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Martinez-Correa S, Morales-Tisnés T, De Leon-Benedetti LS, Lazarte-Rantes C, Otero HJ. Fluoroscopy in pediatric radiology: Review of current use and alternatives. Clin Imaging 2025; 121:110454. [PMID: 40107007 DOI: 10.1016/j.clinimag.2025.110454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Revised: 02/20/2025] [Accepted: 03/10/2025] [Indexed: 03/22/2025]
Abstract
Fluoroscopy has long been an essential imaging modality in pediatric radiology. However, concerns about radiation exposure in children and the need for on-site staff have led to a decline in its use and the exploration of alternative imaging techniques. Data from the Pediatric Health Information System and our institution show a decrease in fluoroscopic studies among pediatric inpatients, from 56,371 per year (2017-2020) to 46,973 per year (2020-2023). Alternative modalities such as endoscopy, ultrasound, and computed tomography demonstrate promise in assessing conditions of the respiratory, gastrointestinal, and urinary systems. Although fluoroscopy remains valuable in certain scenarios, these alternative imaging modalities offer advantages in terms of diagnostic accuracy, accessibility, costs, and reduced radiation exposure. However, the final choice of imaging technique should be based on careful consideration of the specific clinical context, patient factors, and available resources. In this review, we present institutional and national trends on the utilization of fluoroscopic studies over the past years, along with a side-by-side comparison of traditional fluoroscopic studies commonly performed in children and newer alternative modalities.
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Affiliation(s)
- Santiago Martinez-Correa
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America.
| | - Tatiana Morales-Tisnés
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Laura S De Leon-Benedetti
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | | | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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2
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Lee HK, Byon JH, Park EH. A case of orthodontic splint ingestion misclassified as a sharp/pointed foreign body in a child: A case report. Medicine (Baltimore) 2025; 104:e41843. [PMID: 40295265 PMCID: PMC12040022 DOI: 10.1097/md.0000000000041843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Accepted: 02/24/2025] [Indexed: 04/30/2025] Open
Abstract
RATIONALE Foreign body (FB) ingestion is common, particularly among children. While most FBs pass through the gastrointestinal tract without complications, some cases can lead to morbidity or even mortality. Management strategies depend on the size, sharpness, toxicity, and location of the FB. Plain radiographs are essential for diagnosis, treatment planning, and follow-up, especially for radiopaque FBs. Ingestion of dental-related FBs is rare, with reported cases involving orthodontic wires, braces, retainers, and other dental materials. Composite resin-wire splints are commonly used in orthodontics to manage dental traumatic injuries. We present a case of a patient who ingested a composite resin-wire splint, initially misclassified as a sharp FB, leading to unnecessary aggressive treatment. PATIENT CONCERNS A 2-year-old girl presented to the emergency department after accidentally ingesting a FB of dental origin. She had a recent traumatic dental injury and displayed no symptoms of ingestion. Initial radiographs revealed a dental wire in the stomach. DIAGNOSES Ingestion of orthodontic splint (composite resin-wire splint). INTERVENTIONS Considering the pointed tip of the wire, the emergency department physician transferred her to the endoscopy specialist for endoscopic removal. However, given the expected passage into the small bowel after a proper fasting period for endoscopy, close observation with follow-up radiographs was chosen amid parental anxiety. OUTCOMES Follow-up imaging showed FB migration to the ascending colon without perforation. Stool inspection revealed the dental wire and 4 composite resins, with the sharp tips covered by the resin, classifying it as a blunt FB. A retrospective review of radiographs revealed faint oval-shaped, mid-level radiopacities at each end of the wire covering the sharp/pointed tips. LESSONS In evaluating orthodontic splints as FBs, identifying faint composite resin on radiographs is crucial for planning milder treatment and alleviating parental anxiety.
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Affiliation(s)
- Hyun Kyung Lee
- Department of Radiology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Jung Hee Byon
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Eun Hae Park
- Department of Radiology, Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
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3
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Osborne KC, Osborne KD, Schunk PC. Child After Unidentified Ingestion. J Am Coll Emerg Physicians Open 2025; 6:100066. [PMID: 40034195 PMCID: PMC11872646 DOI: 10.1016/j.acepjo.2025.100066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Accepted: 01/13/2025] [Indexed: 03/05/2025] Open
Affiliation(s)
- Kyler C. Osborne
- Department of Emergency Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
| | - Katey D. Osborne
- Department of Emergency Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Paul C. Schunk
- Department of Emergency Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Wahiduzzaman Mazumder M, Islam MR, Begum F, Musabbir N, Khatun A. Accidental Ingestion of an Open Safety Pin by a Two-Year-Old Male Child: A Case Report. Cureus 2025; 17:e82929. [PMID: 40416174 PMCID: PMC12103243 DOI: 10.7759/cureus.82929] [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] [Accepted: 04/24/2025] [Indexed: 05/27/2025] Open
Abstract
Accidental foreign body (FB) ingestion is common in the pediatric age group between six months and five years. Most ingested FBs pass easily through the esophagus, into the stomach, and are expelled from the body without complications. However, some of these foreign bodies may get stuck in any part of the gastrointestinal (GI) tract, and endoscopic removal may be required to avoid complications. We present a case involving the endoscopic removal of an open safety pin from the duodenum of a two-year-old boy. The safety pin went unnoticed until the mother realized one was missing, leading to an incidental diagnosis.
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Affiliation(s)
| | | | - Fahmida Begum
- Pediatric Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Nadira Musabbir
- Pediatric Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Ambia Khatun
- Pediatric Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
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Kapil A, Schuelke S, Angly S, Rocher M, Abdelmoneim SS. An Accidental Discovery of Twenty 312-Size Zinc and Mercury-Containing Disk Batteries in a Sexagenarian Male. Cureus 2025; 17:e83075. [PMID: 40432654 PMCID: PMC12109169 DOI: 10.7759/cureus.83075] [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: 02/25/2025] [Accepted: 04/27/2025] [Indexed: 05/29/2025] Open
Abstract
Foreign body ingestion, while commonly observed in children, also occurs in elderly individuals. Button batteries pose a significant risk that can lead to rapid tissue damage. Herein, we present a case of a 61-year-old Hispanic male with a past medical history of coronary atherosclerosis, hypertension, asthma, and hyperlipidemia, who initially presented with shortness of breath and bilateral lower limb swelling. However, a passive complaint of constipation prompted further imaging, which unexpectedly revealed multiple foreign bodies in the gastrointestinal tract. A colonoscopy was performed, retrieving 14 button batteries, with additional batteries eliminated through a bowel regimen. This case highlights the need for a high index of suspicion for foreign body ingestion in elderly patients, even in the absence of classic symptoms. It illustrates the importance of thorough history-taking and early imaging in patients with unexplained gastrointestinal symptoms, particularly when initial diagnoses do not fully explain the clinical picture. Given the growing aging population and increased risk of accidental ingestion, further research is needed to establish optimal management strategies and prevent severe complications in similar cases.
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Affiliation(s)
- Ambika Kapil
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Sophie Schuelke
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Sohair Angly
- Internal Medicine, Larkin Community Hospital, Miami, USA
| | - Maray Rocher
- Internal Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | - Sahar S Abdelmoneim
- General Internal Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
- General Internal Medicine/Cardiovascular Medicine, Assiut University Hospital, Assiut, EGY
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Radhakrishna V, Vasudev RB, Gadgade BD, Kumar N, Anand A, Basavaraju M, Ramareddy RS, Lakshmaiah VK. Factors Associated with Spontaneous Passage of Ingested Foreign Body in Children: A Prospective Observational Study. J Indian Assoc Pediatr Surg 2025; 30:208-214. [PMID: 40191496 PMCID: PMC11968042 DOI: 10.4103/jiaps.jiaps_265_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 12/10/2024] [Accepted: 12/11/2024] [Indexed: 04/09/2025] Open
Abstract
Aim To identify factors associated with the spontaneous passage of ingested foreign bodies. Methods A prospective observational cohort study was conducted at a tertiary pediatric surgery center from July 2022 to March 2024. Management followed a standardized protocol, with follow-up period of over 6 months. Results The study included 139 children with a mean age of 6.9 years, and 53% of them were boys. Blunt objects, mainly coins, were the most frequently ingested (60%). Most children (88%) were asymptomatic, but 9% reported abdominal pain, particularly with sharp object ingestion (P = 0.006). Spontaneous passage occurred in most cases, with a mean transit time of 119 ± 105 h. Sharp objects passed faster than blunt ones (87 ± 60 h vs. 141 ± 122 h; P = 0.01). Delayed passage was associated with larger object diameter, constipation, and significant colon loading on X-ray. The optimal cutoff diameter predicting a transit time over 72 h for blunt objects was 1.75 cm. Nine children required intervention, and no long-term complications were observed. Conclusion Most ingested foreign bodies pass spontaneously without complications. Sharp objects transit faster than blunt objects, and transit time is influenced by object size, constipation, and colon loading.
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Affiliation(s)
- Veerabhadra Radhakrishna
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Raghunath Bangalore Vasudev
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Bahubali Deepak Gadgade
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Nitin Kumar
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Alladi Anand
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Mamatha Basavaraju
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Raghu Sampalli Ramareddy
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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Kvist O, Garcia JP. Has the cat got your tongue, or is something obstructing your throat? A review of imaging of ingested and aspirated foreign bodies in the paediatric population. Pediatr Radiol 2024; 54:2175-2184. [PMID: 39419854 PMCID: PMC11638315 DOI: 10.1007/s00247-024-06068-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 09/23/2024] [Accepted: 09/25/2024] [Indexed: 10/19/2024]
Abstract
Children frequently swallow or inhale foreign objects, a situation that can be life-threatening. Radiographic imaging plays a lead role in the early identification and location of inhaled or swallowed objects is essential. Promptly identifying and locating inhaled or swallowed objects are essential, as some items require immediate removal. For example, button batteries in the throat can cause grave harm; magnets can attract each other through the gut and cause perforations; and other objects can obstruct the airway or intestinal tract. Radiologists must understand how these objects appear in images to assist doctors in treating patients effectively. Recognising signs of inhaled objects on radiographs is also crucial, as symptoms may not always be clear, and many inhaled objects are not visible on radiographs. Radiographs are the primary means of checking for swallowed or inhaled objects, although other tests like fluoroscopy and computed tomography may be used in complex cases. Doctors working with children should be acquainted with the appearance of these common objects on images and their clinical importance.
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Affiliation(s)
- Ola Kvist
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
- Department of Radiology, Columbia University Medical Center, New York, NY, USA.
| | - Juan Pablo Garcia
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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8
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DiNardo LA, Vijay A, Reese AD, Alzouhayli S, Carr MM. Decreasing the Size of Bottle Caps: Helping or Hurting Children? Otolaryngol Head Neck Surg 2024; 171:1526-1529. [PMID: 38943452 DOI: 10.1002/ohn.876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 05/25/2024] [Accepted: 06/08/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE Our study aims to assess if decreasing bottle cap size was associated with more ingestions and injuries nationally. STUDY DESIGN: Retrospective chart review. SETTING The National Electronic Injury Surveillance System (NEISS) database. METHODS The NEISS was queried for bottle cap ingestions in children 0 to 18 years old between 2002 and 2021. Demographic factors including age, race, and sex of the patient were recorded. The location where the ingestion took place and the disposition of the patient were also analyzed. Data were excluded if the narrative did not specify the ingestion of a cap of a drinking bottle. RESULTS A total of 415 bottle cap ingestion injuries were identified, for a national estimate of 11,683 injuries. The mean age at the time of ingestion was 10.3 ± 5.2 years and the majority of the injuries occurred in males (N = 9129, 78.4%). 46.4% (N = 5398) were Caucasian, 17.6% (N = 2046) were Black or African American, and 2.7% (N = 311) were Hispanic. 55.0% (N = 6405) of injuries occurred at an unknown location, 41.4% (N = 4781) occurred at home, and 2.8% (N = 326) occurred at school. 82.3% (N = 9584) of patients were treated in the emergency department and released, 6.9% (N = 808) were treated and admitted, 6.7% (N = 783) were treated and transferred, and 0.9% (N = 110) were held for observation. From 2002 (N = 6) to 2021 (N = 2291), there was a statistically significant increase in bottle cap ingestions (P < .001). CONCLUSION Plastic bottle cap ingestions have increased in children over the last 20 years, coincident with the change to smaller bottle caps.
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Affiliation(s)
- Lauren A DiNardo
- Jacobs School Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Arunima Vijay
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Alyssa D Reese
- Jacobs School Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Suma Alzouhayli
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Michele M Carr
- Department of Otolaryngology, Jacobs School Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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9
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Bajaber A, Shariff S, Azhar M, Ayashi M, Moawed M, Bajaber O. Unforeseen consequences: A case report of misdiagnosis in pediatric ingestion of a fish bone. Radiol Case Rep 2024; 19:4741-4746. [PMID: 39228950 PMCID: PMC11366894 DOI: 10.1016/j.radcr.2024.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 07/13/2024] [Indexed: 09/05/2024] Open
Abstract
Children are frequently reported as cases of foreign body ingestion, with fishbone ingestion being particularly prevalent in communities where fish consumption is common. Although many instances of foreign body ingestion resolve spontaneously, the ingestion of sharp objects like fishbones poses a greater risk of morbidity and mortality due to their propensity for causing complications. Furthermore, incidents of foreign body ingestion often present with nonspecific symptoms or may go unnoticed, potentially leading to misdiagnosis and complicating the clinical course. We present a case of a 2-year-old boy initially misdiagnosed with constipation and treated with laxatives due to intermittent progressive abdominal pain. Subsequently, he presented to the emergency department where radiological and laboratory investigations revealed signs of inflammation and localized abdominal fluid collection containing a linear hyperdense object, indicating complicated foreign body ingestion with perforation. Urgent laparotomy revealed an omental abscess, which was excised, and the perforation site was repaired with sutures. This case underscores the risk of misdiagnosis and the importance of timely recognition and management. It also emphasizes the critical role of imaging, particularly computed tomography, in accurate diagnosis and differentiation from other common conditions.
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Affiliation(s)
- Abubakr Bajaber
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Safa Shariff
- College of Medicine, Al-Rayan Colleges, Madinah 42541, Saudi Arabia
| | - Muhammad Azhar
- Pediatric Surgery Department, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Mariam Ayashi
- Medical Imaging Department, Pediatric Radiology Section, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Mohammed Moawed
- Medical Imaging Department, Pediatric Radiology Section, King Saud Medical City, Riyadh 12746, Saudi Arabia
| | - Omar Bajaber
- Medical Imaging Department, Pediatric Radiology Section, King Saud Medical City, Riyadh 12746, Saudi Arabia
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10
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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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HATGAONKAR ANAND, HATGAONKAR KAJAL, DHOTE SANDEEP, DHAWAN VAISHALI. Few incidentally found interesting foreign objects in human body: a case series. F1000Res 2024; 12:1306. [PMID: 40123985 PMCID: PMC11927391 DOI: 10.12688/f1000research.134773.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 03/25/2025] Open
Abstract
Foreign bodies are objects that do not typically belong in the human body but can be ingested, inserted, or entered due to injuries. This article presents various cases and examples of foreign bodies, including objects swallowed, objects inserted into the rectum, vagina, urethra, ear, and nose, or due to injuries caused by falls, puncture wounds, and gunshot wounds. Foreign bodies can be difficult to detect, particularly if they are not inherently radio-opaque, and may be overlooked by patients who cannot provide an adequate history. These foreign bodies may cause harm to the patient. Interpretation is done on radiographs, computed tomography (CT), Ultrasonography (USG), and magnetic resonance imaging (MRI) studies. Most foreign objects pass through the gastrointestinal tract without problem; sharp and elongated objects can cause significant injury, and even if they only partially perforate the bowel wall, they can produce chronic inflammatory processes that produce symptoms months or years later. Hence, searching for foreign bodies should be done throughout the gastrointestinal tract, particularly in children and people with mental illness who are more likely to swallow multiple items more than once. Although rare, various materials can be left behind in the body of a patient after surgery, including large and small wire sutures, surgical drains, and retained sponges, which can cause potential complications and foreign body reactions. This article highlights the importance of being aware of the presence of foreign bodies in clinical practice, and a thorough search should be carried out using different modalities, especially CT. Great suspicion and early diagnosis of foreign bodies can avoid potential complications and morbidity. In general, it provides information on the diagnosis and treatment of various types of foreign bodies.
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Affiliation(s)
- ANAND HATGAONKAR
- Radiodiagnosis, Datta Meghe Medical College, Nagpur. Datta Meghe Institute of Higher Education and Research (DU), Swangi (Meghe), Wardha, Maharashtra, 442107, India
| | - KAJAL HATGAONKAR
- Pathology, Datta Meghe Medical College, Nagpur. Datta Meghe Institute of Higher Education and Research (DU), Sawangi (Meghe), Wardha, Maharashtra, 442107, India
| | - SANDEEP DHOTE
- Radiodiagnosis, NKP Salve Institute of Medical College and Research, Nagpur, Maharashtra, 440016, India
| | - VAISHALI DHAWAN
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DU), Sawangi (Meghe), Wardha, Maharashtra, 442107, India
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12
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Aishat M, Irshad OM, Shurafa FM, Mohamed S. The Ingestion of 62 Magnetic Beads by a Two-Year-Old Child: A Case Report of a Novel Approach for Retrieval. Cureus 2024; 16:e64541. [PMID: 39144868 PMCID: PMC11322551 DOI: 10.7759/cureus.64541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2024] [Indexed: 08/16/2024] Open
Abstract
The incidence of foreign body ingestion in young children has been increasing over the past couple of years. Although less than 1% of ingested foreign bodies require surgical intervention, the clinician's awareness should be heightened when the ingested body has a magnetic component. Potential complications of multiple magnetics include intestinal necrosis, perforation, ileus, and sepsis. This case study highlights the clinical presentation, surgical methods, anesthetic considerations, and the need for pediatric intensive care unit (PICU) admission in a two-year-old female child who ingested magnetic beads. The paper presents the patient's history, diagnosis, and surgical procedure, including the use of a novel magnetic apparatus to locate the foreign bodies. Clinicians should have a heightened sense of caution when treating children who have ingested multiple magnetic foreign bodies due to potential gastrointestinal complications and increased morbidity. The case describes the use of a novel approach in utilizing a pacemaker magnet to identify any remaining ingested magnetic foreign bodies in the bowel.
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Affiliation(s)
- Muhammad Aishat
- Medicine, Texas College of Osteopathic Medicine, The University of North Texas Health Science Center, Fort Worth, USA
| | - Omayr M Irshad
- Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, USA
| | | | - Sharif Mohamed
- Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, USA
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13
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Pham ST, Sakai O, Andreu-Arasa VC. Imaging approach to ingested foreign bodies in the neck. Neuroradiology 2024; 66:867-881. [PMID: 38619570 DOI: 10.1007/s00234-024-03348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
Foreign body ingestion is a common clinical occurrence worldwide, with high morbidity in the pediatric population and in adult patients with intentional attempts. Coins and button battery ingestions are more common among children. Bone impaction and swallowed dentures are usually seen in older adults. While most ingested foreign bodies pass through the gastrointestinal tract spontaneously with no complications, some require endoscopic and/or surgical intervention. Complications such as pharyngoesophageal ulceration, perforation, stricture, and deep neck infection can develop without timely diagnosis and management. The purpose of this article is to familiarize radiologists with the imaging approach to assess for characteristics and impacted locations of ingested foreign bodies in the neck.
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Affiliation(s)
- Serena T Pham
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Osamu Sakai
- Division of Neuroradiology, Department of Radiology, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - V Carlota Andreu-Arasa
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Boston, MA, USA.
- Division of Neuroradiology, Department of Radiology, VA Boston Healthcare System, Boston, MA, USA.
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14
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Chen T, M Siu J, Madan Y, Ma GW, Gill PJ, Carman N, Propst EJ, Wolter NE. Pediatric Esophageal Foreign Bodies: The Role of Socioeconomic Status in Ingestion Patterns. Laryngoscope 2024; 134:2945-2953. [PMID: 38197507 DOI: 10.1002/lary.31274] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Pediatric esophageal foreign bodies (EFBs) are common and can result in serious complications. Little is known about the influence of socioeconomic status (SES) on EFB ingestion in children. The goal was to study SES as a risk factor for dangerous foreign body ingestion and in-hospital complications in children. METHODS This was a retrospective cohort study of children presenting to a tertiary care pediatric hospital with an esophageal foreign body from 2010 to 2021. SES was assessed for each patient by linking their postal code to the Ontario Marginalization Index to determine a quintile score across four dimensions of deprivation: residential instability, material deprivation, dependency, and ethnic concentration. Dangerous EFBs were defined as magnets, batteries, sharp objects, or bones. In-hospital complications included: intensive care unit admission, prolonged length of stay, and postoperative sequelae. RESULTS A total of 680 patients were included. Dangerous EFB ingestion was higher for children with increased residential instability (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.6) and increased material deprivation (OR, 2.2; CI, 1.9-2.8), which was similarly true for odds of complications. Odds of dangerous EFB ingestion were higher in older children (OR, 1.1; CI, 1.0-1.1) and odds of complications were higher in children with comorbidities (OR, 1.1; CI, 1.0-1.3). CONCLUSION Higher levels of housing instability and material deprivation are associated with dangerous EFB ingestion and complications related to EFB ingestion. These findings emphasize the role that SES plays on child health outcomes and the need for initiatives to mitigate these disparities. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2945-2953, 2024.
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Affiliation(s)
- Tanya Chen
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer M Siu
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Yasmine Madan
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gar-Way Ma
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Peter J Gill
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Carman
- Department of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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15
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Pokharel S, KC S, Lamichhane S, Pokharel M, Sah RP, Yadav SK, Bhusal A, Poudel S, Shah SK, Pokharel M. Asymptomatic spontaneous expulsion of a long foreign body through the gastrointestinal tract - a curious case report. Radiol Case Rep 2024; 19:1940-1944. [PMID: 38449486 PMCID: PMC10915782 DOI: 10.1016/j.radcr.2024.02.007] [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: 11/02/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Foreign body ingestion and its natural elimination are common in children. However, this is uncommon for long foreign bodies. Here, we report the spontaneous removal of an ingested pencil in an asymptomatic child. To our knowledge, this is the first case report of asymptomatic spontaneous elimination of a normally-sized ingested pencil. A 7-year-old male child presented with a history of ingestion of a pencil 4 hours back, without any complaints. Immediate abdominal radiography revealed a pencil in the stomach with an estimated length of approximately 10 cm and no signs of complications. He was conservatively treated under a semi-solid diet, presumably due to lack of available endoscopic option. Subsequently, he passed the pencil in stool within 24 hours of ingestion. He was asymptomatic and playful during the course and at discharge. Conservative management of a quickly moving long foreign body initially located below the esophagus in an asymptomatic child is possible with the help of imaging guidance, particularly in settings lacking an endoscopy. Although, this should not be considered a norm. However, this suggests that the treatment of ingested foreign bodies must be individualized. Thus, multiple factors related to the child and the foreign body must be assessed before committing to invasive procedures like laparotomy. Similarly, plain X-rays can be helpful even for radiolucent foreign bodies, for diagnosis and ruling out complications. All of these are vital in underdeveloped countries, where endoscopy and computed tomography facilities might be either lacking or unaffordable by patients.
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Affiliation(s)
- Sushan Pokharel
- Department of Pediatric Surgery Division, Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Suraj KC
- Department of Pediatric Surgery Division, Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Samiksha Lamichhane
- Department of Radiodiagnosis and Imaging, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Mohir Pokharel
- Department of General Surgery, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Rajesh P. Sah
- Department of Pediatric Surgery Division, Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sanjaya K. Yadav
- Department of Pediatric Surgery Division, Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Amrit Bhusal
- Department of Radiodiagnosis and Imaging, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sishir Poudel
- Department of Pediatric Surgery Division, Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Siddhartha K. Shah
- Department of Pediatric Surgery Division, Department of General Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Moneec Pokharel
- Birat Medical College and Teaching Hospital, Biratnagar, Nepal
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16
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O'Quinn PC, Smith LM, Cavalea AC. Non-surgical Management of a Malecot Tube Migrating From a Small Bowel Fistula. Cureus 2024; 16:e58630. [PMID: 38770488 PMCID: PMC11103909 DOI: 10.7759/cureus.58630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Foreign bodies are encountered relatively often within the practice of general surgery. We present a unique case of a rubber, self-retaining, radiopaque "mushroom-tip" Malecot tube placed for fistula drainage control due to an enterocutaneous fistula (ECF) that became a gastrointestinal foreign body. A 24-year-old male presented in shock with gunshot wounds to his right chest and right upper abdomen to a Level I trauma center. He required a prolonged hospital stay with additional urological and thoracic procedures and an interventional radiology procedure for hepatic pseudoaneurysm and subsequently developed an ECF. The patient was discharged to a rehabilitation facility with a wound management system (WMS) for ECF drainage but returned to the clinic with chemical burns and skin excoriation due to poorly controlled output and suboptimal WMS fit. A better fitting WMS was employed and a 20-French Malecot catheter was placed to assist with drainage control. The patient later returned with abdominal pain reporting the Malecot advanced forward spontaneously and was not externally visible. CT scan revealed the Malecot across the prior ileocolic anastomosis. After considering potential treatment options, we initially proceeded with aggressive bowel stimulation, and saline enemas hoping the tube would pass through his colostomy. He was discharged and the catheter passed at home a few days later via the stoma. Gastroenterological literature recommends invasive management for sharp, corrosive, or elongated foreign bodies exceeding 6cm in length. This unusual case demonstrates a 30-centimeter (cm) blunt object passing through the small bowel and colon in the absence of an ileocecal valve.
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Affiliation(s)
- Payton C O'Quinn
- Department of Surgery, East Tennessee State University Quillen College of Medicine, Johnson City, USA
| | - Lou M Smith
- Department of Surgery, University of Tennessee Medical Center, Knoxville, USA
| | - Alexander C Cavalea
- Department of Surgery, University of Tennessee Medical Center, Knoxville, USA
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17
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Rizvi A, Rizvi F, Chorath K, Suresh NV, De Ravin E, Romeo D, Lakshmipathy D, Barrette LX, Rajasekaran K. Clinical practice guidelines in the management of pediatric foreign body aspiration and ingestion: a systematic evaluation using the AGREE II instrument. Pediatr Surg Int 2024; 40:59. [PMID: 38411786 DOI: 10.1007/s00383-024-05637-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Several clinical practice guidelines (CPGs) have been produced to optimize the diagnosis and management of pediatric foreign body aspiration and ingestion. However, to date there have been no critical evaluations of their methodological rigor or quality. Herein, we address this need via the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. METHODS A literature search of Embase, MEDLINE via PubMed, and Scopus was performed up until February 25, 2021. Identified CPGs were then assessed by four independent reviewers trained in AGREE II. A scaled domain score of >60% was indicated as satisfactory quality. Intraclass correlation coefficients (ICC) were calculated to assess inter-reviewer agreement. RESULTS 11 guidelines were assessed with only one being classified as high quality and others being either average (two) or low quality (eight). Domain 4 (clarity of presentation) achieved the highest mean score (66.41 ± 13.33%), while domain 5 (applicability) achieved the lowest score (10.80 ± 10.37%). ICC analysis revealed generally strong agreement between reviewers with a range of 0.60-0.98. CONCLUSION Quality appraisal using the AGREE II instrument suggests that the methodologic rigor and quality of current guidelines for the diagnosis and management of pediatric foreign body aspiration and ingestion need significant improvement.
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Affiliation(s)
- Anza Rizvi
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Fatima Rizvi
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kevin Chorath
- Department of Otorhinolaryngology, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19107, USA
| | - Neeraj V Suresh
- Department of Otorhinolaryngology, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19107, USA
| | - Emma De Ravin
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dominic Romeo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Deepak Lakshmipathy
- Department of Otorhinolaryngology, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19107, USA
| | - Louis-Xavier Barrette
- Department of Otorhinolaryngology, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19107, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19107, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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18
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Krencnik T, Jalsovec T, Klemenak M, Riznik P, Dolinsek J. Safety beyond Sight: Handheld Metal Detectors as Diagnostic Allies in the Management of Children Suspected to have Ingested Foreign Bodies. Diagnostics (Basel) 2024; 14:356. [PMID: 38396396 PMCID: PMC10887526 DOI: 10.3390/diagnostics14040356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Foreign body (FB) ingestion remains a common cause of pediatric emergency department referrals, and the gold standard for detection is whole-digestive-tract radiographic examination. Our study explores whether handheld metal detectors (HHMD) can effectively identify the presence and location of ingested metal objects, potentially reducing the need for additional radiographic examination. METHODS We collected medical data from children with suspected metal FB ingestion who were referred to our emergency department (October 2017-March 2023), focusing on object type and correlating metal detector findings with radiographic images. RESULTS Data from 43 children (39.5% female; mean age: 4 y) referred to our emergency department were analyzed. Coins (32.6%), button batteries (18.6%), and hairpins (11.6%) were the most common ingested objects. Metal detectors detected the presence of FBs in 81.4% of cases (sensitivity: 89.7%; specificity: 100%). Radiographs, taken for 40 children, showed that the most common locations were the stomach (37%) and intestine (33%). The metal detector signals matched the radiography results in 69.8% of cases. According to HHMD, 34.9% of objects were accessible via endoscopy, contrasting with 51.2% via radiography (p < 0.05). CONCLUSION While the findings obtained using handheld metal detectors often correlate well with radiograph findings in detecting metal FBs, for an important number of children, this confirmation is lacking, especially when determining the exact location of an object.
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Affiliation(s)
- Tomaz Krencnik
- Department of Pediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia (J.D.)
| | - Tadej Jalsovec
- Department of Pediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia (J.D.)
| | - Martina Klemenak
- Department of Pediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia (J.D.)
| | - Petra Riznik
- Department of Pediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia (J.D.)
| | - Jernej Dolinsek
- Department of Pediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia (J.D.)
- Medical Faculty, University of Maribor, 2000 Maribor, Slovenia
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19
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Abudungor RL, Arif DO, Alsulaiman YS, Alrabghi DA, Jarb AF, Algari LM. A Retrospective Analysis of Foreign Body Ingestions Among the Pediatric Age Group in a Tertiary Care Hospital in Jeddah, Saudi Arabia. Cureus 2023; 15:e48113. [PMID: 38046744 PMCID: PMC10691644 DOI: 10.7759/cureus.48113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Foreign body ingestion (FBI) among the pediatric age group is considered a major clinical problem that can cause life-threatening complications, as it can obstruct the airway due to poor/immature airway protection reflexes. OBJECTIVE In this study, we aimed to retrospectively describe the epidemiology, clinical characteristics, and outcomes of FBI among the pediatric age group in Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia. METHODS We conducted a retrospective study of pediatric patients (0-14 years) presenting to a tertiary care hospital in Jeddah, Saudi Arabia, from January 2019 to October 2022. The study reviewed records of patients with FBI in the emergency department. Data collection included age, gender, comorbidities, foreign body (FB) type, anatomical location, presenting symptoms, time to emergency room (ER) presentation, need for endoscopy, and complications. We performed a statistical analysis using the Statistical Package for Social Sciences (SPSS) 25 (IBM SPSS Statistics, Armonk, NY), where p<0.05 was considered statistically significant. RESULTS We identified 244 FBI cases, with most cases being male (62.7%). The most common site of FB impaction was the stomach (38.9%), followed by the upper esophagus (29.1%). Clinical presentation was variable, with 20.5% of cases experiencing vomiting, 13.5% experiencing drooling, and 9.4% experiencing dysphagia. Out of 244 cases, 132 (54.1%) were referred to gastroenterology for urgent FB removal by endoscopy. A total of 186 cases (76.2%) did not have complications, whereas 3.6% had serious sequela. The association between age and FBI was statistically significant (p=0.00), whereas there was no association between gender and FBI. CONCLUSION Our results showed that FB ingestion was prevalent among children at our tertiary care hospital, with urgent endoscopy being the most common removal procedure. Early detection and immediate presentation to the emergency room are crucial for preventing complications. Common FBI included coins and batteries, with most incidents in 1-3-year-old males. Parents should be aware of the dangers of FBI and implement preventive measures to reduce its incidence.
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Affiliation(s)
- Rahaf L Abudungor
- Faculty of Medicine, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Deema O Arif
- Faculty of Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | | | - Dana A Alrabghi
- Faculty of Medicine, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Ahmed F Jarb
- Faculty of Medicine, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Lojien M Algari
- Department of Pediatrics, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
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20
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Lee JJ, Rugg AL, Wu CK, Hamblin GJ, Larson MC. Ultrasound evaluation of intraluminal magnets in an ex vivo model. Emerg Radiol 2023; 30:589-596. [PMID: 37481679 PMCID: PMC10522730 DOI: 10.1007/s10140-023-02160-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/13/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE The management of foreign body ingestion proves to be a challenge. Magnets pose a unique set of risks when ingested due to their attractive forces and subsequent risk of adherence, pressure necrosis, and perforation complications. Radiographs only provide a limited snapshot in the setting of multiple magnet ingestion when the risk of complication is highest. We hypothesize that abdominal ultrasound (US) has the potential to supplement radiographs in assessing ingested magnets by determining the presence of bowel loop entrapment and of any extraluminal fluid. METHODS We recreated various scenarios of magnet configurations using animal cadaveric bowel models. X-ray and US images were obtained in various bowel-magnet orientations. RESULTS We identified several key US features to suggest bowel wall tethering. These include direct visualization of bowel wall entrapment between magnets (what we term the "dangerous V sign"), anti-dependent positions of the magnets, and inability to separate loops of bowel with compression. CONCLUSION These findings could potentially provide valuable information when directing the urgency of intervention in foreign body ingestion. Ultrasound may supplement and improve the current guidelines in management of magnet ingestion.
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Affiliation(s)
- Jason J Lee
- Department of Medical Imaging, University of Arizona College of Medicine, 1501 N. Campbell Ave, P.O. Box 245067, Tucson, AZ, 85724, USA
| | - Amanda L Rugg
- Department of Medical Imaging, University of Arizona College of Medicine, 1501 N. Campbell Ave, P.O. Box 245067, Tucson, AZ, 85724, USA
| | - Crystal K Wu
- Department of Pediatrics, Tucson Medical Center, 5301 E. Grant Road, Tucson, AZ, 85712, USA
| | | | - Michael C Larson
- Department of Radiology, University of California - Davis Health, 4860 Y Street, Ste 3100, Sacramento, CA, 95817, USA.
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21
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Higashi K, Koike Y, Sato Y, Yamashita S, Nagano Y, Shimura T, Kitajima T, Matsushita K, Yokota K, Amano K, Okugawa Y, Toiyama Y. Extraction of a metallic susceptor after accidental ingestion of the heated tobaccostick TEREA™: a case report. BMC Pediatr 2023; 23:452. [PMID: 37689624 PMCID: PMC10492281 DOI: 10.1186/s12887-023-04285-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/01/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Tobacco ingestion is widely known to cause nicotine toxicity, which may result in severe symptoms. Two heated tobacco sticks, called TEREA™ and SENTIA™, were launched in 2021 by Philip Morris International (New York, NY, USA), and their ingestion is associated with a risk of bowel injury because they contain a partially pointed metallic susceptor. However, this risk is not well known to the general public or healthcare providers. To increase awareness of this risk, we herein report a case involving extraction of a metallic susceptor after ingestion of the heated tobacco stick TEREA™. CASE PRESENTATION A 7-month-old girl presented to the emergency department of a nearby hospital because she was suspected to have accidentally swallowed heated tobacco. Although she presented with no symptoms related to nicotine poisoning, abdominal X-ray examination revealed a metal object in her stomach. According to a statement released by the Japan Poison Information Center, the TEREA™ heated tobacco stick contains a metallic susceptor with a rectangular shape and sharp corners. The patient was transferred to our department because of the risk of bowel injury, and upper gastrointestinal endoscopy was performed. No cigarettes were found by endoscopic observation; however, a metallic susceptor was located in the second part of the duodenum. We grasped it with biopsy forceps and carefully removed it using an endoscope with a cap attached to the tip. The post-endoscopic course was uneventful. CONCLUSIONS Some patients who ingest heated tobacco sticks might be exposed not only to the effects of nicotine but also to physical damage caused by a metallic susceptor. Infants and toddlers especially could swallow these sticks, therefore tobacco companies need to make the problem more public. Clinicians also should alert the problem, and pay attention to this risk in the clinical setting.
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Affiliation(s)
- Koki Higashi
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yuhki Koike
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
| | - Yuki Sato
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Shinji Yamashita
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yuka Nagano
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Tadanobu Shimura
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Takahito Kitajima
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kohei Matsushita
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kazuki Yokota
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Keishiro Amano
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yoshinaga Okugawa
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yuji Toiyama
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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22
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Alareefy A, Barnawi E, Alrashed R, Alamri A, Aleidan AM, Alghofaily M, Alkhelaif M, Kanfar S. Pediatric Magnet Ingestion with Delayed Presentation: Case Series from Tertiary Center in Saudi Arabia. Pediatric Health Med Ther 2023; 14:231-236. [PMID: 37521122 PMCID: PMC10378458 DOI: 10.2147/phmt.s411079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023] Open
Abstract
Swallowing foreign bodies is common in young kids, especially those aged 6 months to 6 years. Magnet ingestion is a hazardous health issue that extremely jeopardizes the most vulnerable group, children, to risks of intestinal obstruction and worse, perforation. We, hereby, report 3 cases of magnet ingestion in the pediatric age group who had multiple beaded magnets stuck inside their GI tract over a variable period of 1 to 10 months before their presentation to the Emergency Department, King Fahad Medical City Riyadh, Saudi Arabia.
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Affiliation(s)
- Abdulaziz Alareefy
- Pediatric Emergency Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Esam Barnawi
- Pediatric Emergency Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Rawan Alrashed
- Pediatric Emergency Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Abdulelah Alamri
- Pediatric Emergency Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Ahmed M Aleidan
- Pediatric Pulmonology Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Mazen Alghofaily
- General Pediatric Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Mayada Alkhelaif
- General Pediatric Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Sara Kanfar
- Pediatric Surgery Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
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23
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Ikegami M, Miyaki Y, Hamano T, Taira Y, Takahashi T. Neodymium magnets migrated into an internal supravesical hernia: a rare case of foreign body ingestion in children. Surg Case Rep 2023; 9:131. [PMID: 37468604 DOI: 10.1186/s40792-023-01713-9] [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: 05/02/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Foreign body (FB) ingestion is a common event in children. The management of the ingested FB depends on the location, type, number, size of the FBs, patient age, and symptoms. Although most FBs pass spontaneously through the gastrointestinal tract without causing serious injuries, the ingestion of multiple high-powered magnetic pieces, especially neodymium magnets (NMs) increases the risks of morbidity and mortality. Supravesical hernia (SH) is rarely occurs in children, and few studies have reported SH in pediatric patients. We report an extremely rare case of ingested NMs that migrated into an internal SH in a pediatric patient. CASE PRESENTATION A 3-year-old boy who had accidentally swallowed two NMs 3 days ago presented with vomiting and lower abdominal pain. X-ray imaging and computed tomography (CT) suspected the presence of a 1.0-cm radiopaque FB located in the terminal ileum dorsal side of the bladder. Although his abdominal pain was gradually getting better after oral feeding, repeat abdominal X-ray imaging showed that the FB was in a stagnant in position. Therefore, surgical intervention was planned to remove the FB 1 week after his admission. Under general anesthesia, laparoscopic and fluoroscopic examinations were performed and the cecum was found adhered to the retroperitoneum between the right medial umbilical fold and the right wall of the urinary bladder. The FB was presumed to be located at the tip of the incarcerated cecum in the retroperitoneal space. Peritoneum incision was started near the medial inguinal fossa, and the Retzius space was opened in a manner similar to the transabdominal pre-peritoneal approach for inguinal hernia repair. Consequently, the patient was diagnosed with internal SH with FB migration. The incarcerated cecum was pulled out, which revealed intestinal wall perforation. The FB remained in the retroperitoneal space in the pelvic cavity. The FB was easily removed using intestinal forceps and identified as combined two NMs. The postoperative course was good, and the patient was discharged on postoperative day 5. CONCLUSIONS We experienced an extremely rare case of a pediatric patient who swallowed multiple NMs that migrated into an internal SH, and the laparoscopic minimally invasive removal was successful.
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Affiliation(s)
- Michiaki Ikegami
- Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka Ward, Hamamatsu City, Shizuoka, 430-8558, Japan
| | - Yuichiro Miyaki
- Department of Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Takashi Hamano
- Department of Colorectal Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yurina Taira
- Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka Ward, Hamamatsu City, Shizuoka, 430-8558, Japan
| | - Toshiaki Takahashi
- Department of Pediatric Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka Ward, Hamamatsu City, Shizuoka, 430-8558, Japan.
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Emeka CK, Chukwuebuka NO, Tochukwu EJ. Foreign body in the gastrointestinal tract in children: A tertiary hospital experience. Afr J Paediatr Surg 2023; 20:224-228. [PMID: 37470560 PMCID: PMC10450112 DOI: 10.4103/ajps.ajps_148_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 08/13/2021] [Accepted: 11/20/2021] [Indexed: 07/21/2023] Open
Abstract
Background Foreign body (FB) ingestion in the gastrointestinal tract (GIT) in children is common. Although most foreign bodies will pass spontaneously, surgical intervention is required when they fail to pass. Aims and Objectives The aim of this study was to evaluate our experience in the management of children who presented with FB in the GIT. Materials and Methods This was a retrospective study of children that underwent laparotomy for the removal of FB in the GIT at the paediatric surgery unit of Enugu State University Teaching Hospital, Enugu over a 10-year period. Results A total of 272 children presented with FB in the GIT during the study period, out of which 30 patients had laparotomy. This gave an operative incidence rate of 11%. There was a slight male predominance and the ages of the patients ranged from 6 months to 5 years (median 3 years). About half of the patients had no symptoms and all the patients were investigated with an abdominal radiograph. Only one-third of the patients had a predisposing factor that could have led to FB impaction. FB impaction was the most common indication for surgery, and enterotomy with FB removal was the most performed surgical procedure. The most common FB removed were tiny parts of toys, and the most common post-operative complication was surgical site infection. There was no mortality. Conclusion FB in GIT in children could be associated with complications that require surgical treatment. FB ingestion is preventable. Focus should be placed on caregivers preventing children from ingesting FB.
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Affiliation(s)
- Chukwubuike Kevin Emeka
- Department of Surgery, Paediatric Surgery Unit, Enugu State University Teaching Hospital, Enugu, Enugu State, Nigeria
| | | | - Enebe Joseph Tochukwu
- Department of Obstetrics and Gynecology, Enugu State University Teaching Hospital, Enugu, Enugu State, Nigeria
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S. P, RB NN, K. G, SR K, S. R. Difficult Bronchoscopy and Foreign Body Removal: Our Experience. INTERNATIONAL JOURNAL OF RECENT SURGICAL AND MEDICAL SCIENCES 2023. [DOI: 10.1055/s-0043-1764365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background Foreign body in the airway is the most life-threatening situation. Most foreign bodies present as acute emergency and can be removed by endoscopy/bronchoscopy, while a few causes complication of a retained foreign body which requires emergency tracheostomy to secure airway followed by foreign body removal.
Case Presentation We report our experience in the management of three children who required tracheostomy through which bronchoscope was introduced and foreign body removed. All patients with unrecognized retained foreign body presented with respiratory distress with desaturation. Imaging was suggestive of atelectasis. After foreign body removal patients recovered well and decannulated by day 5.Subglottis is the narrowest part of pediatric airway. As these foreign bodies were vegetative they are hygroscopic in nature and hence would not be able to remove the foreign body by bronchoscopic guidance. Hence, tracheostomy was done to provide access followed by bronchoscopic removal.
Conclusion Aspirated foreign body present challenges to the ear, nose, and throat surgeon. Newer techniques enable removal of foreign body easier. Tracheostomy combined with bronchoscopy can be a life-saving and easy to perform procedure which involves removal of foreign body at the same time.
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Affiliation(s)
- Prabakaran S.
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
| | - Namasivaya Navin RB
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
| | - Gowthame K.
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
| | - Karthika SR
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
| | - Rajasekaran S.
- Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, India
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Baharudin N, Gendeh H, Teh HM. Neck Radiograph Halo Sign: Do Not Be Fooled. Cureus 2023; 15:e38029. [PMID: 37228521 PMCID: PMC10205967 DOI: 10.7759/cureus.38029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/27/2023] Open
Abstract
An aerodigestive foreign body injury in the throat is an otorhinolaryngology (ORL) emergency. Button batteries and coins are the most common foreign body aspirations or ingestions among the paediatric population. An impacted button battery in the aerodigestive tract is a surgical emergency, requiring urgent removal to prevent complications arising from the corrosive nature of the button battery. We report two cases that were brought in with a history of foreign body ingestion. Both neck radiographs showed a double-ring opaque shadow. The first child had a button battery eroding into his oesophagus. The second case is an ideally impacted stack of coins of different sizes that mimic a double-ring shadow, better known as a halo sign, in an antero-posterior neck radiograph. These cases are unique in comparing ingested coins in alignment with a button battery and a radiological examination mimicking that of a button battery. In this report, we emphasize the importance of a thorough history, endoscopic examination, and the limitations of radiographs in the initial assessment of an ingested foreign body in terms of management and prediction of morbidity.
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Affiliation(s)
- Nurdiana Baharudin
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Hardip Gendeh
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Hui Mon Teh
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Queen Elizabeth, Kota Kinabalu, MYS
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Karišik M. FOREIGN BODY ASPIRATION AND INGESTION IN CHILDREN. Acta Clin Croat 2023; 62:105-112. [PMID: 38746610 PMCID: PMC11090237 DOI: 10.20471/acc.2023.62.s1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Aspiration and ingestion of a foreign body is most frequently seen in children younger than 3 years. Foreign body aspiration is always a life-threatening, urgent state demanding quick recognition and treatment to avoid potentially lethal complications. Most foreign bodies that are ingested pass spontaneously through the gastrointestinal tract without complications, however, some could lead to problems if they become lodged. A literature review was performed via MEDLINE database using key terms. Primary care providers should be trained to give proper initial care. Aspirated/ingested foreign bodies in children removed by rigid or flexible bronchoscopy/gastroscopy always are challenging procedures that require well-planned anesthesia management and excellent intercommunication between anesthesiologists and surgeons. Extracorporeal membrane oxygenation can be used as a rescue mode of support in children with life-threatening foreign body aspiration for stabilization before, during and after removal of the aspirated foreign body. It is of utmost importance that all foreign body extractions, if possible, be done in centers supplied with all the necessary equipment and trained personnel. However, prevention of foreign body aspiration and ingestion is still the best therapy.
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Affiliation(s)
- Marijana Karišik
- Department of Anesthesiology and Intensive Care, Institute for Children Diseases, Clinical Center of Montenegro, Podgorica, Montenegro
- University of Montenegro, Faculty of Medicine, Podgorica, Montenegro
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28
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Sun RC, Mehl S, Rialon K, Vogel AM, Nuchtern J. Magnet Extraction Through Appendectomy Laparoscopically (METAL) technique as a novel method to manage ingested magnets in children. Am Surg 2023; 89:490-492. [PMID: 33283527 DOI: 10.1177/0003134820954849] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Raphael C Sun
- Division of Pediatric Surgery, Texas Children's Hospital, 3989Baylor College of Medicine, USA
| | - Steven Mehl
- Division of Pediatric Surgery, Texas Children's Hospital, 3989Baylor College of Medicine, USA
| | - Kristy Rialon
- Division of Pediatric Surgery, Texas Children's Hospital, 3989Baylor College of Medicine, USA
| | - Adam M Vogel
- Division of Pediatric Surgery, Texas Children's Hospital, 3989Baylor College of Medicine, USA
| | - Jed Nuchtern
- Division of Pediatric Surgery, Texas Children's Hospital, 3989Baylor College of Medicine, USA
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29
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Khan A, Eldos Y, Alansari K. Clinical Presentation and Outcome of Multiple Rare Earth Magnet Ingestions in Children of Qatar. A Single-Center Experience. Qatar Med J 2023; 2023:9. [PMID: 36846273 PMCID: PMC9943907 DOI: 10.5339/qmj.2023.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/08/2023] [Indexed: 02/27/2023] Open
Abstract
INTRODUCTION Rare earth magnets are powerful magnets that can have several negative effects if ingested. The goal of our study is to describe the result of multiple rare earth magnets ingested by children in Qatar. MATERIALS AND METHODS This is observational research. We conducted a retrospective chart review and descriptive analysis of all cases of multiple rare earth magnetic ingestion that werepresented to the Emergency Department of Sidra Medicine between January 2018 and July 2022. We obtained an exemption for this study from our institutional review board (IRB). RESULTS In our research, we identified 21 children having multiple rare earth magnetic ingestions. The predominant symptoms were abdominal pain and vomiting which were observed in 57% (n = 12) and 48% (n = 10) of the patients respectively. The most common sign was abdominal tenderness,observed in 14% (n = 3) of the patients. In our sample, 38% (n = 8) of the patients were managed conservatively whereas 62% (n = 13) needed intervention. In our study, 48% (n = 10) of the patients sustained complications. The frequent complications were intestinal perforation appreciated in 24% (n = 5) and intestinal perforation with fistula formation in 19% (n = 4) of the patients. The median age of these patients was two years while the median number of magnets ingested was six. The ingestions were unwitnessed, and the duration of ingestions was unknowninthemajorityofpatientswhoexperiencedcomplications (n = 8/10). CONCLUSION If numerous rare earth magnetis ingested, children are in high danger of harm. It can be difficult to pinpoint the cases in younger children due to poor communication skills, especially if the intake is unreported. Although Qatar has established restrictions banning the import of rare earth magnets, there are reported cases of children with rare earth magnets ingestions.
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Affiliation(s)
- Abdullah Khan
- Sidra Medical and Research Center. E-mail: ORCID ID is 0000-0003-4314-5202
| | - Yazeed Eldos
- Sidra Medical and Research Center. E-mail: ORCID ID is 0000-0003-4314-5202
| | - Khalid Alansari
- Sidra Medical and Research Center. E-mail: ORCID ID is 0000-0003-4314-5202
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Romero BM, Vilchez-Bravo S, Hernández-Arriaga G, Bueso-Pineda L, Franchi T, Tovani-Palone MR, Mejia CR. Factors associated with complications of foreign body ingestion and/or aspiration in children from a Peruvian hospital. Heliyon 2023; 9:e13450. [PMID: 36846670 PMCID: PMC9947256 DOI: 10.1016/j.heliyon.2023.e13450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To determine the factors associated with complications of foreign body ingestion and/or aspiration in children from a hospital in the Peruvian social security program. MATERIALS AND METHODS An observational, retrospective, analytical, and transverse study was undertaken. Medical records of patients under the age of 14 years old, who were admitted to the National Hospital Edgardo Rebagliati Martins between January 2013 and May 2017, and treated with a diagnosis of foreign body in the digestive or respiratory tract, were selected. Variables that characterized the foreign body ingestion and/or aspiration were assessed. STATA v11.1 was used for all subsequent statistical analyzes. RESULTS A total of 322 cases met the inclusion criteria and the median age of the cohort was 4 years old (interquartile range: 2-6). The most frequently ingested foreign bodies were coins (∼59%) and batteries (∼10%). Fifty-four cases (∼17%) were classed as having a complication. In the multivariate analysis, we observed that the frequency of complications increased when the ingested object was a battery (adjusted prevalence ratio (aPR): 2.89; 95% confidence interval (CI): 2.52-3.32; p-value<0.001), when the time elapsed prior to diagnosis was 8-16 h (aPR: 2.23; 95% CI: 2.18-2.28; p-value<0.001), and when the child was male (aPR: 1.85; 95% CI: 1.24-2.74; p-value = 0.002). However, the frequency decreased in cases where foreign bodies were lodged in the nose (aPR: 0.97; 95% CI: 0.97-0.98; p-value<0.001). CONCLUSIONS Whilst the most frequently ingested foreign bodies in this study were coins, complications were more common in cases of battery ingestion and in those where the diagnosis was made after 8 h.
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Affiliation(s)
- Brian M. Romero
- Facultad de Medicina Humana, Universidad Ricardo Palma, Lima, Peru
| | | | | | - Lotty Bueso-Pineda
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
| | - Thomas Franchi
- The Medical School, The University of Sheffield, Sheffield, United Kingdom
| | - Marcos Roberto Tovani-Palone
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India
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Lee YJ, Lee JH, Park KY, Park JS, Park JH, Lim TJ, Myong JP, Chung JH, Seo JH. Clinical Experiences and Selection of Accessory Devices for Pediatric Endoscopic Foreign Body Removal: A Retrospective Multicenter Study in Korea. J Korean Med Sci 2023; 38:e2. [PMID: 36593686 PMCID: PMC9807773 DOI: 10.3346/jkms.2023.38.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Swallowing of foreign bodies (FBs) is the most common indication of therapeutic endoscopy in children. Endoscopic removal may be necessary depending on the type of FB, age of the child, and location of the FB. We attempted to analyze the characteristics of each device used for the endoscopic removal of FBs in children. METHODS Medical records of the patient's age, sex, weight, type, location, size, shape, type of device used for endoscopic removal, and endoscopic time were retrospectively collected. RESULTS A total of 424 FB removal procedures were analyzed. The average age of the patients at the time of FB removal was 4.1 ± 3.7 years. Coins were the most common FBs (192, 45.3%). The most common locations of the FBs were the esophagus (45.7%) and the stomach (48.3%), respectively. For a total of 371 cases, forceps were used in 96 cases (25.9%) for esophageal FBs and in 25 cases for gastric FBs (6.7%), while nets were used in 250 cases (67.4%) for gastric FBs retrieval; the average durations of the procedures were 7.2 ± 7.4 minutes, 8.5 ± 7.2 minutes, and 5.7 ± 7.3 minutes, respectively (P = 0.003). The procedure time was significantly shorter, in the group of patients with low body weights, when nets were used than when forceps were used to remove gastric FBs (P = 0.001). CONCLUSION The endoscopic procedure duration, in low-weight children, was shorter when retrieval nets were used than that with forceps.
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Affiliation(s)
- Yeoun Joo Lee
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Ji-Hyuk Lee
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kie Young Park
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Ji Sook Park
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Sciences, Gyeongsang National University Hospital, Jinju, Korea
| | - Jae Hong Park
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Taek Jin Lim
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Jun-Pyo Myong
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hun Chung
- Division of Gastrointestinal Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji-Hyun Seo
- Department of Pediatrics, Gyeongsang National University School of Medicine, Gyeongsang Institute of Sciences, Gyeongsang National University Hospital, Jinju, Korea.
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Sutherland J, Bowen L. Ingestion of foreign bodies and caustic substances in children. BJA Educ 2023; 23:2-7. [PMID: 36601025 PMCID: PMC9805929 DOI: 10.1016/j.bjae.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
| | - L. Bowen
- Children's Hospital for Wales, Cardiff, Wales, UK
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Sanmoto Y. Appendiceal foreign body in a two-year-old child: A case report. Pediatr Int 2023; 65:e15533. [PMID: 36942821 DOI: 10.1111/ped.15533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/14/2023] [Accepted: 03/19/2023] [Indexed: 03/23/2023]
Affiliation(s)
- Yohei Sanmoto
- Department of Pediatric Surgery, Takeda General Hospital, Fukushima, Japan
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34
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Gyawali BR, Guragain R, Gyawali DR. Role of Honey and Acetic Acid in Mitigating the Effects of Button Battery in Esophageal Mucosa: A Cadaveric Animal Model Experimental Study. Indian J Otolaryngol Head Neck Surg 2022; 74:5759-5765. [PMID: 36742683 PMCID: PMC9895233 DOI: 10.1007/s12070-021-02382-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/11/2021] [Indexed: 02/07/2023] Open
Abstract
The objective of our study was to evaluate the role of honey and acetic acid in mitigating the mucosal injury posed by button battery using esophagus specimens from goat cadavers. This was an in vitro experimental cadaveric animal model laboratory study. We used 40 specimens of cadaveric goat esophagus and divided into four groups (A, B, C and D). The first comparison was between group A (specimens with button battery only) and group B (specimens with button battery coated with honey) for the difference in the degree of mucosal injury and change in pH and temperature. The second comparison was between group C (specimens with button battery removed after six hours) and group D (specimens with 5% acetic acid applied following the removal of the battery after six hours) for the difference in the progression of the mucosal injury and change in pH and temperature. The observer was blinded regarding the allocation of the groups. We used Fisher's exact test and independent sample t-test, to evaluate the statistical association. There was a statistically significant reduction in the degree of mucosal injury in specimens applied with button battery coated with honey compared to the specimens applied with button battery only. Similarly, progression of the mucosal injury was halted in specimens with the application of acetic acid following the removal of the button battery. Honey and acetic acid can mitigate the mucosal effects posed by the button battery in cadaveric goat esophageal specimens.
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Affiliation(s)
- Bigyan Raj Gyawali
- Department of ENT-HNS, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj road, Kathmandu, 44600 Nepal
| | - Rajendra Guragain
- Department of ENT-HNS, Maharajgunj Medical Campus, Institute of Medicine, Maharajgunj road, Kathmandu, 44600 Nepal
| | - Dhruba Raj Gyawali
- Department of Science & Research, West Point School, Chandragiri-3, Kathmandu, Nepal
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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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Boumarah DN, Binkhamis LS, AlDuhileb M. Foreign body ingestion: Is intervention always a necessity? Ann Med Surg (Lond) 2022; 84:104944. [PMID: 36582912 PMCID: PMC9793207 DOI: 10.1016/j.amsu.2022.104944] [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: 09/05/2022] [Revised: 10/31/2022] [Accepted: 11/13/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Intentional and accidental foreign body ingestion are commonly encountered in clinical practice. In adults, intentional foreign body ingestion is frequently observed among individuals with psychiatric disorders and prisoners. Controversies exist regarding the management of sharp or pointed objects. We contribute to this existing controversy by presenting a case of a 43-year-old male who accidently ingested a metallic screw and was managed successfully through endoscopic retrieval. Case presentation We discuss a case of a 43-year-old male presented to our emergency department after accidently swallowing a metallic screw, 1 h and a half prior to his presentation. He was initially asymptomatic then started to complain of vague abdominal symptoms. X-rays of the chest and abdomen demonstrated the presence of a metallic screw at the mid-abdomen. Computed tomography scan of the abdomen then confirmed its presence within the gastric lumen, with no evidence of gastric or bowel perforation. The patient was managed via esophagogastroduodenoscopy in which the ingested screw was extracted. He was discharged after 24 hours in a good condition. Clinical discussion A limited number of epidemiological studies have shed light on the prevalence and incidence of foreign body ingestion among adult individuals. Probability of spontaneous passage depends on several factors including the size, shape and composition of the impacted item, as well as the age of patient and duration of ingestion prior to presentation. Conclusion Considering the variation of ingested objects and the availability of several therapeutic approaches, a patient-tailored management plan should always be established.
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Affiliation(s)
- Dhuha N. Boumarah
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia,Corresponding author.
| | - Lujain S. Binkhamis
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia
| | - Mohammed AlDuhileb
- Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Wafi A, Wafi M, Hakami T, Alabida NW, Almutairi R, Saad A, Sumaily I. Incidence of pediatric rigid esophagoscopy for foreign body removal before and after coin currency implementation in Saudi Arabia in 2017. Ann Saudi Med 2022; 42:415-418. [PMID: 36444929 PMCID: PMC9706717 DOI: 10.5144/0256-4947.2022.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Foreign body (FB) ingestion is a common problem in children, which can lead to severe complications. Coins are the most common FB ingested. Since coin currency was recently implemented in Saudi Arabia, we decided to assess whether any changes have occurred in the incidence of FB removal by esophagoscopy. OBJECTIVES Incidence of rigid esophagoscopy for ingested FB removal before and after coin currency implementation. DESIGN Medical record review SETTINGS: Main referral hospital in Jazan region. PATIENTS AND METHODS Our study included pediatric patients who underwent rigid esophagoscopy for removal of FB between February 2015 and July 2020 in the otorhinolaryngology department. We reported the incidence, age, gender, and type of FB. As the coin currency implementation started on December 2, 2017, the data were analyzed before and after this date. MAIN OUTCOME MEASURES Annual incidence of pediatric rigid esophagoscopy for removal of ingested FB and type of the FB. SAMPLE SIZE 124 patients RESULTS: The median age and interquartile range was 6.0 (5.0) years. After implementation of coins in 2017, 104 cases were reported over 32 months; before that date, 20 cases were reported over 34 months. Coins were the FB in 2 cases (10%) before implementation of coins and in 83 cases (79.8%) after implementation (P=.0001). CONCLUSIONS The annual incidence of pediatric esophagoscopy for FB removal has increased more than five times since implementation of coin currency. This increase is exclusively related to the increase in coins as a FB. LIMITATIONS Retrospective study. CONFLICT OF INTEREST None.
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Affiliation(s)
- Abdulaziz Wafi
- From the Department of Head and Neck Surgery, Otorhinolaryngology, King Fahad Central Hospital, Jazan, Saudi Arabia
| | - Mousa Wafi
- From the College of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Turki Hakami
- From the Department of Head and Neck Surgery, Otorhinolaryngology, King Fahad Central Hospital, Jazan, Saudi Arabia
| | - Nasser Waleed Alabida
- From the Department of Otorhinolaryngology, Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Raed Almutairi
- From the Department of Otorhinolaryngology, Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Alsaleh Saad
- From the Department of Otorhinolaryngology, Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Sumaily
- From the Department of Head and Neck Surgery, Otorhinolaryngology, King Fahad Central Hospital, Jazan, Saudi Arabia
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da Silva DS, Markus JR, Lopes AB, Sousa LDS, Maciel EDS, do Nascimento LR, Silva LS, Barasuol AM, Pontes-Silva A, Quaresma FRP. Protocol of care for foreign-body ingestion in children: a qualitative study. Rev Assoc Med Bras (1992) 2022; 68:1270-1275. [PMID: 36228258 PMCID: PMC9575034 DOI: 10.1590/1806-9282.20220368] [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: 06/02/2022] [Accepted: 06/12/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: This study aimed to suggest a care protocol for foreign-body ingestion, address the clinical aspects, and identify the ingested object, severity, and professional conduct. METHODS: This is a qualitative study. We used books and original articles published in national and international journals (BIREME, SCIELO, LILACS, and MEDLINE/PubMed) in Portuguese, Spanish, and English. RESULTS: The ingestion of a radiolucent object should be evaluated radiographically and with endoscopy for cases with symptoms of impaction and radiolucent objects. Coins are the most commonly involved foreign bodies. In asymptomatic patients, it often requires only a conservative form of management. Ingestion of batteries, magnets, and sharp objects carries a high risk of serious clinical complications and should have an endoscopic or surgical approach. In view of this, each pediatric emergency service, based on these recommendations, has the possibility to develop an individual protocol to identify and remove the ingested foreign body. CONCLUSIONS: Protocol of care for foreign-body ingestion in children depends on the object ingested, time of ingestion, symptoms, and local epidemiological context. This study provides some suggestions for decision-making in the conduct of health professionals.
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Affiliation(s)
- Dario Silva da Silva
- Universidade Federal do Tocantins, Postgraduate Program in Science and Health Teaching – Palmas (TO), Brazil
| | | | | | | | - Erika da Silva Maciel
- Universidade Federal do Tocantins, Postgraduate Program in Science and Health Teaching – Palmas (TO), Brazil
| | | | - Luiz Sinésio Silva
- Universidade Federal do Tocantins, Postgraduate Program in Science and Health Teaching – Palmas (TO), Brazil
| | - Aldair Martins Barasuol
- Universidade Federal do Tocantins, Postgraduate Program in Science and Health Teaching – Palmas (TO), Brazil
| | - André Pontes-Silva
- Universidade Federal de São Carlos, Postgraduate Program in Physiotherapy – São Carlos (SP), Brazil.,Universidade Federal do Maranhão, Postgraduate Program in Adult Health – São Luís (MA), Brazil.,Corresponding author:
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Sakamoto N, Fujii S, Masumoto K, Matsuoka A, Toumine S, Hara T, Shimada K. Plastic foreign body in the pharynx can evade detection by computed tomography. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Unusual Foreign Body Found on Colonoscopy in an Adolescent Girl. ACG Case Rep J 2022; 9:e00762. [PMID: 35664526 PMCID: PMC9162239 DOI: 10.14309/crj.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/17/2021] [Indexed: 11/25/2022] Open
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Seghers VJ, Kan JH, Somcio R, Sher AC, Paul Guillerman R, Sammer MBK. CT imaging of esophageal foreign bodies in children: a pictorial essay. Jpn J Radiol 2022; 40:262-270. [PMID: 34661860 DOI: 10.1007/s11604-021-01201-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
Foreign body (FB) ingestion is common in children, particularly from 6 months to 3 years of age. As young children may be unable to provide a clinical history and the ingestion is often unwitnessed, imaging plays an important role in diagnosis, predicting outcomes and detecting complications that require surgical intervention. Since 2015, our institution's diagnostic algorithm for suspected airway foreign bodies has included a noncontrast airway FB CT (FB-CT) with the z-axis coverage spanning from the larynx to the proximal segmental bronchi of the lower lung zones. The effective dose of radiation from this FB-CT airway protocol is typically less than 1 mSv, compared to an effective dose of just under 1 mSv to up to 3 mSv for a fluoroscopic esophagram in children under 10 years of age and 1-3 mSv for a routine pediatric CT chest. In using the FB-CT airway protocol at our institution, we observed that esophageal rather than airway FBs were sometimes encountered on these exams. However, the confidence among radiologists for definitively diagnosing an esophageal foreign body on noncontrast CT was variable. Consequently, we created a teaching module of positive cases for our group of 21 pediatric body radiologists to increase their diagnostic confidence. This pictorial essay illustrates our institutional experience and can help others to confidently diagnose esophageal foreign bodies using a dedicated CT foreign body imaging protocol. At a similar radiation dose to a fluoroscopic esophagram, CT provides the additional advantage of an expedited diagnosis without the need for a radiologist on site.
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Affiliation(s)
- Victor J Seghers
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030, USA.
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA.
| | - J Herman Kan
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Ray Somcio
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Andrew C Sher
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - R Paul Guillerman
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Marla B K Sammer
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin Street, Houston, TX, 77030, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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Sadeghi M, Zakariaei Z, Soleymani M, Malakian A. Occurrence of acute cholinergic syndrome in an infant due to donepezil ingestion. Clin Case Rep 2022; 10:e05469. [PMID: 35369389 PMCID: PMC8859403 DOI: 10.1002/ccr3.5469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/23/2022] [Accepted: 02/06/2022] [Indexed: 11/08/2022] Open
Abstract
Donepezil and acetyl cholinesterase inhibitors are the most commonly prescribed medications for the treatment of Alzheimer's disease. We describe a 2-year-old infant who was referred to the emergency department after developing cholinergic syndrome 6 hours after ingesting 10 mg of his grandmother's donepezil tablets and was finally discharged in stable condition.
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Affiliation(s)
| | - Zakaria Zakariaei
- Toxicology and Forensic Medicine DivisionOrthopedic Research CenterImam Khomeini HospitalMazandaran University of Medical SciencesSariIran
- Toxoplasmosis Research CenterCommunicable Diseases InstituteIranian National Registry Center for Lophomoniasis and ToxoplasmosisMazandaran University of Medical SciencesSariIran
| | - Mostafa Soleymani
- Toxoplasmosis Research CenterCommunicable Diseases InstituteIranian National Registry Center for Lophomoniasis and ToxoplasmosisMazandaran University of Medical SciencesSariIran
| | - Abdollah Malakian
- Faculty of MedicineDepartment of Emergency MedicineMazandaran University of Medical SciencesSariIran
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Accidental or intentional ingestion of toothbrushes: experience with 8 adult patients. Emerg Radiol 2022; 29:377-382. [PMID: 35022861 DOI: 10.1007/s10140-021-02009-x] [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: 10/15/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Ingestion of a toothbrush is an unusual event but may occur either accident or by intent. Radiological examinations play a crucial role in determining the exact location of the object within the gastrointestinal tract and in planning for its removal by endoscopic or surgical intervention. METHODS Medical and radiological records of 8 patients who had swallowed the broken heads or entire toothbrush were retrospectively reviewed. This series included 4 men and 4 women, ranging in age from 21 to 57 years (mean: 34 years). RESULTS Radiographs and computed tomography of the abdomen demonstrated the ingested toothbrushes within the stomach in 3, lodged in the duodenum in 1, and entrapped in various parts of the colon in 4 patients. They were removed by laparotomy in 3, laparoscopy in 2, colonoscopy in 2, and upper gastrointestinal endoscopy in 1 patient. There were no perforations or associated complications, and all patients had uneventful recoveries. CONCLUSIONS Ingested toothbrushes can be easily identified on radiological studies because of the radiopaque wires holding the nylon bristles. The plastic parts of it, however, are only visible on computed tomography. All cases would require endoscopic or surgical removal of the retained toothbrushes because spontaneous passage per rectum does not occur.
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Duodenal dislodgement of an ingested sharp foreign body by mucosal unfolding "Gilan maneuver"; A novel surgical approach. Int J Surg Case Rep 2021; 90:106721. [PMID: 34968984 PMCID: PMC8717244 DOI: 10.1016/j.ijscr.2021.106721] [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: 11/15/2021] [Revised: 12/15/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance Foreign body (FB) ingestion is a common challenge for pediatric health care providers globally. Although endoscopic approach for FB extraction is recommended, surgery remains life giving specifically in developing countries. We presented a novel surgical approach called ‘Gilan maneuver’ for removal of FB which lodged in duodenal loop. Case presentation An eighteen months old male infant referred to emergency department while he lied on his mother's arm. Parents stated their son has ingested a sharp metallic pointy thick needle which applies for cattle injection. On examination mid epigastric tenderness was remarkable. Laboratory finding was normal. Plain thoracoabdominal radiologic study confirmed the diagnosis. Patient underwent explorative laparotomy and the needle was removed through ‘Gilan maneuver’ in which mucosal unfolding of duodenal loop facilitated dislodgement of the FB and it was extracted on the jujenal side. Clinical discussion Duodenal lodge of sharp FB is rare and could be masked by gastric deposition diagnosis. Mucosal folding, narrow luminal diameter, retroperitoneal adherence, and hard surgical anatomy of the duodenal loop make both sharp and large FBs spontaneous dislodgement and favorable surgical outcome relatively unanticipated. Conclusion Despite rarity of duodenal deposition of FB it is possible and could be harmful due to adjacent unforgiving organs. Although endoscopic extraction of FB is generally recommended in guidelines, surgical approach is safe and could be considered.
Thick metazlic sharp needle ingestion although is rare, could lodge in duodenal mucosal fold. Mucosal unfolding of duodenum could safely dislodge foreign body and prevent major complication. Gilan maneuver facilitates intraluminal passage of foreign body by pyloric valve extraction and jujenal pulling gently.
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Chen X, Huang A, Yang L, Qin S. A stomach like a utility room: Case report. Ann Med Surg (Lond) 2021; 71:102979. [PMID: 34840743 PMCID: PMC8606704 DOI: 10.1016/j.amsu.2021.102979] [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: 09/30/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background Foreign body (FB) ingestion is an emergency that is more common in children and adults with mental disorders. A wide array of FBs can be ingested, and most of them do not need to be treated. However, if the FB blocks the digestive tract or causes damage, it needs to be removed by endoscopy or even surgery.We describe here a stomach full of FBs, but these FBs did not cause serious damage. Case presentation A 9-year-old male child with mental retardation suffered abdominal pain after swallowing FBs. X-ray and computed tomography (CT) found a large number of FBs of different shapes. We tried to remove them under endoscopy but failed; we then changed to laparotomy and removed a large number of FBs. The patient started normal feeding on the 4th day and was discharged home. Conclusions FB ingestion is very common. Symptoms are used to determine whether further treatment, which is usually feasible, is required. However, for patients who cannot accurately describe the ingestion of FBs, such as children, patients with mental disorders, and patients who are inebriated, FBs should still be treated with caution, especially when the clinical symptoms and related examinations are not typical, and adequate plans should be made, as shown in this case. There may be unexpected discoveries.
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Affiliation(s)
- Xiubing Chen
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Aihua Huang
- Department of Paediatric Surgery, The Tenth Affiliated Hospital of Guangxi Medical University, Qinzhou, 535000, China
| | - Lijian Yang
- Department of Paediatric Surgery, The Tenth Affiliated Hospital of Guangxi Medical University, Qinzhou, 535000, China
- Corresponding author.
| | - Shanyu Qin
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
- Corresponding author
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Paul SP, Holbrook F, Plowman L, James J. Abdominal X-rays in children: indications, procedure and interpretation. Nurs Child Young People 2021; 34:e1410. [PMID: 34779158 DOI: 10.7748/ncyp.2021.e1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 11/09/2022]
Abstract
Abdominal X-rays (AXRs) are often used as an imaging modality in children who present with abdominal pain with a suspected serious underlying pathology. Nausea, vomiting and constipation that are unresponsive to treatment may also prompt a request for an AXR in a child. Nurses play an important role in ensuring that requests for AXRs in children are appropriate and that the procedure is performed safely. This is the second of two articles on the use of AXRs for diagnosing abdominal pathologies in childhood. The first article focused on AXRs in neonates. This one focuses on AXRs in children, discussing their indications, procedure and interpretation and describing abdominal conditions in children for which an AXR is likely to support diagnosis.
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Affiliation(s)
| | | | - Lisa Plowman
- children's ward, Yeovil District Hospital, Yeovil, England
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Sude NS, Karanam VPK. Endoscopic Retrieval of Ingested Foreign Bodies: A Single Surgeon Experience. Cureus 2021; 13:e19293. [PMID: 34754707 PMCID: PMC8570916 DOI: 10.7759/cureus.19293] [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] [Accepted: 11/05/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Foreign body (FB) ingestion either accidental or intentional is a common clinical scenario encountered by general surgeons. This article reports a single surgeon's experience of endoscopic retrieval of foreign bodies from the upper gastrointestinal (UGI) tract. Methods A retrospective analysis of data of all the patients who underwent endoscopic management for foreign body removal by a single surgeon in a tertiary care hospital in southern India between 2015 and 2020 was conducted. Patient variables in terms of age, sex, type of foreign body, its location in the gastrointestinal (GI) tract, the time between ingestion and presentation, the time between presentation and endoscopy, treatment outcomes were reviewed. Results A total of 97 patients were studied. The age range of the patients studied was one month to 71 years. Males were predominant (n=64, 65.97%). The most common retrieved foreign body were coins (n=31, 31.9%). The most common site of foreign body lodgment was the esophagus (n=75, 77.31%), with the upper third esophagus (n=38; 39.37%) being the predominant site. The success rate of endoscopic retrieval in our study was 97%. No procedure-related complications were encountered in any patient. Endoscopic management failed in two patients who ultimately required surgical intervention. Conclusion Endoscopic retrieval of foreign bodies in the UGI tract is a safe and effective modality. Early endoscopy in such patients avoids surgical intervention and reduces morbidity.
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Affiliation(s)
- Nandkishor Sopanrao Sude
- General Surgery, Employees State Insurance Corporation Medical College and Hospital, Hyderabad, IND
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Agolli O, Agolli A, Hange N, Agadi K. Therapeutic dilemma and clinical issues in management of the button battery ingestion: a case report and literature review. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2021. [DOI: 10.1186/s43054-021-00084-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractThe incidence of button battery ingestion in children less than 6 years, from year 1985 to 2019 was 59,000 and it is still a clinical challenge for pediatricians. Objects which are commonly ingested are large amounts of food, coins, toy parts, jewels, batteries, sharp materials and non-metallic sharp objects. It is an increased incidence of mortality and morbidity due to button battery ingestion, compared to accidental ingestion of other objects, due to its small size, and because of its potent source of energy. A literature search was carried out to evaluate the challenges in diagnosing, treatment, and follow-up of button battery ingested cases in children. A total of 36 original articles were included for the review.Conclusions: Button batteries can quickly cause severe damage to the mucosal lining of the GI tract. Esophageal button batteries require emergency removal because they can cause serious complications leading to hemorrhage, and death. In children, where the button battery has passed the esophagus watchful management should be made. In the majority of cases, the button batteries with a diameter less than 2 cm lodged in the stomach will pass spontaneously with no complications. However, asymptomatic children may be followed up with X-rays to assess progression up to 10–14 days after ingestion. Endoscopic or surgical removal may be required to prevent intestinal perforation with peritonitis. Symptomatic children will always need a consultation with a pediatric surgeon for surgery no matter where the button battery is placed in the GI tract. Developing countries shall adopt surveillance and reporting systems for BBI ingestion and related complications and it is recommended as essential to have management protocols in place for button batteries ingestion.
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Liu N. Endoscopic Image-guided treatment of Upper Gastrointestinal foreign body and nursing care of complications. Pak J Med Sci 2021; 37:1636-1640. [PMID: 34712297 PMCID: PMC8520352 DOI: 10.12669/pjms.37.6-wit.4858] [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: 06/09/2021] [Revised: 06/12/2021] [Accepted: 07/17/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: This study used phased array imaging algorithm to explore the epidemiological characteristics of endoscopic treatment of upper gastrointestinal foreign bodies to provide a basis for nursing intervention. Methods: We collected data on the age, sex, cause, type of foreign body, success rate of removal, retention location, time and complications of patients with foreign bodies in the upper gastrointestinal tract who were treated in the emergency department of the Digestive Endoscopy Center in our hospital. The study was conducted from January 2018 to December 2020 and we also performed statistical analysis. Results: The high incidence of foreign bodies in the upper digestive tract was in 45 years old to 74 years old patients. The foreign body types were mostly food balls and sharp foreign bodies, accounting for 37.0% and 44.2%, respectively. The cause was misuse and the most accounted for 52.1%, followed by oesophageal pathological stenosis which accounted for 45.5%. The oesophagus in the retention site accounted for up to 80.0%, and the success rate of foreign body extraction was 96.4%. The complications of patients with foreign body retention within twenty four our retention were mainly esophageal scratches and traumatic esophagitis, accounting for 48.5%. 39.6%. Conclusion: There are high risks in the treatment of foreign bodies in the upper digestive tract. Targeted, prospective, and streamlined nursing interventions can provide patients with fast and professional medical care services and minimize patient pain.
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Affiliation(s)
- Na Liu
- Na Liu, Attending Physician, Endoscopy Room, Heping Hospital Affiliated to Changzhi Medical College of Shanxi Province, Changzhi, 046000, Shanxi Province, China
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Alemu S, Bayileyegn NS, Arefayine MB. Swallowed Metallic Spoon Causing Doudeno-Jejunal Junction Perforation in a 13-Year-Old Child: Case Report. Int Med Case Rep J 2021; 14:731-734. [PMID: 34675692 PMCID: PMC8521338 DOI: 10.2147/imcrj.s331039] [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: 07/25/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background A child swallowing a long metallic spoon is an extremely rare phenomenon. Foreign bodies longer than 6 cm are unlikely to pass through the gastrointestinal tract spontaneously and require endoscopic or surgical removal in order to avoid associated complications, such as visceral perforations. Case Details A 13-year-old child presented with accidental swallowing of a metallic spoon 10 days prior to hospital admission. He had history of loss of appetite, epigastric and left upper quadrant abdominal pain and started to have high grade intermittent fever 11 days after swallowing the spoon. A plain abdominal radiograph revealed a metallic spoon in the mid-abdomen. An exploratory laparotomy revealed an 11 cm long metallic spoon impacted at the duodeno-jejunal junction with walled off perforation and erosion of the mesentery of the colon. The metallic spoon was removed and the perforated site was repaired. The surgery was smooth and the patient recovered fully and was discharged seven days post-operation. Conclusion A swallowed long metallic spoon is unlikely to pass spontaneously and should be removed as soon as possible in order to avoid associated complications like impaction, perforation and subsequent peritonitis.
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Affiliation(s)
- Seifu Alemu
- Department of Surgery, Jimma University, Jimma, Ethiopia
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