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1
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Su HY, Taylor KM, Friedman AB, Cataletti G, Maconi G. Ultrasound assessment of gastrointestinal luminal contents: a narrative review. J Ultrasound 2024; 27:781-792. [PMID: 39292369 PMCID: PMC11496442 DOI: 10.1007/s40477-024-00951-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 07/24/2024] [Indexed: 09/19/2024] Open
Abstract
Gastro-intestinal ultrasound (GIUS) is a non-invasive and cost-effective tool, widely used as a first-line diagnostic method in patients presenting with abdominal complaints, especially in patients affected by inflammatory bowel disease (IBD), such as Crohn's disease and ulcerative colitis. In this setting, gastro-intestinal ultrasound has been especially used to evaluate the bowel wall features (thickening, stratification, vascularization) and complications related to IBD (fistulas, abscesses). Nevertheless, gastro-intestinal ultrasound can be also used to detect and evaluate the content of several segments of the gut. In fact, there is a growing interest in utilizing GIUS for suspected functional disorders, where assessing intestinal content may play a significant diagnostic role, as well as directing therapy. In our review, we provided a sonographic description of GIUS appearances of bowel content in various pathological and physiological conditions, offering potential applications in clinical practice and providing insights for further research.
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Affiliation(s)
- Heidi Y Su
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Kirstin M Taylor
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Antony B Friedman
- Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Giovanni Cataletti
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, "L. Sacco" Hospital, University of Milano, Milan, Italy
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, "L. Sacco" Hospital, University of Milano, Milan, Italy.
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2
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Niset A, Baert J, Dupriez F. Point-of-Care Ultrasound for the Diagnosis of Pediatric Foreign Body Ingestion: A Narrative Review and Illustrative Case Report. Pediatr Emerg Care 2023; 39:728-733. [PMID: 37339160 DOI: 10.1097/pec.0000000000002997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE Foreign body ingestion (FBI) is a frequent concern in emergency departments. Clinical guidelines recommend performing plain x-rays as the primary modality of diagnosis. Although point-of-care ultrasound (PoCUS) has increasingly been integrated into the daily practice of emergency medicine, it has been poorly investigated in the diagnostic approach for FBI.This review aims to highlight the current state of PoCUS use for pediatric FBI.The following research question was considered in this narrative review: Is PoCUS useful for FBI management? METHODS A literature search was conducted to identify articles reporting PoCUS use for the management of FBI. All articles were assessed for quality by 2 reviewers. MAIN RESULTS The 14 selected articles reported 52 FBI cases in which PoCUS successfully identified and located the ingested FB. Point-of-care ultrasound was used either as the primary imaging technique or after positive or negative x-ray findings. In 5 cases (9.6%), PoCUS was the only modality used for the diagnosis. Of these cases, 3 (60%) underwent a successful procedure to remove the FB and 2 (40%) received conservative treatment without complications. CONCLUSIONS This review suggests that PoCUS might be a reliable modality for the initial management of FBI. PoCUS can locate, identify, and evaluate the size of the FB in a wide range of materials and gastrointestinal locations. Point-of-care ultrasound could eventually become the go-to modality in the case of radiolucent FB, thus avoiding the use of radiation. Further studies are nevertheless required to validate PoCUS use for FBI management.
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Affiliation(s)
- Alexandre Niset
- From the Emergency Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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3
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Value of intestinal ultrasound in pediatric magnet ingestion: a case report. J Ultrasound 2022; 25:861-864. [PMID: 35275387 PMCID: PMC8914445 DOI: 10.1007/s40477-021-00631-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/06/2021] [Indexed: 11/03/2022] Open
Abstract
Ingestion of magnetic foreign bodies in pediatric settings has become more common in the last years due to the marketing of various toys containing small magnetic parts. Most magnets, especially if a single element is ingested, usually pass through the gastrointestinal tract without complications. However, ingestion of multiple magnets or magnets and small metallic components may require a prompt intervention due to the risk of attraction across bowel layers, leading to pressure necrosis, perforation, and even death. Routinely, serial radiological evaluations are needed to follow the progression of magnets through the intestine, while the role of small bowel ultrasound is regarded as marginal. Here we report a case of a 5-years old boy who ingested 8 magnets and in which small bowel ultrasound was pivotal for the correct assessment of magnets location to correct address the surgical approach.
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4
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Sacks MA, Goodman LF, Khan FA, Radulescu A. Unusual cause of appendicitis: Orthodontic wire. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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5
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Yildiz H, Okay ST, Yildirim E, Beskardesler N. A pin detected by ultrasonography within the normal appendix: prior to surgery, an impressive use of ultrasonography to localize an ingested foreign body exactly. J Ultrasound 2020; 24:525-528. [PMID: 32002897 DOI: 10.1007/s40477-020-00431-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/18/2020] [Indexed: 11/29/2022] Open
Abstract
We present a 1-year-old boy who was asymptomatic and brought to the emergency room on suspicion of his having swallowed a pin. Confirmation of ingestion of the pin and its passage through the gut was achieved with abdominal radiography. The pin, which was followed with serial abdominal radiographs, was expected to leave the gastrointestinal tract, but was fixed to the right lower quadrant. When the pin had not passed after 10 days, and with increasing concern about the likelihood of perforation, ultrasonography was used to locate its exact position and allow surgical removal. Only a few cases involving the use of ultrasonography to reveal the exact location of an ingested foreign body prior to surgery have been reported ın the literature. This case presents an impressive example of the use of ultrasonography to reveal the intra-appendiceal location of an ingested foreign body, and to facilitate its surgical removal.
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Affiliation(s)
- Harun Yildiz
- Department of Radiology, Dortcelik Children's Hospital, Bursa, Turkey.
| | - Sefer Tolga Okay
- Department of Pediatric Surgery, Dortcelik Children's Hospital, Bursa, Turkey
| | - Elif Yildirim
- Department of Radiology, Dortcelik Children's Hospital, Bursa, Turkey
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6
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Abstract
The ingestion of foreign bodies is a common problem in the pediatric population. Emergent treatment of ingested foreign bodies is dependent on the type of foreign body ingested, patient symptoms, timing of ingestion, and the location of the foreign body. Although X-ray and computed tomography are the imaging techniques used most often to assess for foreign bodies, ultrasonography, which lacks ionizing radiation, may also be useful. This case series describes 8 cases of gastrointestinal tract foreign bodies and the utility of point-of-care ultrasonography for their real-time evaluation.
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7
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Zhao Y, Yang Z, Quan J, Hu H. Sonographic diagnosis of perforation of the gastric antrum caused by a foreign body: A case report. Medicine (Baltimore) 2019; 98:e14586. [PMID: 30813179 PMCID: PMC6408005 DOI: 10.1097/md.0000000000014586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Ingestion of foreign bodies often occurs in clinical environments, especially in toddlers and aged patients. Although plain radiography and CT are widely used for the assessment of foreign bodies, sonography has an advantage in the diagnosis of some radiolucent foreign bodies, such as wood and bamboo materials. PATIENT CONCERNS An 80-year-old woman presented with a 4-day history of right upper quadrant abdominal persistent distended pain without radiation. DIAGNOSES Radiographs, a preliminary abdominal ultrasound (US) and an abdominal computed tomography (CT) were unremarkable. A repeat abdominal US found a foreign body inserted in the gastric wall of antrum. But subsequent gastroscopy was negative. A laparotomy confirmed the diagnosis of bamboo stem penetration out of the gastric antrum. INTERVENTIONS The patient was treated by laparotomy and the bamboo stem was removed successfully. OUTCOMES Bamboo stem-caused digestive perforation was confirmed by laparotomy. The perforation site was at the gastric wall of antrum. Intravenous antibiotic therapy was administered for two weeks until her body temperature dropped to a normal level, and C-reactive protein (CRP) decreased to the normal limits. she was discharged from the hospital. LESSONS Previous studies suggest that US can identify the location and shape of foreign bodies in the alimentary tract in toddlers. This case shows US is also effective in aged patients. The US can be utilized as a problem-solving tool when radiolucent foreign bodies are suspected, especially when the results of CT and gastroscopy are negative.
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Affiliation(s)
- Yanan Zhao
- Department of Ultrasound, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang
| | - Zheng Yang
- Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang
| | - Juan Quan
- Department of Ultrasound, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang
| | - Huisen Hu
- Department of Ultrasound, Lanxi People's Hospital, Jinhua, Zhejiang, China
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8
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Piotto L, Gent R. The value of ultrasound in the investigation of ingested foreign bodies in children. SONOGRAPHY 2018. [DOI: 10.1002/sono.12139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Lino Piotto
- Division of Medical Imaging; Women's and Children's Hospital; South Australia Australia
| | - Roger Gent
- Division of Medical Imaging; Women's and Children's Hospital; South Australia Australia
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9
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Alsharief AN, Blackmore C, Schmit P. Small bowel obstruction due to ingestion of rubber balls. Pediatr Radiol 2017; 47:1539-1541. [PMID: 28516221 DOI: 10.1007/s00247-017-3894-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/11/2017] [Accepted: 05/04/2017] [Indexed: 11/25/2022]
Abstract
We report a case of a 10-month-old girl who presented with a 10-day history of emesis that became bilious on the last day. The initial evaluation suggested small bowel obstruction. An upper gastrointestinal study confirmed the normal location of the duodenojejunal junction with normal rotation and no evidence of midgut volvulus. Ultrasound (US) evaluation demonstrated two intraluminal lesions that do not follow the typical features of solid or cystic lesions. Two rubber balls were found at surgery to be responsible for the small bowel obstruction. Foreign body ingestion is common in children, but this case demonstrates a unusual foreign object to be ingested as well as the US appearance of this particular foreign body.
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Affiliation(s)
- Alaa N Alsharief
- Diagnostic Imaging Department, IWK Health Centre Dalhousie University, Halifax, NS, Canada. .,Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
| | - Christopher Blackmore
- Pediatric General Surgery Department, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Pierre Schmit
- Diagnostic Imaging Department, IWK Health Centre Dalhousie University, Halifax, NS, Canada
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10
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Diagnosis of Ingested Foreign Body in the Stomach by Point-of-Care Ultrasound in the Upright and Slightly Forward Tilting Position (Bowing Position). Pediatr Emerg Care 2017; 33:365-366. [PMID: 28376070 DOI: 10.1097/pec.0000000000001125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case involving accidental ingestion of a marble that was detected by point-of-care ultrasonography of the abdomen with the patient in the upright and slightly forward tilting position, which we term the "bowing position." Using this position for abdominal ultrasonography may be more useful than the usual supine position for such patients.
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11
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Hosokawa T, Yamada Y, Sato Y, Tanami Y, Nanbu R, Hagiwara SI, Oguma E. Role of Sonography for Evaluation of Gastrointestinal Foreign Bodies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2723-2732. [PMID: 27872423 DOI: 10.7863/ultra.16.01042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/13/2016] [Accepted: 03/18/2016] [Indexed: 06/06/2023]
Abstract
Foreign body ingestion is frequently encountered in children. The locations of the foreign bodies and the period during which they have been present in the thorax and abdomen are important for determining the method and timing of treatment. Although plain radiography and computed tomography are primarily used for assessment of foreign bodies, sonography without radiation is also useful for diagnosis of foreign bodies. This report describes 5 cases of foreign bodies in the digestive tract and the usefulness of sonography for real-time evaluation of foreign bodies with high spatial resolution. Physicians can use sonography along with radiography and computed tomography in cases involving foreign bodies.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Ryosuke Nanbu
- Department of General Pediatrics, Saitama Children's Medical Center, Saitama, Japan
| | - Shin-Ichiro Hagiwara
- Department of General Pediatrics, Saitama Children's Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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12
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Gale HI, Gee MS, Westra SJ, Nimkin K. Abdominal ultrasonography of the pediatric gastrointestinal tract. World J Radiol 2016; 8:656-667. [PMID: 27551336 PMCID: PMC4965350 DOI: 10.4329/wjr.v8.i7.656] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/11/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
Ultrasound is an invaluable imaging modality in the evaluation of pediatric gastrointestinal pathology; it can provide real-time evaluation of the bowel without the need for sedation or intravenous contrast. Recent improvements in ultrasound technique can be utilized to improve detection of bowel pathology in children: Higher resolution probes, color Doppler, harmonic and panoramic imaging are excellent tools in this setting. Graded compression and cine clips provide dynamic information and oral and intravenous contrast agents aid in detection of bowel wall pathology. Ultrasound of the bowel in children is typically a targeted exam; common indications include evaluation for appendicitis, pyloric stenosis and intussusception. Bowel abnormalities that are detected prenatally can be evaluated after birth with ultrasound. Likewise, acquired conditions such as bowel hematoma, bowel infections and hernias can be detected with ultrasound. Rare bowel neoplasms, vascular disorders and foreign bodies may first be detected with sonography, as well. At some centers, comprehensive exams of the gastrointestinal tract are performed on children with inflammatory bowel disease and celiac disease to evaluate for disease activity or to confirm the diagnosis. The goal of this article is to review up-to-date imaging techniques, normal sonographic anatomy, and characteristic sonographic features of common and uncommon disorders affecting the gastrointestinal tract in children.
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13
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The Use of Point-of-Care Ultrasound to Evaluate for Intestinal Foreign Bodies in the Pediatric Emergency Department. Pediatr Emerg Care 2015; 31:731-4. [PMID: 26427951 DOI: 10.1097/pec.0000000000000569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We present the use of point-of-care ultrasound to evaluate two patients with examinations concerning for appendicitis who were found to have multiple magnets ingested and subsequent bowel perforations. These cases illustrate the consequences of magnet ingestion as well as the application of point-of-care ultrasound for the identification of intestinal foreign bodies in children.
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14
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Horowitz R, Cico SJ, Bailitz J. Point-of-care Ultrasound: A New Tool for the Identification of Gastric Foreign Bodies in Children? J Emerg Med 2015; 50:99-103. [PMID: 26409678 DOI: 10.1016/j.jemermed.2015.07.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 07/02/2015] [Accepted: 07/25/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) has been used to identify ingested gastric foreign bodies. Our aim was to describe the sonographic findings of radiopaque and radiolucent gastric foreign bodies (FBs) in children. CASE REPORT Three children ingested different FBs. Two were confirmed with standard radiographs, one was not identified radiographically but was passed in the stool. All three objects were initially found in the stomach using POCUS. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With increased training and comfort, emergency physicians may begin to use POCUS for identification and monitoring of ingested FBs in the pediatric population.
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Affiliation(s)
- Russ Horowitz
- Divisions of Emergency and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Stephen John Cico
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Sioux Falls, South Dakota; Division of Emergency Medicine, Department of Family Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota
| | - John Bailitz
- Emergency Ultrasound, Department of Emergency Medicine, Cook County (Stroger) Hospital, Chicago, Illinois; Emergency Medicine, Rush College of Medicine, Chicago, Illinois
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15
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Not all radiopaque foreign bodies shadow on ultrasound: unexpected sonographic appearance of a radiopaque magnet. Ultrasound Q 2015; 30:306-9. [PMID: 25364959 DOI: 10.1097/ruq.0000000000000071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Foreign body ingestion is a common indication for imaging children. Ultrasound can be a useful adjunct to serial radiographs for evaluation of foreign bodies in the enteric tract. This case report describes a child who swallowed a single magnetic rock. Follow-up radiographs 4 days later could not determine progression of the foreign body beyond the stomach. Ultrasound was used to locate it, showing a structure with unexpected posterior reverberation artifact in the stomach. This was correlated with a similar magnet in a water bath demonstrating identical reverberation artifact. This report discusses the underlying factors for the different sonographic appearances and associated ultrasound artifacts of foreign bodies. This knowledge is important when performing sonography as adjunct modality for identification of foreign bodies in the gastrointestinal tract.
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16
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Common and uncommon applications of bowel ultrasound with pathologic correlation in children. AJR Am J Roentgenol 2014; 202:946-59. [PMID: 24758646 DOI: 10.2214/ajr.13.11661] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the indications and techniques for bowel ultrasound for inflammatory bowel disease and other common and uncommon entities and describe and illustrate their imaging appearances, including endoscopic or surgical correlation. CONCLUSION Ultrasound is a useful tool for the evaluation of inflammatory bowel disease and many other bowel diseases. Radiologists must become familiar with the full potential of ultrasound in the evaluation of the bowel in children because the need for alternative radiation-free imaging techniques continues to grow.
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Saps M, Rosen JM, Ecanow J. X-ray detection of ingested non-metallic foreign bodies. World J Clin Pediatr 2014; 3:14-18. [PMID: 25254180 PMCID: PMC4173203 DOI: 10.5409/wjcp.v3.i2.14] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/11/2014] [Accepted: 03/17/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the utility of X-ray in identifying non-metallic foreign body (FB) and assess inter-radiologist agreement in identifying non-metal FB.
METHODS: Focus groups of nurses, fellows, and attending physicians were conducted to determine commonly ingested objects suitable for inclusion. Twelve potentially ingested objects (clay, plastic bead, crayon, plastic ring, plastic army figure, glass bead, paperclip, drywall anchor, eraser, Lego™, plastic triangle toy, and barrette) were embedded in a gelatin slab placed on top of a water-equivalent phantom to simulate density of a child’s abdomen. The items were selected due to wide availability and appropriate size for accidental pediatric ingestion. Plain radiography of the embedded FBs was obtained. Five experienced radiologists blinded to number and types of objects were asked to identify the FBs. The radiologist was first asked to count the number of items that were visible then to identify the shape of each item and describe it to a study investigator who recorded all responses. Overall inter-rater reliability was analyzed using percent agreement and κ coefficient. We calculated P value to assess the probability of error involved in accepting the κ value.
RESULTS: Fourteen objects were radiographed including 12 original objects and 2 duplicates. The model’s validity was supported by clear identification of a radiolucent paperclip as a positive control, and lack of identification of plastic beads (negative control) despite repeated inclusion. Each radiologist identified 7-9 of the 14 objects (mean 8, 67%). Six unique objects (50%) were identified by all radiologists and four unique objects (33%) were not identified by any radiologist (plastic bead, Lego™, plastic triangle toy, and barrette). Identification of objects that were not present, false-positives, occurred 1-2 times per radiologist (mean 1.4). An additional 17% of unique objects were identified by less than half of the radiologists. Agreement between radiologists was considered almost perfect (kappa 0.86 ± 0.08, P < 0.0001).
CONCLUSION: We demonstrate potential non-identification of commonly ingested non-metal FBs in children. A registry for radiographic visibility of ingested objects should be created to improve clinical decision-making.
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Erbil B, Karaca MA, Aslaner MA, İbrahimov Z, Kunt MM, Akpinar E, Özmen MM. Emergency admissions due to swallowed foreign bodies in adults. World J Gastroenterol 2013; 19:6447-6452. [PMID: 24151363 PMCID: PMC3801315 DOI: 10.3748/wjg.v19.i38.6447] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To study a retrospective analysis of patients who presented to the emergency departments (ED) with complaints related to foreign body ingestions.
METHODS: Patients older than 16 years of age who presented to the ED between January 1st and December 31st of 2010 with complaints related to swallowed foreign bodies were identified from electronic health records and patient charts.
RESULTS: A total of 100 patients presented with a complaint of foreign body ingestion during the study period. Overall, an X-ray was performed on 75 patients, and a fiberoptic evaluation was performed on 45 patients. A foreign body was detected in 46 (46%) patients. The diagnostic yield of the X-ray was 27 (36%) out of 75 patients, while the diagnostic yield of the fiberoptic evaluations was 21 (47%) out of 45 patients. The detected foreign bodies were mostly located in the esophagus (17 out of 46 foreign bodies detected). When the types of ingested foreign bodies were evaluated, 52 (52%) patients reported ingesting food, and 19 (19%) patients reported swallowing pins. An X-ray was performed on 33 patients with accidental food ingestions but yielded a positive result in only two cases. In 12 out of 21 patients with accidental food ingestion who underwent fiberoptic evaluation, the foreign material was detected and removed.
CONCLUSION: Plain radiography is helpful in the localization of radiopaque swollen foreign bodies, while fiberoptic methods are useful as both diagnostic and therapeutic tools, regardless of radiopacity.
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Jecković M, Anupindi SA, Barbir SB, Lovrenski J. Is ultrasound useful in detection and follow-up of gastric foreign bodies in children? Clin Imaging 2013; 37:1043-7. [PMID: 24035525 DOI: 10.1016/j.clinimag.2013.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 06/30/2013] [Accepted: 08/01/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective was to show potential value of ultrasound in detection and follow-up of gastric foreign bodies. MATERIAL AND METHODS Medical records of 18 children with gastric foreign bodies were evaluated retrospectively. RESULTS The following gastric foreign bodies were identified: eight coins, five button batteries, domino, lollipop stick, hairclip, screw nut, and small plastic cylinders. All were confirmed by ultrasound. The batteries, domino, and two coins were removed endoscopically, the screw nut was removed surgically, while the rest were recovered in the stool. CONCLUSIONS Ultrasound examination of water-filled stomach can be useful in diagnostic workup of gastric foreign bodies in children, especially radiolucent ones.
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Affiliation(s)
- Mihajlo Jecković
- Institute for Children and Youth Health Care of Vojvodina, Department of Radiology, Hajduk Veljkova 10, 21000 Novi Sad, Serbia.
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Ingested foreign bodies: a case series demonstrating a novel application of point-of-care ultrasonography in children. Pediatr Emerg Care 2013; 29:870-3. [PMID: 23823272 DOI: 10.1097/pec.0b013e3182999ba3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In an era of recognizing the risks of radiation exposure, it is important to develop alternatives to radiographs. Bedside ultrasound has become an important adjunct to clinical diagnoses and procedural guidance in the emergency department. We present a case series of two patients who presented to a pediatric emergency department after witnessed coin ingestions. Point-of-care ultrasonography was able to accurately identify the location of each of the coins, at the thoracic inlet and in the stomach, as confirmed by chest radiography. To our knowledge, point-of-care ultrasonography has not been previously utilized to detect and localize esophageal foreign bodies in the emergency department.
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Ambe P, Weber SA, Schauer M, Knoefel WT. Swallowed foreign bodies in adults. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:869-75. [PMID: 23293675 DOI: 10.3238/arztebl.2012.0869] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 10/04/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Foreign-body ingestion is a common event most often seen in children from 6 months to 6 years of age. In adults, foreign bodies are usually ingested accidentally together with food. This happens more commonly in persons with certain pathological changes of the gastrointestinal tract. METHODS We present a selective review of pertinent literature retrieved by a search in the PubMed database. RESULTS The foreign bodies most commonly ingested by adults are fish bones and chicken bones. The clinical approach to the problem depends on the type of material ingested and on the patient's symptoms and physical findings. In about 80% of cases, the ingested material passes uneventfully through the gastrointestinal tract; endoscopy is performed in about 20% of cases, and surgery in less than 1%. Emergency esophagogastroduodenoscopy (EGD) is recommended when the esophagus is completely occluded (because of the risk of aspiration and/or pressure necrosis), when the ingested object has a sharp point or edge (because of the risk of perforation, with ensuing mediastinitis or peritonitis), and when a battery has been ingested (because of the risk of necrosis and fistula formation). For non-occluding esophageal foreign bodies, including magnets, an urgent but non-emergency EGD within 12 to 24 hours is recommended. CONCLUSION Most patients can be treated conservatively by observation alone, but there should be a low threshold for deciding to proceed to endoscopic retrieval. Surgery is reserved for complicated cases.
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Affiliation(s)
- Peter Ambe
- Department of General-, Visceral- and Pediatric Surgery, Düsseldorf University Hospital, Düsseldorf, Germany. peter.ambe@med.-uni-duesseldorf.de
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