OJPed  Vol.3 No.4 , December 2013
Endoscopic management of ingested foreign bodies in children: A retrospective review of cases, and review of the literature
Abstract: Background: Foreign body (FB) ingestion by children is a common problem worldwide. Management may include endoscopic removal. This paper describes the clinical findings, sites and types of FBs, and outcomes in children who underwent endoscopic management of ingested FBs at our institution. The published literature regarding the management of FB ingestion in children is also reviewed. Methods: We retrospectively reviewed the records of all patients aged <14 years who underwent endoscopic management of gastrointestinal FBs between July 2002 and June 2012 (47 patients) and tracheobronchial FBs between December 2010 and June 2012 (17 patients) at our institution. Patient characteristics, clinical findings, sites and types of FBs, and outcomes were recorded. Results: The 47 patients with gastrointestinal FBs included 29 males and 18 females with a mean age of 3.5 years. The most common symptoms were difficulty with swallowing and vomiting in 16 patients (34%), chest pain in 10 (21%), and coughing and breathing difficulty in 7 (15%). The most common FB site was the esophagus (36 patients). Most gastrointestinal FBs were metallic, with coins being the most common. Endoscopic removal was successful in 43 patients. The 17 patients with tracheobronchial foreign bodies included 9 males and 8 females with a mean age of 3.2 years. The most common symptoms were breathing difficulty in 12 patients (71%) and coughing in 3 (18%). The most common tracheobronchial FBs were nuts (10 patients). Bronchoscopic removal was successful in all 17 patients. Conclusions: Coins were the most common gastrointestinal FBs, and nuts were the most common tracheobronchial FBs. Clinical presentations were variable, and a high index of suspicion is necessary. Endoscopic removal is safe and effective, and early diagnosis and management result in favorable outcomes.
Cite this paper: Abbas, T. , Shahwani, N. and Ali, M. (2013) Endoscopic management of ingested foreign bodies in children: A retrospective review of cases, and review of the literature. Open Journal of Pediatrics, 3, 428-435. doi: 10.4236/ojped.2013.34077.

[1]   Wahbeh, G., Wyllie, R. and Kay, M. (2002) Foreign body ingestion in infants and children: Location, location, location. Clinical Pediatrics, 41, 633-640.

[2]   Wai Pak, W., Chung Lee, W., Kwok Fung, H. and van Hasselt, C.A. (2001) A prospective study of foreign body ingestion in 311 children. International Journal of Pediatric Otorhinolaryngology, 58, 37-45.

[3]   Gün, F., Salman, T., Abbasoglu, L., Celik, R. and Celik, A. (2003) Safety pin ingestion in children: A cultural fact. Pediatric Surgery International, 19, 482-484.

[4]   Kay, M. and Wyllie, R. (2005) Pediatric foreign bodies and their management. Current Gastroenterology Reports, 7, 212-218.

[5]   Dahshan, A. (2001) Management of ingested foreign bodies in children. Journal of the Oklahoma State Medical Association, 94, 183-186.

[6]   Chen, M.K. and Beierle, E.A. (2001) Gastrointestinal foreign bodies. Pediatric Annals, 30, 736-742.

[7]   Kim, J.K., Kim, S.S., Kim, J.I., Kim, S.W., Yang, Y.S., Cho, S.H., Lee, B.S., Han, N.I., Han, S.W., Chung, I.S., Chung, K.W. and Sun, H.S. (1999) Management of foreign bodies in the gastrointestinal tract: An analysis of 104 cases in children. Endoscopy, 31, 302-304.

[8]   Chaves, D.M., Ishioka, S., Félix, V.N., Sakai, P. and Gama-Rodrigues, J.J. (2004) Removal of a foreign body from the upper gastrointestinal tract with a flexible endoscope: A prospective study. Endoscopy, 36, 887-892.

[9]   Yal?in, S., Karnak, I., Ciftci, A.O., Senocak, M.E., Tanyel, F.C. and Büyükpamuk?u, N. (2007) Foreign body ingestion in children: An analysis of pediatric surgical practice. Pediatric Surgery International, 23, 755-761.

[10]   Arana, A., Hauser, B., Hachimi-Idrissi, S. and Vandenplas, Y. (2001) Management of ingested foreign bodies in childhood and review of the literature. European Journal of Pediatrics, 160, 468-472.

[11]   Hesham, A. and Kader, H. (2010) Foreign body ingestion: Children like to put objects in their mouth. World Journal of Pediatrics, 6, 301-310.

[12]   Ozguner, I.F., Buyukyavuz, B.I., Savas, C., Yavuz, M.S. and Okutan, H. (2004) Clinical experience of removing aerodigestive tract foreign bodies with rigid endoscopy in children. Pediatric Emergency Care, 20, 671-673.

[13]   Harris, C.S., Baker, S.P., Smith, G. and Harris, R.M. (1984) Childhood asphyxiation by food: A national analysis and overview. JAMA, 251, 2231-2235. 39029

[14]   Crysdale, W.S., Sendi, K.S. and Yoo, J. (1991) Esophageal foreign bodies in children: 15-year review of 484 cases. Annals of Otology, Rhinology, and Laryngology, 100, 320-324.

[15]   Friedman, E.M. (2000) Tracheobronchial foreign bodies. Otolaryngologic Clinics of North America, 33, 179-185.

[16]   Healy, G.B. (1991) Aerodigestive tract foreign bodies. In: Fallis, J.C., Filler, R.M. and Lemoine, G., Eds., Pediatric Thoracic Surgery, Elsevier, New York, 192-200.

[17]   Stack, L.B. and Munter, D.W. (1996) Foreign bodies in the gastrointestinal tract. Emergency Medicine Clinics of North America, 14, 493-521.

[18]   Newman, B. and Girdany, B.R. (1990) Gastric trichobezoars—Sonographic and computed tomographic appearance. Pediatric Radiology, 20, 526-527.

[19]   Digoy, G.P. (2008) Diagnosis and management of upper aerodigestive tract foreign bodies. Otolaryngologic Clinics of North America, 41, 485-496, vii-viii. 013

[20]   Ciftci, A.O., Bingol-Kologlu, M., Senocak, M.E., Tanyel, F.C. and Büyükpamukcu, N. (2003) Bronchoscopy for evaluation of foreign body aspiration in children. Journal of Pediatric Surgery, 38, 1170-1176.

[21]   Tokar, B., Ozkan, R. and Ilhan, H. (2004) Tracheobronchial foreign bodies in children: Importance of accurate history and plain chest radiography in delayed presentation. Clinical Radiology, 59, 609-615.

[22]   Webb, C.V. (1995) Management of foreign bodies of the upper gastrointestinal tract: Update. Gastrointestinal Endoscopy, 41, 4139-4149.

[23]   Waltzman, M.L., Baskin, M., Wypij, D., Mooney, D., Jones, D. and Fleisher, G. (2003) A randomized clinical trial of the management of esophageal coins in children [see comment]. Pediatrics, 116, 614-619.

[24]   Mehta, D., Attia, M., Quintana, E. and Cronan, K. (2001) Glucagon use for esophageal coin dislodgment in children: A prospective, double-blind, placebo-controlled trial. Academic Emergency Medicine, 8, 200-203.

[25]   Caravati, E.M., Bennett, D.L. and McElwee, N.E. (1989) Pediatric coin ingestion. A prospective study on the utility of routine roentgenograms. American Journal of Diseases of Children, 143, 549-551.

[26]   Litovitz, T. and Schmitz, B.F. (1992) Ingestion of cylindrical and button batteries: An analysis of 2382 cases. Pediatrics, 89, 747-757.

[27]   Litovitz, T., Whitaker, N., Clark, L., White, N.C. and Marsolek, M. (2010) Emerging battery ingestion hazard: Clinical implications. Pediatrics, 125, 1168-1177.

[28]   Samad, L., Ali, M. and Ramzi, H. (1999) Button battery ingestion: Hazards of esophageal impaction. Journal of Pediatric Surgery, 34, 1527-1531.

[29]   Yardeni, D., Yardeni, H., Coran, A.G. and Golladay, E.S. (2004) Severe esophageal damage due to button battery ingestion: Can it be prevented? Pediatric Surgery International, 20, 496-501.

[30]   Bass, D.H. and Millar, A.J. (1992) Mercury absorption following button battery ingestion. Journal of Pediatric Surgery, 27, 1541-1542.

[31]   Temple, D.M. and McNeese, M.C. (1983) Hazards of battery ingestion. Pediatrics, 71, 100-103.

[32]   Chung, S., Forte, V. and Campisi, P. (2010) A review of pediatric foreign body ingestion and management. Clinical Pediatric Emergency Medicine, 11, 225-230. cpem.2010.06.002

[33]   Louie, M.C. and Bradin, S. (2009) Foreign body ingestion and aspiration. Pediatrics in Review, 30, 295-301.

[34]   Hachimi-Idrissi, S., Corne, L. and Vandenplas, Y. (1998) Management of ingested foreign bodies in childhood: Our experience and review of the literature. European Journal of Emergency Medicine, 5, 319-323.

[35]   Pinero Madrona, A., Fernández Hernández, J.A., Carrasco Prats, M., Riquelme Riquelme, J. and Parrila Paricio, P. (2000) Intestinal perforation by foreign bodies. European Journal of Surgery, 166, 307-309.

[36]   Abel, R.M., Fischer, J.E. and Hendren, W.H. (1971) Penetration of the alimentary tract by a foreign body with migration to the liver. Archives of Surgery, 102, 227-229. archsurg.1971.01350030065021

[37]   Kountouras, J., Chatzopoulos, D. and Vrettos, M. (2001) Perforation of midpart of ileum caused by entrapment of a large, wide foreign body. Annals of Gastroenterology, 14, 329-332.

[38]   Steenvoorde, P., Moues, C.M. and Viersma, J.H. (2002) Gastric perforation due to the ingestion of a hollow toothpick: Report of a case. Surgery Today, 32, 731-733.

[39]   Maleki, M. and Evan, W.E. (1970) Foreign-body perforation of the intestinal tract. Report of 12 cases and review of the literature. Archives of Surgery, 101, 475-477. 1970.01340280027008

[40]   Chaikhouni, A., Kratz, J.M. and Crawford, F.A. (1985) Foreign bodies of the esophagus. The American Surgeon, 51, 173-179.

[41]   Tokar, B., Cevik, A.A. and Ilhan, H. (2007) Ingested gastrointestinal foreign bodies: Predisposing factors for complications in children having surgical or endoscopic removal. Pediatric Surgery International, 23, 135-139.

[42]   Zerella, J.T., Dimler, M., McGill, L.C. and Pippus, K.J. (1998) Foreign body aspiration in children: Value of radiography and complications of bronchoscopy. Journal of Pediatric Surgery, 33, 1651-1654.

[43]   Sersar, S.I., Rizk, W.H., Bilal, M., El Diasty, M.M., Eltantawy, T.A., Abdelhakam, B.B., Elgamal, A.M. and Bieh, A.A. (2006) Inhaled foreign bodies: Presentation, management and value of history and plain chest radiography in delayed presentation. Otolaryngology-Head and Neck Surgery, 134, 92-99.