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Pediatric Foreign Body
Ingestion
Meshkini M.
2015 – 07 – 12
Pediatric Surgical Rotation Conference - Tabriz
Children Hospital
Foreign Body Ingestion
Foreign Body Aspiration
Background
• The lack of molar teeth
• The propensity of children to talk, laugh, and run while
chewing
• examine even nonfood substances with their mouth
Epidemiology
• more than 100,000 cases of foreign body ingestion
reported each year in the United States
• 80% occur in children, with the majority of the foreign
body ingestion being accidental
• Most often foreign body ingestion occurs in children
between ages of six months and three years
Epidemiology
• Coins are the most common foreign body ingested by
children
• others include toys, toy parts, magnets, batteries, safety
pins, screws, marbles, bones and food boluses
• Fortunately, mortality rates are low
• most foreign bodies pass harmlessly and are
eliminated in the stool
• Also there is no symptom of Pain or discomfort
Epidemiology
Complications include
• systemic reactions due to allergies to ingested
object,
• gastrointestinal mucosal erosion or perforation
• Peritonitis
• Pneumothorax
• production of an aortoenteric fistula.
• Once the foreign body has reached the stomach in a
child with a normal GI tract, it is less likely to lead to
complications
Pathophysiology
The location of the foreign body ingested is important for
determining the appropriate investigations, prognosis
and treatment.
• This is usually categorized anatomically into esophagus
and stomach/lower gastrointestinal tract
• Most complications from pediatric foreign body ingestion
are due to esophageal impaction
Pathophysiology
• about 70% at the upper
esophageal sphincter or
thoracic inlet
• about 15% in the mid-
esophagus at the level of
the aortic notch
• about 15% just above
lower esophageal
sphincter
Pathophysiology
Patients are at an increased risk if they are
• Small
• have an underlying esophageal disease such as a
stricture
• have undergone previous esophageal surgery
• have ingested several coins at one time or Magnets
Pathophysiology
Once the foreign body has reached the stomach in a child
with a normal GI tract, it is less likely to lead to
complications.
• exceptions include
• sharp or toxic bodies
• objects too large to pass through the pyloric
sphincter (greater than 2×6 cm)
• more than one magnet
• Obstruction
• necrosis of intervening tissues
• the formation of a fistula
History Taking & Physical Examination
• Did you witness the child ingesting a foreign body?
• Did the child report to you that he/she ingested a foreign
body?
• Do you know what the foreign body is? (size, shape,
identity)
• Do you know when the child ingested the foreign body?
• Have you found the foreign body in the stool already?
• Has the child previously swallowed any objects before?
History Taking & Physical Examination
• Does the child have any other medical illnesses or have
had previous surgery?
• Does the child have fever, abdominal pain, or vomiting?
If yes, where is the pain? What color, and how much
vomit? Any blood in the vomit?
• Has the child had any stools? If so, how many times,
what color? We need to be aware of potential GI
obstruction
• Is the child having difficulty breathing or showing any
signs of airway compromise? If yes, we need to retrieve
the object promptly.
Esophageal Foreign Body Symptoms
• Dysphagia
• Food refusal, weight loss
• Drooling, gagging
• Emesis, hematemesis
• Foreign body sensation
• Chest pain, sore throat
• Stridor, cough
• Unexplained fever
Stomach/Lower GastroIntestinal Foreign
Body Symptoms
• Abdominal distention
• Pain
• Vomiting
• Hematochezia
• Unexplained fever
History Taking & Physical Examination
• examine airway and breathing – always manage ABCs
before continuing
• examine neck for swelling, erythema, crepitus
suggesting potential esophageal perforation and
requiring surgical consult
• examine chest for stridor or wheezing suggesting
lodged esophageal foreign body with tracheal
compression
• examine abdomen for small bowel obstruction
(auscultate) or perforation (palpate for pain) which
requires immediate surgical consult and
chest/abdominal imaging
LAB Tests
• children with foreign body ingestion do not usually
require lab testing, although they may be indicated if
suspect potential infection
Imaging Studies
• Single frontal radiograph of neck, chest and entire
abdomen to locate the object; this only works if
swallowed object is radiopaque
• If the object is below diaphragm, no further
radiographs are necessary
• If object is in esophagus, frontal and lateral chest
radiographs are necessary to precisely locate and
better identify the object
Imaging Studies
• General rule:
• if coin is in esophagus, it appears in coronal
orientation
• if coin is in trachea, it appears in sagittal
orientation
• Coin versus battery: disk batteries have a distinctive
two-step profile and a double circle appearance
• Endoscopy is preferred over barium contrast studies
for radiolucent objects as it allows removal of object
as well
Imaging Studies
Imaging Studies
Imaging Studies
Urgent Considerations
• When the ingested object is sharp, long (>5 cm),
consists of multiple magnets, and is in the esophagus or
stomach.
• When a disk battery is in the esophagus (and in some
cases in the stomach)
• When the patient shows signs of airway compromise
• When there is evidence of near-complete esophageal
obstruction
• When there are signs or symptoms suggesting
ApproachConsiderations
Approach Considerations - Coins
• usually can be observed for up to 24 hours after
ingestion as 20-30% will pass into stomach
spontaneously
• Esophageal coins should be removed promptly if patient
is symptomatic or does not pass esophagus
spontaneously by 24 hours after ingestion
Approach Considerations – Disk
Batteries
• a medical emergency
• as contact with esophageal wall with both poles of
battery can conduct electricity which can rapidly lead to
necrosis and perforation of esophagus
• However, once passed to stomach, most pass
harmlessly.
Approach Considerations – Sharp
Pointed Objects
• if lodged in esophagus, represents a medical emergency
because 15-35% risk of perforation
• Endoscopy should be performed because many sharp
pointed objects are not readily visible by x-ray
Approach Considerations - Magnets
• a single ingested magnet is usually low risk
• two or more magnets may attract across layers of bowel
leading to necrosis, fistula, perforation or obstruction
• Thus, location, and number of ingested magnets are
important to determine and multiple magnets ingestion
indicates preemptive removal
Thanks for your kind Attention!
‫مطالب‬‫ارائه‬‫شده‬‫در‬‫این‬‫سری‬،‫اسلیدها‬‫تحت‬‫قوانین‬‫انتشار‬‫آزاد‬‫بنیاد‬‫نرم‬‌‫افزارهای‬
‫آزاد‬)Free Software Foundation(‫و‬‫تحت‬‫مجوز‬‫انتشار‬‫آزاد‬‫مستندات‬‫این‬
‫بنیاد‬)GNU Free Documentation License(‫منتشر‬‫شده‬‌‫اند‬.
،‫تغییر‬‫ارائه‬‌‫ی‬‫مجدد‬‫و‬‫انتشار‬‫آن‬‌‫ها‬‫طبق‬‫این‬‫مجوز‬‫ل‬ً ‫آ‬ ‫کام‬‫آزاد‬‫بوده‬‫و‬‫مورد‬‫استقبال‬‫نیز‬
‫می‬‌‫باش‬‌‫ند‬.
‫این‬‫مجوز‬‫در‬‫رابطه‬‫با‬‫آثار‬‫تحت‬‫حمایت‬‫حقوق‬‫مؤلف‬/‫کپی‬‌‫رایت‬‫که‬‫در‬‫این‬،‫اسلیدها‬‫به‬‫آن‬‌‫ها‬
‫اشاره‬‫شده‬‌‫اند‬‫ن‬‌‫بوده‬‫و‬‫استفاده‬‫از‬‫آن‬‌‫ها‬‫منوط‬‫به‬‫نظر‬‫صاحب‬‫حق‬‌‫تألیف‬‫اثر‬‫می‬‌‫باش‬‌‫ند‬.
Each single word of this presentation belongs to «Free Software
Foundation»'s «GNU Free Documentation License»; any kind
of using, changing, representing & distributing of these are
free up to this License's protocol & are welcomed!
This is not about Copy-Right protected materials used or
republished in this presentation(which are mentioned), and
must be respected to Author's Opinion & Decision on his/her
right.

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Pediatric foreign body ingestion

  • 1.
  • 2. Pediatric Foreign Body Ingestion Meshkini M. 2015 – 07 – 12 Pediatric Surgical Rotation Conference - Tabriz Children Hospital
  • 5. Background • The lack of molar teeth • The propensity of children to talk, laugh, and run while chewing • examine even nonfood substances with their mouth
  • 6. Epidemiology • more than 100,000 cases of foreign body ingestion reported each year in the United States • 80% occur in children, with the majority of the foreign body ingestion being accidental • Most often foreign body ingestion occurs in children between ages of six months and three years
  • 7. Epidemiology • Coins are the most common foreign body ingested by children • others include toys, toy parts, magnets, batteries, safety pins, screws, marbles, bones and food boluses • Fortunately, mortality rates are low • most foreign bodies pass harmlessly and are eliminated in the stool • Also there is no symptom of Pain or discomfort
  • 8. Epidemiology Complications include • systemic reactions due to allergies to ingested object, • gastrointestinal mucosal erosion or perforation • Peritonitis • Pneumothorax • production of an aortoenteric fistula. • Once the foreign body has reached the stomach in a child with a normal GI tract, it is less likely to lead to complications
  • 9. Pathophysiology The location of the foreign body ingested is important for determining the appropriate investigations, prognosis and treatment. • This is usually categorized anatomically into esophagus and stomach/lower gastrointestinal tract • Most complications from pediatric foreign body ingestion are due to esophageal impaction
  • 10. Pathophysiology • about 70% at the upper esophageal sphincter or thoracic inlet • about 15% in the mid- esophagus at the level of the aortic notch • about 15% just above lower esophageal sphincter
  • 11. Pathophysiology Patients are at an increased risk if they are • Small • have an underlying esophageal disease such as a stricture • have undergone previous esophageal surgery • have ingested several coins at one time or Magnets
  • 12. Pathophysiology Once the foreign body has reached the stomach in a child with a normal GI tract, it is less likely to lead to complications. • exceptions include • sharp or toxic bodies • objects too large to pass through the pyloric sphincter (greater than 2×6 cm) • more than one magnet • Obstruction • necrosis of intervening tissues • the formation of a fistula
  • 13. History Taking & Physical Examination • Did you witness the child ingesting a foreign body? • Did the child report to you that he/she ingested a foreign body? • Do you know what the foreign body is? (size, shape, identity) • Do you know when the child ingested the foreign body? • Have you found the foreign body in the stool already? • Has the child previously swallowed any objects before?
  • 14. History Taking & Physical Examination • Does the child have any other medical illnesses or have had previous surgery? • Does the child have fever, abdominal pain, or vomiting? If yes, where is the pain? What color, and how much vomit? Any blood in the vomit? • Has the child had any stools? If so, how many times, what color? We need to be aware of potential GI obstruction • Is the child having difficulty breathing or showing any signs of airway compromise? If yes, we need to retrieve the object promptly.
  • 15. Esophageal Foreign Body Symptoms • Dysphagia • Food refusal, weight loss • Drooling, gagging • Emesis, hematemesis • Foreign body sensation • Chest pain, sore throat • Stridor, cough • Unexplained fever
  • 16. Stomach/Lower GastroIntestinal Foreign Body Symptoms • Abdominal distention • Pain • Vomiting • Hematochezia • Unexplained fever
  • 17. History Taking & Physical Examination • examine airway and breathing – always manage ABCs before continuing • examine neck for swelling, erythema, crepitus suggesting potential esophageal perforation and requiring surgical consult • examine chest for stridor or wheezing suggesting lodged esophageal foreign body with tracheal compression • examine abdomen for small bowel obstruction (auscultate) or perforation (palpate for pain) which requires immediate surgical consult and chest/abdominal imaging
  • 18. LAB Tests • children with foreign body ingestion do not usually require lab testing, although they may be indicated if suspect potential infection
  • 19. Imaging Studies • Single frontal radiograph of neck, chest and entire abdomen to locate the object; this only works if swallowed object is radiopaque • If the object is below diaphragm, no further radiographs are necessary • If object is in esophagus, frontal and lateral chest radiographs are necessary to precisely locate and better identify the object
  • 20. Imaging Studies • General rule: • if coin is in esophagus, it appears in coronal orientation • if coin is in trachea, it appears in sagittal orientation • Coin versus battery: disk batteries have a distinctive two-step profile and a double circle appearance • Endoscopy is preferred over barium contrast studies for radiolucent objects as it allows removal of object as well
  • 24. Urgent Considerations • When the ingested object is sharp, long (>5 cm), consists of multiple magnets, and is in the esophagus or stomach. • When a disk battery is in the esophagus (and in some cases in the stomach) • When the patient shows signs of airway compromise • When there is evidence of near-complete esophageal obstruction • When there are signs or symptoms suggesting
  • 26. Approach Considerations - Coins • usually can be observed for up to 24 hours after ingestion as 20-30% will pass into stomach spontaneously • Esophageal coins should be removed promptly if patient is symptomatic or does not pass esophagus spontaneously by 24 hours after ingestion
  • 27. Approach Considerations – Disk Batteries • a medical emergency • as contact with esophageal wall with both poles of battery can conduct electricity which can rapidly lead to necrosis and perforation of esophagus • However, once passed to stomach, most pass harmlessly.
  • 28. Approach Considerations – Sharp Pointed Objects • if lodged in esophagus, represents a medical emergency because 15-35% risk of perforation • Endoscopy should be performed because many sharp pointed objects are not readily visible by x-ray
  • 29. Approach Considerations - Magnets • a single ingested magnet is usually low risk • two or more magnets may attract across layers of bowel leading to necrosis, fistula, perforation or obstruction • Thus, location, and number of ingested magnets are important to determine and multiple magnets ingestion indicates preemptive removal
  • 30. Thanks for your kind Attention!
  • 31. ‫مطالب‬‫ارائه‬‫شده‬‫در‬‫این‬‫سری‬،‫اسلیدها‬‫تحت‬‫قوانین‬‫انتشار‬‫آزاد‬‫بنیاد‬‫نرم‬‌‫افزارهای‬ ‫آزاد‬)Free Software Foundation(‫و‬‫تحت‬‫مجوز‬‫انتشار‬‫آزاد‬‫مستندات‬‫این‬ ‫بنیاد‬)GNU Free Documentation License(‫منتشر‬‫شده‬‌‫اند‬. ،‫تغییر‬‫ارائه‬‌‫ی‬‫مجدد‬‫و‬‫انتشار‬‫آن‬‌‫ها‬‫طبق‬‫این‬‫مجوز‬‫ل‬ً ‫آ‬ ‫کام‬‫آزاد‬‫بوده‬‫و‬‫مورد‬‫استقبال‬‫نیز‬ ‫می‬‌‫باش‬‌‫ند‬. ‫این‬‫مجوز‬‫در‬‫رابطه‬‫با‬‫آثار‬‫تحت‬‫حمایت‬‫حقوق‬‫مؤلف‬/‫کپی‬‌‫رایت‬‫که‬‫در‬‫این‬،‫اسلیدها‬‫به‬‫آن‬‌‫ها‬ ‫اشاره‬‫شده‬‌‫اند‬‫ن‬‌‫بوده‬‫و‬‫استفاده‬‫از‬‫آن‬‌‫ها‬‫منوط‬‫به‬‫نظر‬‫صاحب‬‫حق‬‌‫تألیف‬‫اثر‬‫می‬‌‫باش‬‌‫ند‬. Each single word of this presentation belongs to «Free Software Foundation»'s «GNU Free Documentation License»; any kind of using, changing, representing & distributing of these are free up to this License's protocol & are welcomed! This is not about Copy-Right protected materials used or republished in this presentation(which are mentioned), and must be respected to Author's Opinion & Decision on his/her right.