Factors Associated with Removal of Impactted Fishbone in Children, Suspected Ingestion

Abstract

PurposeThe management and clinical course in pediatric patients who had ingested foreign body were investigated retrospectively to evaluate the frequency and factor associated with successful removal of fishbone foreign body.MethodsBased on the medical records of patients younger than 15 years old who visited emergency room because of foreign body ingestion from January 1999 to December 2012, the authors reviewed clinical characteristics including type of ingested foreign bodies, time to visits, managements and complications.ResultsFishbone (50.1%) was the most common ingested foreign body in children. Among 416 patients with ingested fishbone, 245 (58.9%) were identified and removed using laryngoscope, rigid or flexible endoscope from pharynx or upper esophagus by otolaryngologists and pediatric gastroenterologists. The kind of ingested fish bone in children was diverse. The mean age of identified and removed fishbone group was 7.39 years old, and higher than that of unidentified fishbone group (5.81 years old, p<0.001). Identified and removed fishbone group had shorter time until hospital visit than the unidentified fishbone group (2.03 vs. 6.47 hours, p<0.001). No complication due to ingested fishbone or procedure occurred.ConclusionOlder age and shorter time from accident to hospital visit were the different factors between success and failure on removal of ingested fish bone in children.

Foreign Body Ingestion in Children

“…Children usually show fish bone impaction in the palatine tonsils, tongue base, vallecula and pyriform sinus because the laryngopharynx is narrower and the tonsils are larger in children than in adults. A Korean study has reported that ingested fish bones in children were most commonly detected in the pharynx (57.7%) [ 6 ]. In fact, fish bone impaction is rare in the esophagus below the pharynx.…”

“…Parameters that need to be considered regarding the timing of endoscopy in children with ingested FBs are the children’s age or body weight, the clinical presentation, time since the last meal, time lapse since ingestion, type, as well as the size and the shape of the FB, and its present location in the GI tract [ 6 ].…”

Sharp foreign body ingestion by a young girl

“…Foreign body ingestion is an international problem among children starting from fishbone impaction which is more commonly observed in countries where fish is the main dietarysnack 1 to large object that lead to esophageal perforation. 2 Some foreign bodies need urgent removal like button batteries 3 while others remains dormant for years like in this case.…”

Prevention of ingestion injuries in children

“…[2,3] Distress and a healthcare consultation also occasionally result from choking on age-inappropriate food items (typically hard sweets or large chunks of meat) or bones (especially fish bones [4] ), and accidental medication ingestion. At Red Cross War Memorial Children's Hospital, nearly two of three ingested foreign bodies require endoscopic or surgical removal.…”