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Ingestie van corpora aliena op de kinderleeftijd

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Tijdschrift voor Kindergeneeskunde

Samenvatting

Doel. Het beschrijven van symptomen en complicaties bij ingestie van een corpus alienum (CA) op de kinderleeftijd. Opzet. Retrospectieve analyse. Methode. Door middel van statusonderzoek werden gegevens geanalyseerd van kinderen die zich in het Emma Kinderziekenhuis/AMC presenteerden na ingestie van een CA in de periode 1981-2008. Gedocumenteerd werden: leeftijd, geslacht, soort voorwerp, locatie, klachten, diagnostiek, beleid, complicaties/mortaliteit. Dit werd vergeleken met de literatuur.

Resultaten. In totaal werden 113 patiënten gezien (68% jongens), leeftijd tussen 7 maanden en 17 jaar (mediaan 3,6 jaar). Negentien (17%) van deze patiënten waren bekend met een onderliggend lijden: gecorrigeerde oesofagusatresie (12), eosinofiele oesofagitis (2), peptische stenose (1) en verstandelijke beperking (4). Munten werden het vaakst ingeslikt (46%). De meeste voorwerpen waren gelokaliseerd in de maag (41%, n = 46), gevolgd door proximale oesofagus (19%), midoesofageaal (14%) en distale oesofagus (9%). Bij 17% was het CA de pylorus al gepasseerd. 51% van deze kinderen was bij presentatie klachtenvrij. Frequente symptomen waren: retrosternale pijn (16%), braken (13%), speekselvloed (8%), voedselweigering (7%) en respiratoire klachten (4%). Bij 97/113 (86%) werd endoscopie verricht. Bij 70% waren er geen afwijkingen. Bij 26% werden er erosies/ulceraties gezien. Bij 2% was er sprake van oesofagusperforatie. Er was geen mortaliteit.

Conclusie. Endoscopische verwijdering van een CA is noodzakelijk wanneer het CA de slokdarm niet gepasseerd is. Endoscopische afwijkingen werden slechts bij 30% van de patiënten gezien en treden voornamelijk op na lang verblijf van het CA in oesofagus of maag. Een afwachtend beleid is geïndiceerd wanneer het CA de slokdarm is gepasseerd.

Summary

Objective. Foreign body (FB) ingestion is a common paediatric problem. Although ingestion usually does not require intervention, complications are reported.

Design. Retrospective analysis.

Methods. We analysed data from children presenting after FB ingestion at our pediatric department (Emma Kinderziekenhuis; Academic Medical Center, Amsterdam) between 1981-2008. Data extracted included age, gender, nature of FB, location, symptoms, investigations, interventions, complications/mortality.We compared our results with the literature.

Results. A total of 113 patients were analysed (68% boys), aged 7 months to 17 years (median: 3,6 years). Nineteen patients (17%) suffered from an underlying disease: oesophagus atresia (12), eosinophilic oesophagitis (2), peptic stenosis (1) and mental retardation (4). Coins (46%) were the most ingested FB. At presentation 41% of the FB’s were located in the stomach, 19% in the proximal oesophagus, 14% mid oesophageal and 9% in the distal oesophagus. In 17% of the cases the FB had passed the pylorus. No symptoms were found in 51% of the patients at presentation. Common symptoms were retrosternal pain (16%), vomiting (13%), excessive saliva production (8%), food refusal (7%) and respiratory symptoms (4%). Upper endoscopy was performed in 97/113 (86%) of the cases, 26% had erosions/ulcerations and 2% perforations of the oesophagus. In 70% no abnormalities were seen. There was no mortality.

Conclusions. Rapid endoscopic removal is indicated if the FB does not pass the oesophagus spontaneously. Endoscopic abnormalities were seen in only 30% of the cases, and were more severe if the FB was ingested weeks ago. Our data support a ‘wait and observe’ policy in case the FB passed the oesophagus.

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    A. Kindermann

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  1. T. E. Matthews
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  2. M. A. Benninga
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  3. J. A. Taminiau
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  4. M. M. Tabbers
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  5. B. G. P. Koot
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Correspondence to A. Kindermann.

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Dhr. T.E. Matthews, student geneeskunde, Rijksuniversiteit Groningen. Dhr. dr. M.A. Benninga, dhr. dr. J.A. Taminiau, mw. M.M. Tabbers, dhr. B.G.P. Koot, mw. dr. A. Kindermann, afdeling Kindergastro-enterologie, Emma Kinderziekenhuis/AMC, Amsterdam.

Correspondentieadres: dr. A. Kindermann, afdeling Kindergastro-enterologie, Emma Kinderziekenhuis/AMC, AMC G8-260, Postbus 22660, 1100 DD Amsterdam.

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Matthews, T.E., Benninga, M.A., Taminiau, J.A. et al. Ingestie van corpora aliena op de kinderleeftijd. KIND 77, 139–147 (2009). https://doi.org/10.1007/BF03086380

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