Current Gastroenterology Reports

, Volume 7, Issue 3, pp 212–218 | Cite as

Pediatric foreign bodies and their management

  • Marsha Kay
  • Robert Wyllie


Ingestion of foreign bodies is a common pediatric problem, with more than 100,000 cases occurring each year. The vast majority of pediatric ingestions are accidental; increasing incidence of intentional ingestions starts in the adolescent age group. In the United States, the most common pediatric foreign bodies ingested are coins, followed by a variety of other objects, including toys, toy parts, sharp objects, batteries, bones, and food. In adolescents and adults, meat or food impactions are the most common accidental foreign body ingestion. Esophageal pathology underlies most cases of food impaction. Management of foreign body ingestions varies based on the object ingested, its location, and the patient’s age and size. Esophageal foreign bodies as a group require early intervention because of their potential to cause respiratory symptoms and complications, esophageal erosions, or even an aortoesophageal fistula. Ingested batteries that lodge in the esophagus require urgent endoscopic removal even in the asymptomatic patient due to the high risk of complications. Sharp foreign bodies increase the foreign body complication rate from less than 1% to 15% to 35%, except for straight pins, which usually follow a relatively benign course unless multiple pins are ingested. Magnets are increasingly ingested, due to their ubiquitous nature and the perception that they do not pose a risk. Ingestion of multiple magnets creates a significant risk of obstruction, perforation, and fistula development. Methods to deal with foreign bodies include the suture technique, the double snare technique, and the combined forceps/ snare technique for long, large, and sharp foreign bodies, along with newer equipment, such as retrieval nets and a variety of specialized forceps.


Foreign Body Eosinophilic Esophagitis Endoscopic Removal Food Impaction Foreign Body Ingestion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Litovitz TL, Klein-Schwartz W, White S, et al.: 2000 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2001, 19:337–395. Comprehensive and interesting report from the toxic exposure surveillance system compiled by the American Association of Poison Control Centers that reviews number, nature, demographics, and outcome of a variety of exposures.PubMedCrossRefGoogle Scholar
  2. 2.
    Webb WA: Management of foreign bodies of the upper gastrointestinal tract: Update. Gastrointest Endosc 1995, 41:39–51.PubMedCrossRefGoogle Scholar
  3. 3.
    Ginsberg GG: Management of ingested foreign objects and food bolus impactions. Gastrointest Endosc 1995, 41:33–38.PubMedCrossRefGoogle Scholar
  4. 4.
    Tiwana KK, Morton T, Tiwana PS: Aspiration and ingestion in dental practice: a 10-year institutional review. J Am Dental Assoc 2004, 135:1287–1291.Google Scholar
  5. 5.
    Cheung KM, Oliver MR, Cameron DJ, et al.: Esophageal eosinophilia in children with dysphagia. J Pediatr Gastroenterol Nutr 2003, 37:498–503.PubMedCrossRefGoogle Scholar
  6. 6.
    Liacouras CA, Markowitz JE: Eosinophilic esophagitis: a subset of eosinophilic gastroenteritis. Curr Gastroenterol Rep 1999, 1:253–258.PubMedGoogle Scholar
  7. 7.
    Khan S, Orenstein SR, Di Lorenzo C, et al.: Eosinophilic esophagitis: Strictures, impactions, dysphagia. Dig Dis Sci 2003, 48:22–29.PubMedCrossRefGoogle Scholar
  8. 8.
    Losanoff JE, Kjossev KT: Gastrointestinal ’crosses’: an indication for surgery. J Clin Gastroenterol 2001, 33:310–314.PubMedCrossRefGoogle Scholar
  9. 9.
    Pitetti RD, Kuspis D, Krenzelok EP: Caterpillars: an unusual source of ingestion. Pediatr Emerg Care 1999, 15:33–36.PubMedCrossRefGoogle Scholar
  10. 10.
    Ren PL: A rare foreign body: a mouse entrapped in the adult esophagus. Endoscopy 2002, 34:847.PubMedCrossRefGoogle Scholar
  11. 11.
    Kay M, Wyllie R: Techniques of foreign body removal in infants and children. Tech Gastrointest Endosc 2002, 4:188–195. Comprehensive review including description of the endoscopic techniques and equipment used for a variety of pediatric foreign body ingestions.CrossRefGoogle Scholar
  12. 12.
    Miller RS, Willging JP, Rutter MJ, Rookkapan K: Chronic esophageal foreign bodies in pediatric patients: a retrospective review. Int J Pediatr Otorhinolaryngol 2004, 68:265–272.PubMedCrossRefGoogle Scholar
  13. 13.
    Gilchrist BF, Valerie EP, Nguyen M, et al.: Pearls and perils in the management of prolonged, peculiar, penetrating esophageal foreign bodies in children. J Pediatr Surg 1997, 32:1429–1431.PubMedCrossRefGoogle Scholar
  14. 14.
    Byard RW: Mechanisms of unexpected death in infants and young children following foreign body ingestion. J Forensic Sci 1996, 41:438–444. Interesting review outlining the tragic consequences of unrecognized foreign body ingestions.PubMedGoogle Scholar
  15. 15.
    Chaves DM, Ishioka S, Felix VN, et al.: Removal of a foreign body from the upper gastrointestinal tract with a flexible endoscope: a prospective study. Endoscopy 2004, 36:887–892.PubMedCrossRefGoogle Scholar
  16. 16.
    VanArsdale JL, Leiker RD, Kohn M, et al.: Lead poisoning from a toy necklace. Pediatrics 2004, 114:1096–1099.PubMedCrossRefGoogle Scholar
  17. 17.
    Fischer CD, Mukherjee A: Appendicitis due to tongue stud ingestion: a case study and review of management plans. S D J Med 2004, 57:19–22.PubMedGoogle Scholar
  18. 18.
    Tay ET, Weinberg G, Levin TL: Ingested magnets: the force within. Pediatr Emerg Care 2004, 20:466–467.PubMedCrossRefGoogle Scholar
  19. 19.
    Chung JH, Kim JS, Song YT: Small bowel complication caused by magnetic foreign body ingestion of children: two case reports. J Pediatr Surg 2003, 38:1548–1550.PubMedCrossRefGoogle Scholar
  20. 20.
    Ohno Y, Yoneda A, Enjoji A, et al.: Gastroduodenal fistula caused by ingested magnets. Gastrointest Endosc 2005, 61:109–110.PubMedCrossRefGoogle Scholar
  21. 21.
    Jefferson T: A thought for your pennies. JAMA 1999, 281:122.PubMedCrossRefGoogle Scholar
  22. 22.
    Sharieff GQ, Brousseau TJ, Bradshaw JA, Shad JA: Acute esophageal coin ingestions: Is immediate removal necessary? Pediatr Radiol 2003, 33:859–863.PubMedCrossRefGoogle Scholar
  23. 23.
    Litovitz T, Schmitz BF: Ingestion of cylindrical and button batteries: an analysis of 2382 cases. Pediatrics 1992, 89:747–757.PubMedGoogle Scholar
  24. 24.
    Sica GS, Djapardy V, Westaby S, Maynard ND: Diagnosis and management of aortoesophageal fistula caused by a foreign body. Ann Thorac Surg 2004, 77:2217–2218.PubMedCrossRefGoogle Scholar
  25. 25.
    Jackson C, Jackson CL: Diseases of the Air and Food Passages of Foreign Body Origin. Philadelphia: Saunders; 1937.Google Scholar
  26. 26.
    Aktay AN, Werlin SL: Penetration of the stomach by an accidentally ingested straight pin. J Pediatr Gastroenterol Nutr 2002, 34:81–82.PubMedCrossRefGoogle Scholar
  27. 27.
    Gun F, Salman T, Abbasoglu L, Celik R, Celik A: Safety-pin ingestion in children: a cultural fact. Pediatr Surg Int 2003, 19:482–484.PubMedCrossRefGoogle Scholar
  28. 28.
    Karaman A, Cavusoglu YH, Karaman I, et al.: Magill forceps technique for removal of safety pins in upper esophagus: a preliminary report. Int J Pediatr Otorhinolaryngol 2004, 68:1189–1191.PubMedCrossRefGoogle Scholar
  29. 29.
    Karjoo M, Kader H: A novel technique for closing and removing an open safety pin from the stomach. Gastrointest Endosc 2003, 57:627–629. New technique to increase safety of endoscopic removal of safety pins.PubMedCrossRefGoogle Scholar
  30. 30.
    Aoyagi K, Maeda K, Morita I, et al.: Endoscopic removal of a spoon from the stomach with a double-snare and balloon. Gastrointest Endosc 2003, 57:990–991.PubMedCrossRefGoogle Scholar
  31. 31.
    Cauchi JA, Shawis RN: Multiple magnet ingestion and gastrointestinal morbidity. Arch Dis Child 2002, 87:539–540.PubMedCrossRefGoogle Scholar
  32. 32.
    Lao J, Bostwick HE, et al.: Esophageal food impaction in children. Pediatr Emerg Care 2003, 19:402–407.PubMedCrossRefGoogle Scholar
  33. 33.
    Fox VL, Nurko S, Furuta GT: Eosinophilic esophagitis: it’s not just kid’s stuff. Gastrointest Endosc 2002, 56:260–270.PubMedCrossRefGoogle Scholar
  34. 34.
    Bulstrode N, Banks F, Shrotria S: The outcome of drug smuggling by ’body packers’: the British experience. Ann R Coll Surg 2002, 84:35–38. Very interesting and up-to-date review of a single center’s large experience with body packing in adult patients and management protocols.Google Scholar
  35. 35.
    Traub SJ, Kohn GL, Hoffman RS, Nelson LS: Pediatric ’body packing’. Arch Pediatr Adolesc Med 2003, 157:174–177.PubMedGoogle Scholar

Copyright information

© Current Science Inc. 2005

Authors and Affiliations

  • Marsha Kay
    • 1
  • Robert Wyllie
    • 1
  1. 1.Department of Pediatric Gastroenterology and NutritionThe Cleveland Clinic FoundationClevelandUSA

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