Foreign bodies of digestive tract in children: new aspects of the known problem
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Diagnosis and treatment of magnetic foreign bodies in the gastrointestinal tract: the experience of four centers
Introduction. Magnetic foreign bodies of the gastrointestinal tract are a relatively rare problem of pediatric urgent surgery, meanwhile, in the structure of foreign bodies they are the most difficult both in terms of timely diagnosis and treatment. There are no generally accepted therapeutic and diagnostic standards, traditional algorithms for managing patients with foreign bodies, focused on dynamic observation, are not correct; algorithms described in foreign literature contradict each other. The frequency of surgical interventions is high, and the risk of complications is high. Surgical tactics leave many "white spots". All of this leaves this issue open for discussion. Materials and methods. The experience of treating 76 patients with magnetic foreign bodies of the gastrointestinal tract in four pediatric surgical hospitals for the period 2010-2023 was analyzed. The study included patients with neodymium magnetic balls from the constructor – 38 people (50%), 30 people (39.5%) with neodymium magnets of a different shape and purpose, 6 people (7.9%) with ferrite magnets, 2 people (2.6%) with magnets of an unidentified nature. Results and discussion. The average age of the patients was 4 ± 3.65 years. The fact of ingestion of a foreign body was revealed in the anamnesis in 46 (60.5%) cases. Mental illnesses were diagnosed in 4 children – 5.3%, which is higher than the average in the child population. Clinical symptoms were found in 4 (11.8%) children with a single magnetic foreign body and in 33 (78.6%) with multiple. The main diagnostic method was an overview X-ray of the abdominal cavity (70 cases - 92%), which allowed to identify both a foreign body and possible complications (signs of obstruction, free gas in the abdominal cavity). Fibrogastroduodenoscopy was performed in 50 cases (65.8%), of which a foreign body was detected in 34 (68% of all cases), including in 28 cases the foreign body was removed. Other diagnostic methods (ultrasound, spiral computed tomography) were used much less frequently. Among the treatment methods, open types of surgical intervention prevailed – 32 cases (42%). Laparoscopy was used in isolated cases. Conclusion. Magnetic foreign bodies are the most difficult category of foreign bodies, both in terms of diagnosis and treatment. Diagnosis often depends on anamnesis data and, in its absence, is often delayed, and the frequency of intraoperative diagnosis remains high. Among the diagnostic methods, it is difficult to identify a universal one that can be recommended as the "gold standard", however, the most widely used and practical informative is an overview radiograph of the abdominal cavity and FGDS. Among the methods of surgical treatment, the role of laparoscopic technologies is relatively small, endoscopic removal is mainly performed, or "open" surgery is used.
Diagnosis and treatment of magnetic foreign bodies in the gastrointestinal tract: the experience of four centers
Introduction. Magnetic foreign bodies of the gastrointestinal tract are a relatively rare problem of pediatric urgent surgery, meanwhile, in the structure of foreign bodies they are the most difficult both in terms of timely diagnosis and treatment. There are no generally accepted therapeutic and diagnostic standards, traditional algorithms for managing patients with foreign bodies, focused on dynamic observation, are not correct; algorithms described in foreign literature contradict each other. The frequency of surgical interventions is high, and the risk of complications is high. Surgical tactics leave many "white spots". All of this leaves this issue open for discussion. Materials and methods. The experience of treating 76 patients with magnetic foreign bodies of the gastrointestinal tract in four pediatric surgical hospitals for the period 2010-2023 was analyzed. The study included patients with neodymium magnetic balls from the constructor – 38 people (50%), 30 people (39.5%) with neodymium magnets of a different shape and purpose, 6 people (7.9%) with ferrite magnets, 2 people (2.6%) with magnets of an unidentified nature. Results and discussion. The average age of the patients was 4 ± 3.65 years. The fact of ingestion of a foreign body was revealed in the anamnesis in 46 (60.5%) cases. Mental illnesses were diagnosed in 4 children – 5.3%, which is higher than the average in the child population. Clinical symptoms were found in 4 (11.8%) children with a single magnetic foreign body and in 33 (78.6%) with multiple. The main diagnostic method was an overview X-ray of the abdominal cavity (70 cases - 92%), which allowed to identify both a foreign body and possible complications (signs of obstruction, free gas in the abdominal cavity). Fibrogastroduodenoscopy was performed in 50 cases (65.8%), of which a foreign body was detected in 34 (68% of all cases), including in 28 cases the foreign body was removed. Other diagnostic methods (ultrasound, spiral computed tomography) were used much less frequently. Among the treatment methods, open types of surgical intervention prevailed – 32 cases (42%). Laparoscopy was used in isolated cases. Conclusion. Magnetic foreign bodies are the most difficult category of foreign bodies, both in terms of diagnosis and treatment. Diagnosis often depends on anamnesis data and, in its absence, is often delayed, and the frequency of intraoperative diagnosis remains high. Among the diagnostic methods, it is difficult to identify a universal one that can be recommended as the "gold standard", however, the most widely used and practical informative is an overview radiograph of the abdominal cavity and FGDS. Among the methods of surgical treatment, the role of laparoscopic technologies is relatively small, endoscopic removal is mainly performed, or "open" surgery is used.
Large foreign body – pencil in the pelvic cavity of a girl two years
Резюме Цель данной работы: информирование врачей, оказывающих помощь детскому населению, об особенностях течения патологических процессов и клинической картине случаев попадания инородного тела больших размеров-карандаш, располагавшийся в полости малого таза. Клиническое наблюдение: в приемное отделение Курской областной детской больницы № 2 обратилась мать с девочкой М. в возрасте двух лет с жалобами на беспокойство ребенка, нарушения отхождения стула, повышение температуры тела до субфебрильных значений. За три дня до обращения, вечером, мать вышла в ванную комнату, в этот момент девочка рисовала карандашами. После чего мать обнаружила осаднения в области промежности, скудное геморрагическое отделяемое и обратились за помощью. Девочка осмотрена дежурным врачом-гинекологом, по итогам осмотра острая гинекологическая патология была исключена. В динамике беспокойство ребенка сохранилось, появились нарушения отхождения кала, повышение температуры тела. Выполнено обследование: на обзорной рентгенограмме органов брюшной полости-слева паравертебрально от уровня L V и ниже, в проекции малого таза, определяется продолговатое стержневидное рентгеноконтрастное инородное тело с четкими контурами длиной 8 см и диаметром 0,3-0,4 см. При ультразвуковом исследовании органов брюшной полости и малого таза, позади мочевого пузыря по ходу прямой и сигмовидной кишки, визуализируется верхний контур анэхогенного инородного тела протяженностью около 60 мм, толщиной около 8,5 мм. Заключение. В статье наглядно продемонстрирован план и этапность обследования ребенка с инородным телом больших размеров в свободной брюшной полости. Стоит подчеркнуть, что в случае подобной локализации последнего важным критерием успешного лечения и ведения пациента является четкая и слаженная работа двух служб-детской хирургической и гинекологической. Также авторы обращают внимание читателей на необходимость тщательного расспроса родителей с особой концентрацией на мелких деталях (питание, стул, поведение и др.).
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