Foreign body ingestion: children like to put objects in their mouth

Abstract

Some foreign bodies can be harmful and require evaluation and intervention. The challenge in management is to distinguish the patients who require intervention from those who can be safely observed. In this review we suggest an algorithm for evaluation and management of children suspected to ingest a radiopaque foreign body.

Spontaneous passage of long, sharp gastrointestinal foreign body in a child

“…Impaction is most commonly seen at anatomic constrictions in the oesophagus6 and in over 75% patients, the commonest site is upper oesophagus at the cricopharyngeus 6. Beyond the gastro-oesophageal junction, FBs usually pass through the GIT without complications7 and impaction in the intestines is seen in less than 10% children 1. FB impaction leads to mucosal abrasions, bleeding, GI perforation, secondary mediastinitis and peritonitis,1 and hence impaction is a strong indication for removal.…”

Endoscopic management of ingested foreign bodies in children: A retrospective review of cases, and review of the literature

“…Most children are asymptomatic at the time of presentation. Common symptoms include drooling, gagging, dysphagia, odynophagia, decreased appetite, food refusal, fever, nausea, vomiting, hematemesis, rectal bleeding, neck pain, chest pain, abdominal pain, halitosis, cough, stridor, wheezing, and respiratory distress [11]. Signs and symptoms associated with foreign body aspiration typically have three stages.…”

“…At least 75% of retained coins get stuck at this site [22]. The other two sites are the mid-esophagus at the level of the aortic arch and carina, and the lower esophageal sphincter [11].…”

“…Coins less than 2.5 cm in diameter usually pass uneventfully. The parents should be instructed to inspect the stools for passage of the coin [11].…”

“…Objects longer than 5 cm (3 cm in young children) and wider than 2 cm are unlikely to pass through the gastrointestinal tract and should be removed endoscopically before they pass through the pylorus, if possible [11].…”