Gastroesophageal reflux

Gastroesophageal reflux disease (GERD) is a very common condition and affects approximately 7–20% of the pediatric population. Symptoms from pathological GERD include regurgitation, irritability when feeding, respiratory problems, and substernal pain. Treatment typically starts with dietary modifications and postural changes. Antireflux medications may then be added. Indications for operative management in the pediatric population include failure of medical therapy with poor weight gain or failure to thrive, continued respiratory symptoms, and complications such as esophagitis. Laparoscopic Nissen fundoplication has become the standard of care for surgical treatment of children with GERD. The key technical aspects of laparoscopic Nissen fundoplication include creation of an adequate intra-abdominal esophagus, minimal dissection of the hiatus with exposure of the right crus to identify the gastroesophageal junction, crural repair, and creation of floppy, 360° wrap that is oriented at the 11 o׳clock position.     

Allergic eosinophilic esophagitis

Allergic eosinophilic esophagitis is an increasingly recognized disease in various parts of the world. The clinical presentation mimics other gastrointestinal diseases, especially gastroesophageal reflux disease, making endoscopic examination and histological evaluation of esophageal mucosal biopsies crucial to accurate diagnosis. The pathogenesis likely involves allergen-initiated, TH2-dependent, IL-5 mediated infiltration of eosinophilis into the esophageal mucosa. Therapies currently favored include dietary modifications and use of corticosteroids.     

Hepatic foreign body in a child

The majority of foreign bodies (FBs) swallowed by children are passed spontaneously without event. Perforation of the intestine with migration to the liver is rare. A child with a needle in the right lobe of the liver is reported.     

Spontaneous expulsion of unusual tracheobronchial foreign body

An extremely rare case of long, thin and sharp pin in a young boy which was inhaled initially and defied removal at branchoscopy was eventually recovered in stool after a long and variable course through alimentary tract has been reported.     

Multiple foreign body ingestion and ileal perforation

Foreign body ingestion is a common problem encountered in the pediatric age group. The swallowed object is often passed with little or no morbidity. Problems ensue if the ingested foreign body is hazardous, is multiple, or becomes impacted. We describe an ileal perforation following the ingestion of an alkaline disc battery, a magnet, and a steel ball impacted in the ileum for about 48 h. The magnet and the steel ball were attracted to each other, forming a composite unit. The disc battery and the magnet were attracted to each other across a loop of ileum, causing necrosis and perforation of the ileum. Disclaimer No aid, financial or otherwise, has been or will be received for this report.     

Inspiratory stridor and dysphagia because of prolonged oesophageal foreign body

A 2-year-old boy with severe inspiratory stridor and sysphagia is described.The delay in the diagnosis of an impacted foreign body resulted in severe deformation of the oesophagus.After surgical extraction of the foreign body the oesophagus was splinted for 4 months by a nasogastric tube because of persistent severe dysphagia.Removal of this tube was followed by a gradual disappearance of the complaints.     

Tracheobronchial foreign body aspiration in childhood

In 224 patients aged 7 months to 14 years aspirated foreign bodies (FB) were extracted from the tracheobronchial system. Eighty-one percent of the children were younger than 3 years, 50% were in the second year of life. There were twice as many boys as girls. Sixty-seven percent of the FB were nuts, of these more than half were peanuts. Fifty-six percent of aspirated FB were localized in the right bronchial system, 39% in the left and 5% subglottic or tracheal. All FB could be removed by endoscopy under general anaesthesia with muscle relaxation. The development of an extraction technique without forceps (encasing) led to an easier way of removing crumbling FB, like nuts. Complications were rare, no postoperative tracheotomy was necessary, no cardiac arrest and no death occurred.The interval between aspiration and intervention was longer than 3 weeks in one-third of the cases; in some cases it was months or years with the consequence of chronic damage of the bronchial system or the lung. The possibilities of prevention appear to be limited; thus it is necessary to diminish the frequency of prolonged lodging of FB in the respiratory tract by considering aspiration early in the differential diagnosis of airway symptoms.Abbreviation FB foreign body Dedicated to Prof. Klaus Betke on the occasion of his 70th birthday     

Non-operative removal of an unusual foreign body from the duodenum after duodeno-jejunostomy

The authors report a case of peroral removal of an intraduodenal foreign body in a 6 week old infant. The coaxial technique employed facilitates catheter manipulation and avoids traumatic lesions arising from manoeuvres during removal.     

Impact of community educational programmes on foreign body aspiration in Israel

The study objectives were to determine the impact of a nation-wide educational campaign on the incidence of foreign body aspiration (FBA) in Israeli children. Impressed by the alarming number of FBAs, we conducted an educational campaign through the media during 1982–1983. The campaign included television and radio broadcasts, newspaper articles and interviews, and medical educational programmes in community paediatric care centres. Questionnaires were sent to all Departments of Paediatrics in Israel. Results showed a reduction in the incidence of FBA by 35% in 1983 as compared to 1981. Re-evaluation studies conducted in 1992 showed no further reduction of FBA.Conclusion Continuous and extensive educational programmes should be undertaken by the health authorities if FBA is to be prevented. Furthermore, it is important to legislate mandatory labelling of seed and nut containers with the warning that the intake of seeds is dangerous to children under 5 years of age.     

Pneumopericardium as a complication of foreign body aspiration

A case of pneumopericardium in an infant complicating aspiration of a foreign body is reported. In addition to X-ray studies echocardiography is valuable for the control of the disease. The pathogenesis and the treatment are discussed and a short review of the literature is given.     

Obstructive sleep apnoea probably related to a foreign body

A 2-year-old child was admitted because of sudden onset of symptoms compatible with obstructive sleep apnoea. Physical examination revealed slightly hypertrophic tonsils. A polygraphic study showed 150 apnoeic episodes of obstructive type during 8 h night sleep.A foreign body consisting of a piece of a celophane candy wrapper was found by surgery. Removal of the foreign body, the adenoids and tonsils resulted in a complete recovery. A second polygraphic study performed 4 months after surgery gave entirely normal results. A foreign body should be considered in the aetiology of obstructive sleep apnoea of sudden onset in children.Abbreviation OSA obstructive sleep apnoea     

Three-dimensional computed tomography for detection of tracheobronchial foreign body aspiration in children

Foreign body aspiration (FBA) into the tracheobronchial tree is a frequent and serious cause of respiratory problems in children. Chest X-ray (CXR) is often inaccurate in diagnosing FBA when the object is radiolucent. Three-dimensional computed tomography (CT) is a noninvasive technique that can detect the narrowing of the airway resulting from the presence of a foreign body. We conducted a retrospective study comparing the performance of CT scan and CXR in the diagnosis of FBA. Eleven patients (mean age 2.1 years) with a history suggestive of foreign body aspiration were examined by three-dimensional chest CT and CXR during the study. The presence of foreign bodies was confirmed and they were removed by rigid or flexible bronchoscopy under general anesthesia. Foreign body aspiration (FBA) was detected in all the 11 patients by CT scan (sensitivity, 100%), but CXR of three of the patients showed no evidence of FBA (sensitivity, 72.7%). The foreign bodies were located in the right main bronchus (n = 4), the left main bronchus (n = 5), and the trachea (n = 2). The mean length of hospital stay was 3.8 days. In our study, three-dimensional chest CT scan was more sensitive than CXR in detecting the presence of aspirated foreign bodies in children. The superior sensitivity and short time required for CT should help to reduce delays in diagnosis. These benefits may prompt further studies to determine whether CT could be used to reduce the number of unnecessary bronchoscopies performed in children being evaluated for FBA.     

三维CT对支气管异物诊断价值的临床研究

目的 探讨三维CT在支气管异物诊断和鉴别诊断中的作用.方法 对37例可疑支气管异物的患儿行螺旋CT检查,并进行支气管三维CT重建,通过支气管镜检术、保守及手术治疗的结果 判断三维CT检查结果 的准确性.结果 37例可疑支气管异物的患儿中,X线胸部透视提示支气管异物8例(A组);X线胸部透视不提示支气管异物29例(B组).A组中,CT提示肺内感染5例、先天性肺发育异常-肺叶缺如2例、气管食管瘘1例.B组29例患儿中,CT提示支气管异物25例,经支气管镜检证实其中24例存在植物性异物,1例为气管内肿物;CT不提示支气管异物4例,证实为肺内感染、小儿急性喉炎各2例.手术证实存在植物性异物的24例中,CT显示气管支气管内异物影共14例次,不规则狭窄共6例次;阻塞性肺不张、肺气肿、肺炎共7例次;前两项为直接征象,占74%(20/27),后三项为间接征象,占26%(7/27).结论 三维CT检查对支气管异物的诊断及鉴别诊断有重要意义,有助于疑难病例的诊断和鉴别诊断.     

Fluoroscopically controlled removal of a blunt esophageal foreign body using a Foley catheter in children

The removal of foreign bodies from the esophagus with a Foley catheter is a simple, safe, and highly successful procedure. This technique should be used initially when managing a blunt foreign body in the esophagus; it reduces the risk, time, and expense involved in endoscopic removal.Offprint requests to: P. Mogle     

An unusual complication of nasal foreign body in a pediatric patient: A case report

Foreign body (FB) of nasal cavity is a common clinical incidence in Pediatric Otorhinolaryngology. Inferior meatus is a rare location for FB lodgment inside the nasal cavity. In case of nasal FB, patients usually present with nasal obstruction, foul smell discharge and epistaxis. FB at the inferior meatus blocking the nasolacrimal outflow is an extremely rare complication of nasal FB leading to dacryocystitis. X-ray skull will help to rule out the radio-opaque FB in the nasal cavity. Diagnostic nasal endoscopy will help for accurate diagnosis of nasal FB. Early diagnosis and safe removal of FB from nasal cavity help to reduce complications. We present an unusual case of nasal FB in a 10-year-old boy presented with chronic dacryocystitis. Chronic dacryocystitis is an extremely rare presentation due to FB of nasal cavity.     

Gastroesophageal reflux among severely retarded children.

Of 136 institutionalized severely retarded children, 20 (15%) had recurrent vomiting. Of these 20, 15 had gastroesophageal reflux diagnosed by x-ray examination, acid reflux text, or both. Esophagitis was noted by endoscopy in ten of 14 patients with GER. Four patients were anemic and six had had one or more episodes of aspiration pneumonia in the 12 months prior to study. Reduced basal lower esophageal sphincter pressure was the most common manometric abnormality noted in the patients with GER. Responses of the LES to bethanechol and swallow were normal, as was the basal pressure of the upper esophageal sphincter. Abnormal propagation of esophageal peristalsis was seen in six patients, all of whom had moderate or severe esophagitis. When compared to the nonvomiting retarded patients, the GER patients had significantly lower mental age and higher incidence of scoliosis. Patients with GER who had basal LES pressure less than 10 mm Hg did not improve with medical management. Recurrent vomiting is a common and serious problem in severely retarded children, the organic cause of which can be demonstrated by the application of appropriate investigative techniques.     

CT virtual bronchoscopy: New non invasive tool in pediatric patients with foreign body aspiration

A 2-year-old girl presented with recurrent cough, wheese and breathing difficulty. Her imaging (CT and virtual bronchoscopy) revealed a foreign body in tracheobronchial tree, that was removed by rigid bronchoscopy.     

Epidural emphysema associated with subcutaneous emphysema following foreign body in the airway

Epidural emphysema is a rare condition and usually accompanies pneumothorax, subcutaneous emphysema (SCE), or pneumomediastinum. We report a child who presented with epidural emphysema (pneumorachis) and SCE. The child was subsequently found to have a foreign body obstructing the airway, which was the likely cause of the pneumorachis. Thus, foreign body aspiration should be considered in an infant with SCE, and early intervention in the form of bronchoscopy should to be done to arrest the condition’s progressive nature.     

Gastroesophageal reflux in children with recurrent abdominal pain

In this study we investigated the presence of gastroesophageal reflux in children with recurrent abdominal pain and its possible relationship to food intolerance-associated duodenal inflammation. Twenty-four-hour intra-esophageal pH monitoring, an endoscopic duodenal biopsy and a small bowel 51Cr-EDTA permeability test were performed in 25 children with recurrent abdominal pain. In 14 cases (56%) the pH monitoring was abnormal, pointing to the presence of pathological gastroesophageal reflux. Treatment of gastroesophageal reflux in the latter patients resulted in resolution or improvement of abdominal pain in 10 cases (71%). Gastroesophageal reflux did not appear to be associated with either intestinal permeability to 51Cr-EDTA or duodenal biopsy findings. We conclude that pathological gastroesophageal reflex is a frequent finding in children with recurrent abdominal pain, that it is unrelated to duodenal inflammation and that there might be a causal relationship between pathological gastroesophageal reflux and recurrent abdominal pain in children.