty eight (59%) of 64 children who were included in the assessment were below the age of five years. The most common complaint at presentation was parental recognition of the ingested object and dysphagia. The most commonly ingested foreign bodies included coins, sewing pins, safety pins and hairclips. Nail clipper detected in the stomach, sewing pin which penetrated through the duodenal wall and stuck to hepatic parenchyma were the first pediatric cases in the literature. Upper esophagus was the most common location for foreign bodies. Endoscopic examinations were performed in 55 of 64 children. CONCLUSIONS Early detection and treatment of ingested foreign bodies in the upper gastrointestinal system is important in terms of preventing possible complications. In our study, the most frequent foreign bodies detected in the upper digestive tract were coins and they were most frequently detected in the upper esophagus. Most of our patients were below the age of five years. Flexible endoscopic method was used commonly for treatment.
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Affiliation(s)
- Selim Dereci
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Tuğba Koca
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Filiz Serdaroğlu
- Department of Pediatrics, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Mustafa Akçam
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
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Investigation and management of foreign body ingestion in children at a major paediatric trauma unit in South Africa. Afr J Emerg Med 2015. [DOI: 10.1016/j.afjem.2015.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Magalhães-Costa P, Carvalho L, Rodrigues JP, Túlio MA, Marques S, Carmo J, Bispo M, Chagas C. Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract: An Evidence-Based Review Article. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 23:142-152. [PMID: 28868450 PMCID: PMC5580008 DOI: 10.1016/j.jpge.2015.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/02/2015] [Indexed: 12/11/2022]
Abstract
Gastrointestinal foreign bodies (FB) are comprised of food bolus impaction and intentionally or unintentionally ingested or inserted true FB. Food bolus impaction and true FB ingestion represent a recurrent problem and a true challenge in gastrointestinal endoscopy. More than 80-90% of the ingested true FB will pass spontaneously through the gastrointestinal tract without complications. However, in 10-20% of the cases an endoscopic intervention is deemed necessary. True FB ingestion has its greatest incidence in children, psychiatric patients and prisoners. On the other hand, food bolus impaction typically occurs in the elderly population with an underlying esophageal pathology. The most serious situations, with higher rates of complications, are associated with prolonged esophageal impaction, ingestion of sharp and long objects, button batteries and magnets. Physicians should recognize early alarm symptoms, such as complete dysphagia, distressed patients not able to manage secretions, or clinical signs of perforation. Although many papers are yearly published regarding this subject, our knowledge is mainly based on case-reports and retrospective series. Herein, the authors summarize the existing evidence and propose an algorithm for the best approach to FB ingestion.
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Safe and effective management of esophageal coins in children with bougienage. Surgery 2015; 158:1065-70; discussion 1071-2. [PMID: 26239181 DOI: 10.1016/j.surg.2015.06.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/22/2015] [Accepted: 06/03/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Coins are the foreign body most commonly ingested in infants and children. Coins retained in the esophagus require intervention to prevent complications. Management of retained esophageal coins remains variable both between and within institutions. We hypothesize that the incorporation of bougienage in the management of pediatric esophageal coins is safe and more cost-effective compared with traditional management strategies that use endoscopy. METHODS We conducted a retrospective review of infants and children diagnosed with an esophageal foreign body managed at Children's Hospital of Wisconsin between January 2003 and June 2012. Pediatric otolaryngologists (ear-nose-throat, ie, ENTs) or pediatric surgeons manage all children with esophageal foreign bodies in a prospective call schedule that alternates weekly. RESULTS During an 8.5-year period, 1,642 children were diagnosed with esophageal foreign bodies and 518 had a retained coin. For esophageal coins, ENT managed 218 cases and pediatric surgery managed 300. ENTs preferentially used endoscopy for coin removal, whereas pediatric surgeons used either endoscopy or esophageal bougienage for selected children meeting specific criteria. Bougienage was successful at advancing the coin into the stomach in 94% of patients, and endoscopy was successful at removing the coin from the esophagus in 100% of patients. The mean duration of stay was 0.6 days for endoscopy by ENT, 0.6 days for endoscopy by pediatric surgery, and 0.1 days for bougienage (P < .05). The median hospital charge was $4,593 for endoscopy by ENT, $5,379 for endoscopy by pediatric surgery, and $579 for bougienage (P < .05). There were 3 complications each in the endoscopy group for ENT and pediatric surgery. There were no complications in children undergoing bougienage. CONCLUSION This is the first case series evaluating the management of children with esophageal coins using a prospective assignment to endoscopy versus endoscopy or bougienage. Our data support bougienage as a safe and cost-effective treatment for managing retained esophageal coins in selected children.
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Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr 2015; 60:562-74. [PMID: 25611037 DOI: 10.1097/mpg.0000000000000729] [Citation(s) in RCA: 314] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Foreign body ingestions in children are some of the most challenging clinical scenarios facing pediatric gastroenterologists. Determining the indications and timing for intervention requires assessment of patient size, type of object ingested, location, clinical symptoms, time since ingestion, and myriad other factors. Often the easiest and least anxiety-producing decision is the one to proceed to endoscopic removal, instead of observation alone. Because of variability in pediatric patient size, there are less firm guidelines available to determine which type of object will safely pass, as opposed to the clearer guidelines in the adult population. In addition, the imprecise nature of the histories often leaves the clinician to question the timing and nature of the ingestion. Furthermore, changes in the types of ingestions encountered, specifically button batteries and high-powered magnet ingestions, create an even greater potential for severe morbidity and mortality among children. As a result, clinical guidelines regarding management of these ingestions in children remain varied and sporadic, with little in the way of prospective data to guide their development. An expert panel of pediatric endoscopists was convened and produced the present article that outlines practical clinical approaches to the pediatric patient with a variety of foreign body ingestions. This guideline is intended as an educational tool that may help inform pediatric endoscopists in managing foreign body ingestions in children. Medical decision making, however, remains a complex process requiring integration of clinical data beyond the scope of these guidelines. These guidelines should therefore not be considered to be a rule or to be establishing a legal standard of care. Caregivers may well choose a course of action outside of those represented in these guidelines because of specific patient circumstances. Furthermore, additional clinical studies may be necessary to clarify aspects based on expert opinion instead of published data. Thus, these guidelines may be revised as needed to account for new data, changes in clinical practice, or availability of new technology.
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Tarrats LA, Rivera-Rodríguez M, González L, Vargas-Pinto S, Garratón M, Quintero E, Riera-March A. Anterior-commissure laryngoscope extraction of esophageal coins in children using an apnea technique. Otolaryngol Head Neck Surg 2015; 152:1145-8. [PMID: 25805639 DOI: 10.1177/0194599815576131] [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: 08/13/2014] [Accepted: 02/13/2015] [Indexed: 11/15/2022]
Abstract
This is a case series with chart review of 59 consecutive pediatric patients with a diagnosis of cervical esophageal coin who underwent anterior-commissure laryngoscope (ACLA) extraction during apnea. The purpose of this study was (1) to evaluate the efficacy and safety of coin extraction and (2) to analyze foreign body features and intraoperative physiological parameters (apnea time, O2 saturation and end-tidal CO2 (ETCO2) of apnea, minimum O2 during procedure, and heart rate). The technique was completed in 94.9% of the sample. The mean of the length of apnea was 57.7 ± 25.2 seconds. The median minimum O2 saturation was 99.5% (minimum = 93, maximum = 100), and the median of the ETCO2 at the end of the procedure was 35.7 ± 4.8 mm Hg. Heart rates remained at baseline values during the procedure (P < .001). This technique represents an efficient and secure modality for treatment. If successful, the patient can be safely discharged after clearance from anesthesia and a swallowing trial.
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Affiliation(s)
- Luis A Tarrats
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, USA
| | - Marinell Rivera-Rodríguez
- Department of Anesthesiology, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, USA
| | - Lorena González
- Research Design, Biostatistics, and Clinical Research Ethics, Puerto Rico Clinical and Translational Research Consortium, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, USA
| | - Susana Vargas-Pinto
- Department of Surgery, Saint Luke's Episcopal Hospital, Ponce School of Medicine, Ponce, Puerto Rico, USA
| | - Miguel Garratón
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, USA
| | - Elisa Quintero
- Department of Anesthesiology, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, USA
| | - Antonio Riera-March
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico, USA
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Allie EH, Blackshaw AM, Losek JD, Tuuri RE. Clinical effectiveness of bougienage for esophageal coins in a pediatric ED. Am J Emerg Med 2014; 32:1263-9. [PMID: 25178851 DOI: 10.1016/j.ajem.2014.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/02/2014] [Accepted: 08/03/2014] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To describe a tertiary care pediatric emergency department (PED) experience with bougienage for esophageal coins. METHODS This was a large retrospective case series of children with esophageal coins presenting to a tertiary PED from January 2004 to October 2012. Bougienage eligibility criteria were medically stable, no prior gastro-esophageal surgery or disease, single coin, and witnessed ingestion within 24 hours. Abstracted data were age, signs and symptoms, coin type, management, efficacy, complications, returns, length of stay (LOS), and hospital charges. Main outcomes included procedural success and complications. Secondary outcomes included LOS and hospital charges. RESULTS There were 245 patients with esophageal coins with 136/145 (94%) successful bougienage procedures and 109/109 (100%) successful surgical retrievals. There were 18 minor complications and 5 return visits for patients with bougienage. There were 10 minor and 2 major complications with surgical retrieval. Patients undergoing bougienage were 4 years (SD 2) vs 3 years (SD 3) for surgical retrieval (P < 0.001). Mean LOS for successful bougienage was 137 minutes (SD 54) vs 769 (SD 535) for surgical retrieval. The difference in the means was 632, 95% CI for the difference in means of -723 to -541 (P < .001). Mean charges for successful bougienage were $984 (SD $576) vs. $7022 (SD $3132) for surgical retrieval. The difference in means was $6038, 95% CI -$6,580 to -$5,496 (P < .001). CONCLUSIONS Esophageal bougienage is safe and highly effective. It is also more time and cost efficient than other treatment options.
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Affiliation(s)
- Evan H Allie
- Medical University of South Carolina Children's Hospital, Department of Pediatrics Residency Program, Charleston, SC
| | - Aaron M Blackshaw
- Medical University of South Carolina, College of Medicine, Charleston, SC
| | - Joseph D Losek
- Medical University of South Carolina Children's Hospital, Department of Pediatrics, Division of Pediatric Emergency Medicine, Charleston, SC
| | - Rachel E Tuuri
- Medical University of South Carolina Children's Hospital, Department of Pediatrics, Division of Pediatric Emergency Medicine, Charleston, SC.
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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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Removal and management of esophageal foreign bodies. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2013.10.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
Although most ingested foreign bodies in children pass spontaneously, certain foreign bodies can be harmful and they require special attention and emergent medical intervention to prevent significant morbidity and mortality. This article presents an overview of the epidemiology, diagnosis, management, and complications of foreign body ingestions in children. Particular attention is paid to coins, sharp objects, long objects, food bolus, caustic liquids, batteries, and magnets.
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Affiliation(s)
- Christian C Wright
- Division of Emergency Medicine, Department of Pediatrics, University of Maryland School of Medicine, University of Maryland Children's Hospital, 22 South Greene Street, Baltimore, MD 21201, USA.
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Jayachandra S, Eslick GD. A systematic review of paediatric foreign body ingestion: presentation, complications, and management. Int J Pediatr Otorhinolaryngol 2013; 77:311-7. [PMID: 23261258 DOI: 10.1016/j.ijporl.2012.11.025] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/13/2012] [Accepted: 11/17/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Foreign body ingestion is a common problem among paediatric populations. A variety of foreign bodies are ingested, some of which are particularly harmful and life threatening such as button batteries, magnets and bones. Common household items such as small toys, marbles, batteries and erasers are often ingested. The aim of this systematic review is to study the problem of foreign body ingestion among paediatric populations in terms of commonly ingested objects, and attempt to identify the link between location of impaction, associated symptoms, complications, spontaneous passage, methods and timing of removal. METHODS A literature search of multiple databases including PubMed, Embase, Current Contents Connect and Medline were conducted for studies on foreign body ingestions. Based on strict inclusion and exclusion criteria, 17 studies were selected. A qualitative review of these studies was then performed to identify commonly ingested foreign bodies, symptoms, signs and complications of foreign body ingestion, rates of spontaneous passage and methods of retrieval of the ingested objects. RESULTS Coins are the most commonly ingested foreign body. A variety of gastrointestinal symptoms such vomiting and drooling as well as respiratory symptoms such as coughing and stridor are associated with foreign body ingestion. The oesophagus, in particular the upper third, is the common site of foreign body obstruction. Objects in the stomach and intestine were spontaneously passed more frequently than at any other sites in the gastrointestinal system. Complications such as bowel perforations, infection and death are more commonly associated with ingestion of objects such as batteries and sharp objects such as bones and needles. Ingested objects are most commonly removed by endoscopic means. CONCLUSION Foreign body ingestion is a common paediatric problem. Batteries and sharp objects should be removed immediately to avoid complications while others can be observed for spontaneous passage. Endoscopy has a high success rate in removing ingested foreign bodies.
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Affiliation(s)
- Shruti Jayachandra
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
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Abbas TO, Shahwani NA, Ali M. Endoscopic management of ingested foreign bodies in children: A retrospective review of cases, and review of the literature. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojped.2013.34077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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McNeill MB, Sperry SLW, Crockett SD, Miller CB, Shaheen NJ, Dellon ES. Epidemiology and management of oesophageal coin impaction in children. Dig Liver Dis 2012; 44:482-6. [PMID: 22321620 PMCID: PMC3338868 DOI: 10.1016/j.dld.2012.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 12/20/2011] [Accepted: 01/03/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The epidemiology of oesophageal coin impaction in children is poorly understood. We aimed to assess characteristics of patients with coin impaction and identify predictors of type of coin impacted and management strategies. METHODS Cases of coin impaction from 2002 to 2009 were identified by querying a tertiary care centre's billing, clinical, and endoscopy databases for the International Classification of Diseases, 9th Revision code "935.1 - foreign body in the oesophagus." Charts were reviewed to confirm case status and to extract pertinent data. RESULTS Of 113 patients with oesophageal coin impaction (55% male; 45% Caucasian; mean age 2.9 years), 65 (58%) swallowed a penny, 85 (80%) had the impaction in the proximal oesophagus, and 103 (91%) required a procedure. Thirty-five (34%) patients had an upper endoscopy performed by a gastroenterologist and 68 (66%) had a laryngoscopy or oesophagoscopy performed by an otolaryngologist. Only 2 minor complications were noted. There was no significant relationship between the coin type and location of impaction, but 99% of cases performed by otolaryngologists were for proximally impacted coins, compared to 49% for gastroenterologists (p<0.001). CONCLUSIONS Oesophageal coin impaction disproportionately affected young children and extraction was frequently required. Whilst pennies were the most commonly impacted coin, there were no clear predictors on impaction based on coin type.
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Affiliation(s)
- Matthew B. McNeill
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Sarah L. W. Sperry
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC,Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Seth D. Crockett
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC,Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - C. Brock Miller
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Nicholas J. Shaheen
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC,Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Evan S. Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC,Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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Orji FT, Akpeh JO, Okolugbo NE. Management of esophageal foreign bodies: experience in a developing country. World J Surg 2012; 36:1083-1088. [PMID: 22382767 DOI: 10.1007/s00268-012-1510-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The outcome of esophagoscopy for removal of suspected esophageal foreign bodies (EFBs) is dependent on the FB characteristics and the surgeon's experience. This study was conducted to review our experience and highlight challenges in the management of EFBs in a developing country. The value of radiologic signs in FB detection was also evaluated. METHODS We conducted a retrospective chart review of 131 patients: 58.8% males and 41.9% females aged 8 months to 64 years, treated for suspected EFBs in our institution over a 13-year period. Statistics were derived by univariate analysis RESULTS Foreign bodies were found and retrieved in 118 cases. Coins were the predominant FB in children (35%), and bones (25%) and dentures (17%) were predominant in adults. Plain radiography was highly useful in detecting FBs in children (coins/metals 100%) but less so in adults (bones 25%, dentures 11%). Repeated esophagoscopy attempts were encountered more in patients with impacted sharp objects (85%) and were recorded significantly among trainee surgeons (p = 0.004). Open esophagotomy was carried out in 13 (10%) difficult cases. Major complications including two iatrogenic esophageal perforations and one death occurred following esophagoscopy by trainee surgeons. CONCLUSIONS Rigid esophagoscopy is relatively safe and useful procedure in trained hands for removal of EFBs. Management of long-standing EFBs, dentures, and other sharp objects requires the skills of the most experienced members of the surgical team for a successful outcome. Open surgical treatment is unavoidable in cases of irretrievable esophageal FBs or in the presence of esophageal perforation.
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Affiliation(s)
- Foster Tochukwu Orji
- Department of Otolaryngology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
- Abia State University Teaching Hospital, Aba, Abia State, Nigeria.
- Sunshine Hospital, Umuahia, Abia State, Nigeria.
| | - James O Akpeh
- Department of Otolaryngology, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Sondhi V, Patnaik SK, Khullar A. Procedural sedation associated displacement of sharp oesophageal foreign body. BMJ Case Rep 2012; 2012:bcr.11.2011.5235. [PMID: 22605707 DOI: 10.1136/bcr.11.2011.5235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Oesophageal foreign body is a common clinical problem. The therapeutic intervention varies from endoscopic removal to observation for spontaneous passage of foreign body. The authors illustrate a case of sharp board pin ingestion by a child, which stayed impacted at C(7)-T(1) level for 8 h with indentation of tracheal mucosa. However, upon administration of midazolam and ketamine for procedural sedation, the pin spontaneously advanced to stomach when muscle relaxation had set in. A few oesophageal mucosal erosions were noted on the endoscopy. The foreign body could not be retrieved by the procedure and was spontaneously egested impacted in faeces. This case presents a distinctive hazard associated with procedural sedation for a foreign body in aero-digestive tract, where the associated muscle relaxation can lead to complications due to spontaneous movement of foreign body.
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Affiliation(s)
- Vishal Sondhi
- Pediatrics Department, Military Hospital, Ambala Cantt, India.
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Al-Reesi A, Ashour M. Foreign body (pen) in the stomach and lower esophagus. J Emerg Med 2011; 44:173-4. [PMID: 21982987 DOI: 10.1016/j.jemermed.2011.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 03/12/2011] [Accepted: 06/02/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Abdullah Al-Reesi
- Department of Emergency Medicine, Sultan Qaboos University Hospital, Muscat, Oman
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