Acta Endoscopica

, Volume 42, Issue 2, pp 84–89 | Cite as

Prise en charge en urgence des corps étrangers ingérés

Revue De Congrès / Congress Review

Résumé

L’ingestion de corps étranger (CE) est fréquente chez l’enfant. Dans environ 80 % des cas, l’élimination spontanée du CE par les voies naturelles a lieu en moins d’une semaine; mais 20 % des CE ingérés nécessitent une extraction endoscopique et moins de 1 % une intervention chirurgicale. Des complications sévères (perforation, abcès, fistules, hémorragies massives), voire des accidents mortels ont été rapportés. Des radiographies de face et de profil comprenant le cou, le thorax et l’abdomen sont nécessaires pour confirmer l’ingestion du CE et le localiser. Les CE de plus de 2 cm de diamètre ou de plus de 5 cm de long ont un risque de blocage important au niveau de l’oesophage, du pylore, du duodénum, de l’angle de Treitz, du diverticule de Meckel, de la valvule iléo-caecale de l’appendice ou de la charnière recto-sigmoïdienne. Comme les objets traumatisants, ils nécessitent une extraction endoscopique en urgence. Les piles bouton doivent être extraites de l’oesophage en moins de deux heures car elles entraînent des lésions très rapides par différents mécanismes. Le risque lié à l’ingestion d’aimants est lié à leur nombre, car si un aimant peut passer facilement, plusieurs aimants peuvent s’attirer dans le grêle au travers de différentes anses intestinales, entraînant des complications chirurgicales. Les impactions alimentaires oesophagiennes peuvent être associées à une sténose, à un trouble de la motricité oesophagienne, à une oesophagite à éosinophiles qui justifient la réalisation de biopsies endoscopiques. Les CE « mousse » gastriques justifient une surveillance de leur extériorisation à domicile et si besoin un contrôle radiologique après trois à quatre semaines.

L’extraction endoscopique du CE chez l’enfant se fait sous anesthésie générale et intubation trachéale, à l’aide de différents accessoires, ce qui donne un bon taux de réussite, limite les complications et permet de rechercher des lésions muqueuses.

Mots clés

Corps étranger Ingestion Endoscopie Extraction Urgence 

Management of foreign body ingestion

Abstract

Foreign body (FB) ingestion is frequent in children. FB can pass through spontaneously in around 80% of cases during the first week, but 20% of them require endoscopic removal, and <1% need surgery. Severe complications (perforation, abscess, fistula, massive haemorrhage) were reported. Radiographs of the neck, chest and abdomen, with anteroposterior and lateral views, are recommended to diagnose and to locate FB. The risk that FB > 2 cm in diameter or > 5 cm in size block in the esophagus, at the pylorus, duodenal curve, ligament of Treitz, Meckel diverticulum, ileocecal valve, appendix and rectosigmoid junction, is important. Like sharp and pointed FB, their endoscopic removal should be performed in emergency. Disk batteries should be removed from the esophagus during the first 2 hours because of the damages they can quickly induce. Concerning magnet ingestion, it is to note that one magnet can pass through spontaneously, but several magnets can attract themselves across intestinal loop inducing necrosis, then perforation or fistula. Esophageal food impaction can be associated with stenosis, motility disorder, or eosinophilic esophagitis that requires endoscopic biopsies for its diagnosis. Patients with small, blunt objects located at the lower third of the esophagus or in the stomach could be observed at home; radiograph should be performed 3 to 4 weeks later if the FB was not found in faeces.

In children, it is recommended to perform FB extraction by endoscopy under general anaesthesia and tracheal intubation, using several accessories. This gives good success rate, reduces perendoscopic complications, and enables to diagnose mucosal lesions.

Keywords

Foreign body Ingestion Endoscopy Extraction Emergency 

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Copyright information

© Springer-Verlag France 2012

Authors and Affiliations

  1. 1.Unité de gastroentérologie, hépatologie, nutrition et diabétologiehôpital des EnfantsToulouse cedex 9France

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