Extraluminal migration of a coin in the oesophagus of a child misdiagnosed as asthma

Persaud, Raj

doi:10.1136/emj.18.4.312

Cited by 19 publications

(15 citation statements)

References 7 publications

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“…Therefore, children of all age groups may have FB ingestion but may not provide positive history. In other words, negative history does not exclude the possibility of FB ingestion and the surgeon should raise a high index of suspicion to avoid overlooking an ingested FB [8,9]. The symptoms of FB ingestion vary with the location and size of the FB and with the age of patient.…”

Section: Discussionmentioning

confidence: 96%

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Foreign body ingestion in children: an analysis of pediatric surgical practice

et al. 2007

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Ingestion of a foreign body (FB) is a prevalent condition among children. The type of FB varies according to the feeding habits and sociocultural features of communities. The management modality differs also between disciplines due to use of conventional techniques. We aimed to picture the general characteristics of FB ingestion and treatment alternatives, to mention the indications of open surgery in an advanced pediatric surgical center. The records of patients who were hospitalized for FB ingestion between 1973 and May 2005 were evaluated retrospectively. One hundred and twelve patients were enrolled into the study. The mean age was 2.27 +/- 2.84 years with a M/F ratio of 59/53. The history was suggestive of ingestion in 92% of patients. The age did not differ significantly whether the history was positive or negative (3.6 years vs. 4.8 years and P = 0.19). Most common presenting symptom was vomiting (28.6%). The duration of symptoms was longer in patients with negative history (median 47.7 h vs. 28.1 h and P < 0.002). Physical examination was normal in 89.3% of cases. Most common localization of the FB shown in plain X-ray was the esophagus (67%). Esophagography revealed nonopaque FB in the esophagus in 4.4%. X-ray was normal in 6.3% of the patients. The age of patient did not determine the localization of FB on admission (P = 0.436). Endoscopic removal was attempted in 75% and was successful in 68% of patients in which FB was extracted by using laryngoscope and Magill forceps (12%), rigid esophagoscope with FB forceps (51%), and flexible endoscope with FB forceps (5%). FB could not be found in 32% of patients at initial rigid esophagoscopy or flexible endoscopy. FB was eliminated spontaneously (n = 19) or extracted surgically (n = 8). Follow-up was preferred in 21% of patients on initial admission. FB proceeded uneventfully in 15 patients or was extracted by flexible endoscopy or surgery in one and eight patients, respectively. Surgery was performed in 4% on admission. Surgery or endoscopy were essentially required in cases whose follow-up period exceeded 4 days when compared with patients who eliminated FB spontaneously within 4 days, independent to the location of FB. The metallic objects were the frequently ingested FBs (83.8%) in which the safety pins (SPs) (n = 53) and coins (n = 25) were the most frequent. The type of FB did not affect the FB localization on admission (P = 0.38). The duration of hospitalization was longer in patients with delayed admission; 2.46 +/- 3.51, 3.80 +/- 8.17, and 5.72 +/- 4.24 days for the admissions within first, second-fifth days, and sixth or later days after ingestion, respectively (P = 0.000). Pediatric surgery has the largest spectrum of duty in the treatment of FB ingestion in children. Negative history, normal physical examination findings and absence of symptoms do not exclude the possibility of FB ingestion. Presentation with isolated respiratory symptoms is an enigma that can lead to misdiagnoses. The mode of management should be selected according to the patient'...

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Section: Discussionmentioning

confidence: 96%

“…It can be misleading and the child may be understood to have FB aspiration or other airway diseases such as asthma or infection [8][9][10].…”

Section: Discussionmentioning

confidence: 98%

Foreign body ingestion in children: an analysis of pediatric surgical practice

et al. 2007

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“…Usually, the treatment of the infection after FB diagnosis and removal can heal the patients with perforation, with or without sequelae. However, some may present with atypical evolution, as the ones presented in this study, that is, they cross the organ's wall and migrate through the extraluminal tissue 4,12,14,15 . During such migration, they may rupture large vessels such as the carotid, aorta or damage neighboring organs, such as the thyroid gland.…”

Section: Discussionmentioning

confidence: 96%

“…In our study, in a tertiary hospital, we had 4 cases among some 3,000 of FB seen in 40 years of activities and they were all pointed FBs. Nonetheless, we find in the literature cases of non-pointed FBs causing perforation, such as coins 12 and nuts skins 13 which invade the thyroid and the mediastinum, respectively.…”

Section: Resultsmentioning

confidence: 99%

Corpos estranhos caminham pelo corpo em direção ao coração?

Mamede

Amaral²,

Raimundo³

et al. 2009

Rev. Bras. Otorrinolaringol.

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Fi xation of foreign bodies (FB), in the mucosa, can favor its migration, giving origin to the popular saying: "FB walk to the heart". Aim: describe the mechanisms involved in FB migration and how to diagnose them. Methodology: From a sample of 3,000 foreign bodies, during 40 years, we analyzed four which had extra-lumen migration. We analyzed clinical, radiologic, endoscopic and ultrasound data collected at the medical documentation service. Results: three clinical histories are presented, describing two fish bones and one piece of fish cartilage. FB shifting was analyzed in all of them. Migration started in the esophagus in two, one going to the aorta and the other to the neck area. In the other two, migration started in the pharynx, and the FB moved towards the prevertebral fascia and the other externalized in the submandibular region. The mechanisms and the risks posed to the patient, by FB migration, and the way to diagnose them are hereby discussed. Conclusions: the study allows us to determine that FB can move through the body but not towards the heart. The study also serves as a warning sign: in cases of prolonged histories of FB ingestion, imaging studies are mandatory before endoscopic examination.

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“…Coins lodged in the esophagus have been associated with complications, including reports of extraluminal migration producing vascular fistulas or abscesses, esophageal perforation, and esophageal strictures. [2][3][4] However, in general, it is felt that once coins reach the stomach they will most likely pass without difficulty through the rest of the gastrointestinal tract. 5 In fact, studies of the management of pediatric coin ingestions have used passage into the stomach as a successful end point.…”

Section: Discussionmentioning

confidence: 98%

Cecal Retention of a Swallowed Penny Mimicking Appendicitis in a Healthy 2 Year Old

Betz¹,

Hampers²

2004

Pediatric Emergency Care

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Toddlers commonly ingest coins. Studies of the evaluation and management of such ingestions have focused on the risk of complications from impaction in the esophagus. It is commonly assumed that coins that have passed through the esophagus present little or no risk for distal complications. We present the first report of cecal retention of a penny in a previously healthy 2 year old, ultimately resulting in surgical intervention.

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Extraluminal migration of a coin in the oesophagus of a child misdiagnosed as asthma

Cited by 19 publications

References 7 publications

Foreign body ingestion in children: an analysis of pediatric surgical practice

Foreign body ingestion in children: an analysis of pediatric surgical practice

Corpos estranhos caminham pelo corpo em direção ao coração?

Cecal Retention of a Swallowed Penny Mimicking Appendicitis in a Healthy 2 Year Old

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