Foreign Body Ingestion in children, 5 years’ study

IntroductionForeign body (F.B) ingestion is a common pediatric problem that refers to emergency pediatric centers. It frequently occurs in children between 6 month and 4 years of age, with similar distribution in both genders. Most ingested foreign bodies are passed spontaneously through the gastrointestinal tract without any complication (80-90%). But some of them require endoscopic removal (10-20%), andscarcely lead to open surgery (1%). Materials and MethodWe conducted a descriptive retrospective study over a period of 5 years (Feb 2015–Feb 2019) in order to assess the particular aspects of foreign body ingestions in children admitted in a Children s medical center in Tehran. All the children with documented cases of foreign body ingestion were included in the study. Exclusion criteria are documented aspiration of foreign bodies. The data (age, sex, object type, clinical presentation, location and endoscopic findings) were collected from patients’ files and endoscopic records. If the F.B existed in esophagus or stomach, and upper flexible endoscopy able to extract it, the pediatric gastroenterologist was done. In other cases, that failed in upper endoscopy, or in cases that trapped in the small bowel or colon, the pediatric surgeon was accomplished.ResultsWe encountered 420 cases of foreign body ingestions. The gender distribution: 230 in boys (54.8%), and 190 in girls (45.2%). The age was between 3 months to 16 years, with average of 4.2 years. 238 patients of them the F.B was in the esophagus, 143 cases the F.B was in the stomach, and 39 cases the F.B detected in the small bowel and colon. More of them the F.B passed spontaneously through the gastrointestinal tract and didn’t need to any endoscopy or surgery. Among 238 patients with esophagus foreign body, 35 cases were cured by flexible endoscopy, and 190 cases cured by rigid esophagoscopy by pediatric surgeon (79%). In one case of button battery the flexible endoscopy lead to esophagus perforation that finally required gastric pull-up surgery. Among 143 patients that referred with stomach foreign body, 98 of the them were cured by esophagogastroduodenoscopy, and 9 cases (6%) leaded to open surgery (laparotomy: gastrotomy). Between 39 patients with intestinal foreign body, just 4 cases (10%) went under the surgery(enterotomy).Discussions31% of patients in this study were managed via successful endoscopic removal, (35 cases in esophagus and 98 cases in stomach. In conclusion 31% of patients in these study); this rate is higher compared to that in Yang’s study (23%) and lower compared to that in Pokharel et al.’s study (98.06%). These differences could be due to the variable time elapsed until hospital presentation, the size and type of objects swallowed, or the different technical resources in pediatric centers. Only 1 of the patients that underwent endoscopic removal presented complication (esophagus perforation). No deaths were recorded, which is consistent with the low mortality rates associated with foreign body ingestionsworldwide reported by other studies. However, in our series we had a high proportion of failed endoscopic removals. This is due to our limited resources in terms of endoscopic retrieval devices.