Pediatric Surgery International

, Volume 23, Issue 8, pp 755–761 | Cite as

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

  • Şule Yalçin
  • Ibrahim Karnak
  • Arbay O. Ciftci
  • Mehmet Emin Şenocak
  • F. Cahit Tanyel
  • Nebil Büyükpamukçu
Original Article

Abstract

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’s condition, surgeon’s experience, and available technical equipment as well as the location and type of ingested FB. Especially, SPs should be treated by experienced surgeons. Simple extraction techniques and both rigid and flexible endoscopies with appropriate forceps as well as surgery can be used for the extraction of FBs lodged in the alimentary tract. Surgery can be expected especially in asymptomatic cases that have been followed up for more than 4 days irrespective of the location of FB.

Keywords

Foreign body Ingestion Child Endoscopy Safety pin Coin 

Notes

Acknowledgments

Our department has been accredited by the Paediatric Surgery Section of European Union of Medical Specialties (EUMS) since February 2005. F. Cahit Tanyel is supported by Turkish Academy of Sciences (TUBA). İbrahim Karnak is supported by Turkish Academy of Sciences—Program to Reward Successful Young Scientists (TUBA-GEBIP).

References

  1. 1.
    Wahbeh G, Wyllie R, Kay M (2002) Foreign body ingestion in infants and children: location, location, location. Clin Pediatr 41:633–640CrossRefGoogle Scholar
  2. 2.
    Pak MW, Lee WC, Fung HK, et al (2001) A prospective study of foreign body ingestion in 311 children. Int J Pediatr Otorhinolaryngol 58:37–45CrossRefGoogle Scholar
  3. 3.
    Gün F, Salman T, Abbasoğlu L, et al (2003) Safety pin ingestion in children: a cultural fact. Pediatr Surg Int 19:482–484PubMedCrossRefGoogle Scholar
  4. 4.
    Panieri E, Bass DH (1995) The management of ingested bodies in children. A review of 663 cases. Eur J Emerg Med 2:83–87PubMedCrossRefGoogle Scholar
  5. 5.
    Arana A, Hauser B, Hachimi-Idrissi S, et al (2001) Management of ingested foreign bodies in childhood and review of the literature. Eur J Pediatr 160:468–472PubMedCrossRefGoogle Scholar
  6. 6.
    Amin MR, Buchinsky FJ, Gaughan JP, et al (2001) Predicting outcome in pediatric coin ingestion. Int J Pediatr Otorhinolaryngol 59:201–206PubMedCrossRefGoogle Scholar
  7. 7.
    Campbell JB, Condon VR (1989) Catheter removal of blunt esophageal foreign bodies in children. Survey of the society for pediatric radiology. Pediatr Radiol 19:361–365PubMedCrossRefGoogle Scholar
  8. 8.
    Satoh S, Tsugawa C, Tsubota N, et al (1999) Ingested ring-pull causing bronchoesophageal fistula and transection of the left main bronchus: successful salvage of the left lung and esophagus five years after injury. J Pediatr Surg 34:1658–1660PubMedCrossRefGoogle Scholar
  9. 9.
    Persaud RAP, Sudhakaran N, Ong CC, et al (2001) Extraluminal migration of a coin in the esophagus of a child misdiagnosed as asthma. Emerg Med J 18:312–313PubMedCrossRefGoogle Scholar
  10. 10.
    Mohiuddin S, Siddiqui MSR, Mayhew JF (2004) Esophageal foreign body aspiration presenting as asthma in the pediatric patient. South Med J 97:93–95PubMedCrossRefGoogle Scholar
  11. 11.
    Shinhar SY, Strabbing RJ, Madgy DN (2003) Esophagoscopy for removal of foreign bodies in the pediatric population. Int J Pediatr Otorhinolaryngol 67:977–979PubMedCrossRefGoogle Scholar
  12. 12.
    Karaman A, Çavuşoğlu YH, Karaman İ, et al (2004) Magill forceps technique for removal of safety pins in upper esophagus: a preliminary report. Int J Pediatr Otorhinolaryngol 68:1189–1191PubMedCrossRefGoogle Scholar
  13. 13.
    Soprano JV, Mandl KD (2000) Four strategies for the management of esophageal coins in children. Pediatrics 105:1–5CrossRefGoogle Scholar
  14. 14.
    Kelley JE, Leech MH, Carr MG (1993) A safe and cost-effective protocol for the management of esophageal coins in children. J Pediatr Surg 28:898–900PubMedCrossRefGoogle Scholar
  15. 15.
    Alkan M, Büyükyavuz İ, Doğru D, et al (2004) Tracheoesophageal fistula due to disc battery ingestion. Eur J Pediatr Surg 14:274–278PubMedCrossRefGoogle Scholar
  16. 16.
    Türken A, Tanyel FC, Hiçsönmez A (1999) Respiratory distress due to esophageal perforation by ball point. Turk J Pediatr 41:391–393PubMedGoogle Scholar
  17. 17.
    Chaves DM, Ishioka S, Felix VN, et al (2004) Removal of a foreign body from the upper gastrointestinal tract with a flexible endoscope: a prospective study. Endoscopy 36:887–892PubMedCrossRefGoogle Scholar
  18. 18.
    Mosca S (2000) Management of endoscopic techniques in cases of ingestion of foreign bodies. Endoscopy 32:272–273PubMedGoogle Scholar
  19. 19.
    Shivakumar AM, Naik Ashok S, Prashanth KB, et al (2004) Foreign body in upper digestive tract. Ind J Pediatr 71:689–693Google Scholar
  20. 20.
    Metzl K (2003) Coin ingestion. Pediatr Rev 24:395PubMedGoogle Scholar
  21. 21.
    Fujiwara T, Kino M, Takeoka K, et al (1999) Intraluminal duodenal diverticulum in a child: incidental onset possibly associated with the ingestion of a foreign body. Eur J Pediatr 158:108–110PubMedCrossRefGoogle Scholar
  22. 22.
    Li Voti G, Di Pace MR, Castagnetti M, et al (2004) Needle perforation of the bowel in childhood. J Pediatr Surg 39:231–232PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Şule Yalçin
    • 1
  • Ibrahim Karnak
    • 1
  • Arbay O. Ciftci
    • 1
  • Mehmet Emin Şenocak
    • 1
  • F. Cahit Tanyel
    • 1
  • Nebil Büyükpamukçu
    • 1
  1. 1.Department of Pediatric SurgeryHacettepe University Faculty of MedicineAnkaraTurkey

Personalised recommendations