Lead foreign body ingestion in children

Abstract: Foreign body ingestion is seen commonly in paediatric surgical practice and the vast majority of ingested foreign bodies will pass spontaneously once they have made their way into the stomach. Lead foreign body ingestion in children represents a special case in view of the potential for acute lead intoxication secondary to dissolution and absorption of the ingested lead. Lead dissolves poorly in physiological solutions with the exception of the acid environment of the stomach. We report a case of a 4-year-old child who ingested a lead sinker which was removed from the stomach by emergency endoscopy. This case stimulated a review of the relevant literature and the formulation of a management plan for lead foreign body ingestion in children. The principles of this management plan are observation of the child in hospital and use of a protein pump inhibitor until the foreign body has passed out of the stomach.     

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.     

儿童幽门下消化道异物治疗分析

目的 探讨在儿童不同年龄阶段,对于幽门以下消化道异物处理及预防办法.方法 回顾我院2011年6月到2014年6月间因吞食异物,异物位于幽门管或以下消化道且内镜治疗无效,外科经保守或手术治疗好转的16例患儿(11男5女).结果 16例患儿平均年龄66月龄;手术治疗9例(56％),保守治疗7例(44％);有意吞食异物(年龄＞1岁)为31％(5/16);异物类型包括胃石3例、钢针4例,磁铁2例,温度计碎裂2例,坚果类3例,刀片1例等;腹部X平片及CT阳性率81％ (13/16);病史中可问诊到异物吞食史为75％ (12/16);因消化道穿孔需要急诊手术的5例,穿孔部位以回盲部为主(磁石类引起两处以上穿孔),其中直接入PICU的1例;平均住院时间9.13d.结论 (1)对于磁石类型异物,一旦确诊为双极磁石,建议手术干预为主,已经穿孔的患者,其穿孔数目及肠段应反复探查全肠段后再确定,穿孔部位往往呈跳跃性,无规律性.(2)误食钢针等尖锐异物,除按时评估患儿体征变化外,应间隔6～8h复查腹部平片等检查,及时更改治疗策略.建议＜1岁儿童,不建议喂食坚果核仁类食物.建议使用电子体温计,玻璃水银体温计使用需谨慎.(3)加强儿童心理治疗,特别青春期前的心理健康应注意.     

Vaginal foreign body in childhood: A multidisciplinary approach

A 5-year-old girl referred to our division for evaluation of persisting foul-smelling brown vaginal discharge with pruritus for over 2 years, not corresponding to antibiotic therapy. Transabdominal ultrasound identified a heterogeneous mass intensely fixed in the upper third of vaginal wall. Vaginography revealed a filling defect in the upper part of vagina, confirming the diagnosis of an intravaginal foreign body. The foreign body was grasped and removed by traction; it turned out to be a thin double-wrapped piece of sponge. Psychological assessment of the girl was undertaken, in order to illuminate the potential of an underlying emotional and behavioural problem and revealed the existence of psychological disturbances mostly affecting social competence and adaptiveness.     

Intraluminal duodenal diverticulum in a child: incidental onset possibly associated with the ingestion of a foreign body

Funnel-type intraluminal duodenal diverticulum (windsock web) is a rare congenital malformation. A 4-year-old boy with vomiting and abdominal pain for several weeks was referred to the hospital. A plain abdominal X-ray on admission disclosed a double bubble sign. Abdominal echography and CT disclosed a foreign body lodged in the alimentary tract. After the foreign body was removed with a fibrescope, endoscopy showed a stenotic descending portion where the foreign body was located. An upper gastro-intestinal contrast study demonstrated a post-bulbar duodenal stenosis with a barium-filled pear-shaped sac in the descending portion of the duodenum. Surgical exploration was done under the diagnosis of windsock web of the duodenum. A simple excision of the web at its base was carried out. A hole 7 mm in diameter was found at the edge of the web. The microscopic appearance of the resected specimen was characterized by the duodenal mucosa with an extensive chronic inflammation lining both sides of the diverticulum and the lack of muscular layer of mucosa. Conclusion If an ingested material is not excreted in the stool, possible clogging in the intestinal tract should always be considered and a further intensive examination is warranted. Received: 2 September 1997 / Accepted in revised form: 1 July 1998     

Non-fatal asphyxiation and foreign body ingestion in children 0-14 years.

OBJECTIVES: To examine the frequency and nature of non-fatal asphyxiation and foreign body ingestion injuries among children in the state of Victoria, Australia, and to identify possible areas for prevention. METHODS: For children under 15 years, all Victorian public hospital admissions, July 1987 to June 1995, due to asphyxiation or 'foreign body entering through other orifice' (which includes ingestions), were reviewed. Emergency department presentations due to asphyxiation and foreign body ingestion provided information on circumstances of, and the type of foreign bodies involved in the injuries. RESULTS: The childhood average annual admission rate for asphyxiation was 15.1 per 100,000. Food related asphyxiation peaked in infants under 1 year, and declined to low levels by 3 years. The main foods involved were nuts, carrot, apple, and candy. The rate of non-food related asphyxiation was relatively constant to 3 years of age and then declined by 6 years. Mechanical suffocation was less common. The annual admission rate for 'foreign body entering through other orifice' was 31.7 per 100,000. These injuries peaked in 2-3 year olds then gradually declined. About 80% of these foreign body admissions were ingestions, with coins being the major object ingested. Admission rates for these causes remained constant over the eight years. Asphyxiation resulted in a higher proportion admitted and longer hospital stays. CONCLUSIONS: Prevention of suffocation and strangulation needs to focus on a safe sleeping environment and avoidance of ropes and cords, while foreign body asphyxiation and ingestion needs a focus on education of parents and child carers regarding age, appropriate food, risk of play with coins, and other small items. Legislation for toy small parts could be extended to those used by children up to the age of 5 years, and to other products marketed for children. Design changes and warning labels also have a place in prevention.     

Management of foreign body ingestion and food bolus impaction in children: a retrospective analysis of 675 cases

Although foreign body ingestion is a common problem in children, there are no clear guidelines regarding the management of ingested foreign bodies. The aim of this study was to evaluate the effectiveness of our protocol in the work-up and management of children with ingested foreign bodies. Between September 2002 and August 2010, a total of 675 children with suspected foreign body ingestion were seen in the emergency department. At initial presentation, the majority of foreign bodies were located in the stomach (n=392, 58.1%) followed by the small intestine (n=221, 32.7%) and esophagus (n=62, 9.2%). Based on our protocol, 84 (12.4%) patients were admitted at initial presentation, and 5 after a 48-hour observation period at home; 61 (9%) required prompt endoscopic removal. Sixty-eight (10.1%) patients returned for endoscopic removal after a four-week observation period, and 3 (0.4%) patients underwent delayed surgery due to complications. The overall success rate of endoscopic retrieval was 96.1%. There were no major complications. The majority of ingested foreign bodies will pass spontaneously and most children can be safely observed at home. Selective endoscopic intervention is the preferable method for the removal of ingested foreign bodies in pediatric patients.     

Uncommon case of a foreign body ingestion with consecutive small-bowel obstruction in a child.

A 12-year-old boy with Lennox syndrome presented with an acute abdomen and a history of progressive abdominal pain and vomiting over 3 weeks. The uncommon finding in this case was a foreign body detected in a lower loop of the jejunum causing radiological and clinical signs of jejunitis/ileitis. The foreign body had to be removed surgically and turned out to be a hard (originally soft) plastic part of a towel rack.     

Paint in the pipe: An unusual foreign body

Background

Foreign bodies in the airway can be a diagnostic and therapeutic challenge.

Case characteristics

30-month-old girl with complaints of noisy and fast breathing following fall over a pile of sand. Sand was suctioned out by direct bronchoscopy. The child improved initially but condition worsened in next four days with marked stridor and wheeze.

Observation

Imaging revealed elongated sharp radiodense opacity in the cervical region, suggestive of foreign body. At repeat bronchoscopy, paint material was removed from the airway, leading to recovery

Message

Paint material mixed in the sand can adhere to the walls of the airway, and cause persistent symptoms of obstruction.

     

A novel percutaneous approach to retrieve an ingested extra-esophageal foreign body

Pediatric Radiology - We report a case of an 8-year-old boy who presented to our emergency department with progressive onset of dysphagia and odynophagia after eating barbecued steak that evening....     

Prolonged foreign body impaction in the oesophagus

The severe consequences of prolonged impaction in the oesophagus of a fairly radiolucent foreign object (aluminium can top) in 2 children are reported. The value of endoscopy in cases of unexplained dysphagia, even in the presence of normal radiographic examination, is stressed.