Foreign body ingestion

Wright CC, Closson FT. Updates in pediatric gastrointestinal foreign bodies. Pediatr Clin North Am. 2013 Oct;60(5):1221-39.

“Of the more than 100,000 foreign bodies ingested each year, approximately 1500 of the patients who ingest them die. It has been previously reported that 80% to 90% of ingested foreign objects pass spontaneously through the GI tract and less than 1% cause severe complications requiring surgical intervention. However, all swallowed foreign bodies should be considered as potential medical emergencies, because of the risk of aspiration and subsequent airway obstruction. Common foreign bodies with a high risk for airway obstruction include balloons, pieces of soft deformable plastic, and food boluses (either cut into large pieces or food which has been poorly chewed). [21] Most foreign bodies pass through the body without causing the patient any discomfort and do not produce any symptoms; however, in some children, significant complications occur. Potential complications from swallowed foreign bodies include airway obstruction, tracheal edema, stenosis, erosion or perforation, abscess formation, bowel obstruction or perforation, mediastinitis, pneumothorax, severe hemorrhage, aortoesophageal fistula, and migration into adjacent structures.”

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Jayachandra S, Eslick GD. A systematic review of paediatric foreign body ingestion: presentation, complications, and management. Int J Pediatr Otorhinolaryngol. 2013 Mar;77(3):311-7.

“Coins are the most commonly ingested foreign body. A variety of gastrointestinal symptoms such vomiting and drooling as well as respiratory symptoms such as coughing and stridor are associated with foreign body ingestion. The oesophagus, in particular the upper third, is the common site of foreign body obstruction. Objects in the stomach and intestine were spontaneously passed more frequently than at any other sites in the gastrointestinal system. Complications such as bowel perforations, infection and death are more commonly associated with ingestion of objects such as batteries and sharp objects such as bones and needles. Ingested objects are most commonly removed by endoscopic means.

Foreign body ingestion is a common paediatric problem. Batteries and sharp objects should be removed immediately to avoid complications while others can be observed for spontaneous passage. Endoscopy has a high success rate in removing ingested foreign bodies.”

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ASGE Standards of Practice Committee, Ikenberry SO, Jue TL, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, Decker GA, Fanelli RD, Fisher LR, Fukami N, Harrison ME, Jain R, Khan KM, Krinsky ML, Maple JT, Sharaf R, Strohmeyer L, Dominitz JA. Management of ingested foreign bodies and food impactions. Gastrointest Endosc. 2011 Jun;73(6):1085-91.

ASGE RECOMMENDATIONS:

Please see Table 1 in article for evidence grading

  1. We suggest avoiding contrast radiographic examinations with before removal of foreign objects.
  2. We suggest an otorhinolaryngology consultation for foreign bodies at or above the level of the cricopharyngeus.
  3. We recommend emergent removal of esophageal food bolus impactions and foreign bodies in patients with evidence of complete esophageal obstruction.
  4. We suggest that acceptable methods for the management of esophageal food impactions include en bloc removal, piecemeal removal, and the gentle push technique.
  5. We suggest endoscopic removal of all objects with a diameter larger than 2.5 cm from the stomach.
  6. We suggest endoscopic removal of sharp-pointed objects or objects longer 6 cm in the proximal duodenum or above.
  7. We recommend emergent removal of disk batteries in the esophagus.
  8. We recommend urgent removal of all magnets within endoscopic reach. For those beyond endoscopic reach, close observation and surgical consultation for nonprogression through the GI tract is advised.
  9. We suggest that coins within the esophagus may be observed in asymptomatic patients but should be removed within 24 hours of ingestion if spontaneous passage does not occur.
  10. We recommend against endoscopic removal of drug containing packets.

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Hesham A-Kader H. Foreign body ingestion: children like to put objects in their mouth. World J Pediatr. 2010 Nov;6(4):301-10.

“In the absence of controlled studies management of foreign body ingestion depends on clinical experience and should be decided in each case on an individual basis. At least 80% of swallowed foreign bodies pass the gastrointestinal system spontaneously whereas 20% will require endoscopic intervention. On the other hand less than 1% of foreign body ingestion cases will require surgical intervention in order to retrieve them or to deal with complications.[6] Therefore, the vast majority of cases can be observed until they pass through the gastrointestinal tract. Objects failing to pass are usually those with a large diameter or a long length. An exception is the swallowing of multiple magnets which may leave the stomach separated from one another but as they proceed through the adjacent loops of the bowel, they attract each other compressing the intervening bowel walls, causing pressure necrosis, resulting in perforation, fistula formation, or obstruction.[7]”

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Louie MC, Bradin S. Foreign body ingestion and aspiration. Pediatr Rev. 2009 Aug;30(8):295-301, quiz 301.

After completing this article, readers should be able to:

  •  Recognize the presenting history, signs, and symptoms of patients who have swallowed or inhaled foreign bodies.
  •  Discuss the long-term complications of gastrointestinal and airway foreign bodies.
  •  Describe appropriate management strategies for patients who have common esophageal and gastric foreign bodies.
  •  Identify the risks associated with ingestion of button batteries and recognize when emergent removal is necessary.
  •  Maintain a high level of suspicion for aspirated foreign bodies, recognizing that delays in diagnosis can lead to increased complications.

Full-text for Children’s users.

More PubMed results on FB ingestion.

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