Foreign-body ingestion in children: experience with 1,265 cases

This study aims to elucidate the clinical presentation, the effectiveness of investigations, and treatment of foreign body ingestion in children and to formulate an algorithm of management.

The records of children admitted to a single institution who had a history of foreign body ingestion over 33 years were reviewed. Symptoms, radiological findings, and endoscopic findings were assessed.

Foreign bodies were detected in 552 (43%) of the 1,265 children admitted. The age of the children ranged from 6 months to 16 years (mean, 5.2 years). The preschool toddlers (mean age, 3.8 years) were most prone to ingest inanimate objects. The most common objects were coins (49%) and nonmetallic sharp objects (NMSO; 31%). Although x-rays could detect all the metallic objects and 86% of glass objects, the sensitivity of fish bone detection is only 26%. Absence of symptoms was common (50% in metallic group and 29% in NMSO group). Forty-one percent of coins and 95% of NMSO were lodged at sites suitable for removal by direct laryngoscopy alone with success rates of 86% and 77%, respectively. There were 3 disease-related complications and 1 mortality. Two of these children were mentally retarded and presented late.

Efforts for prevention of ingestion of inanimate foreign body should focus on the preschool toddler group. Particular attention should be paid to mentally retarded children with vague gastrointestinal symptoms. Absence of symptoms does not preclude presence of foreign body in children. Children with history of NMSO ingestion should undergo direct laryngoscopy despite negative radiological finding, both as a screening procedure or treatment.