History of possible foreign body ingestion in children: don??t forget the rarities

Abstract

Foreign body ingestion in children is a common presenting complaint to the emergency department. Although the majority of ingested foreign bodies pass through the gastrointestinal tract unaided, some children will require either non-surgical or surgical intervention. Retained oesophageal foreign bodies may cause a multitude of problems, including mucosal ulceration, inflammation or infection, and more seriously paraoesophageal or retropharyngeal abscess formation, mediastinitis, empyema, oesophageal perforation and aorta-oesophageal fistula formation. We present a case of a 12-month-old child in whom delayed diagnosis of glass ingestion resulted in the development of a retropharyngeal abscess, oesophageal perforation and mediastinitis. Such complications following foreign body ingestion in children are rare but potentially fatal. A high index of suspicion must be maintained in young children presenting with a possible history of foreign body ingestion as a delayed diagnosis may lead to significant morbidity and mortality. We review the literature surrounding paediatric retropharyngeal abscesses and mediastinitis.

Ingested gastrointestinal foreign bodies: predisposing factors for complications in children having surgical or endoscopic removal

“…Children may present with no history of ingestion or Table 1 The indications accepted for endoscopic or surgical exploration and removal of ingested foreign bodies (FBs) Retention in the same location of esophagus for more than 12 h Signs of airway compromise Complete esophageal obstruction A diseased esophagus obstructed by food boluses Sharp objects such as open safety pin, straight pins or objects that may perforate esophagus Button batteries in upper gastrointestinal (GI) tract (from esophagus to duodenum) Patient becoming symptomatic at any time Sharp or pointed gastric or duodenal objects longer than 4 cm in length, 2 cm in diameter Sharp or pointed gastric or intestinal objects with no movement at 3 days after ingestion Gastric or duodenal blunt objects with no movement at 7 days after ingestion Objects causing acute abdominal findings, intestinal obstruction or perforation atypical history with nonspecific symptoms [4][5][6][7]. Ideal approach is to confirm ingestion within hours, and remove the object within 24 h [4].…”

An extreme foreign body ingestion (surgical blade) in a soldier

“…Foreign body ingestion is commonly seen in children (1,3–5). However it is seen only in some adults with psychiatric disorders, intellectual impairment or prison inmates (2,4,5).…”

“…Ingestion of foreign bodies is uncommon in adults except patients with psychiatric disorders, mental retardation and prisoners (1–4). In this group of patients, the foreign body is mostly ingested volitionally.…”

Management Strategies for Ingestion of Foreign Objects in the Laryngopharynx

“…Foreign bodies that are not removed from the esophagus can cause extensive health issues, such as mucosal ulceration, inflammation or infection, para-esophageal or retropharyngeal abscess formation, mediastinitis, empyema, esophageal perforation, and aortaesophageal fistula formation [29]. Endoscopic retrieval of ingested batteries is particularly urgent as potentially serious complications can arise from (1) direct pressure necrosis and (2) caustic injuries caused by the passage of local electrical currents or alkali leakage in the esophagus [30].…”