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A prospective study of foreign-body ingestion in 311 children
M Wai Pak1, W Chung Lee, H Kwok Fung
1Division of Otorhinolaryngology, Department of Surgery, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong.
Insights
A study on pediatric foreign body ingestion found most sharp objects, like fish bones, lodge in the oropharynx and are visible. Coins are rare and require X-ray evaluation for proper management.
Area of Science:
- Otolaryngology
- Pediatric Emergency Medicine
- Gastroenterology
Background:
- Foreign body ingestion is common in children.
- Management protocols vary, necessitating evidence-based guidelines.
- Understanding age-related presentation differences is crucial.
Purpose of the Study:
- To establish an optimal management protocol for pediatric foreign body ingestion.
- To analyze the diagnostic utility of symptoms and procedures.
Main Methods:
- Prospective study of pediatric patients (<12 years) with suspected foreign body ingestion.
- Analysis of presenting symptoms and diagnostic tool effectiveness.
- Categorization of foreign body type, location, and patient demographics.
Main Results:
- 115 foreign bodies found in 311 children; 93% were sharp (fish bones).
- Sharp foreign bodies predominantly located in the oropharynx, visible directly.
- Coins (7%) were the only type impacted below the cricopharyngeus; X-ray sensitivity was low.
Conclusions:
- Oropharyngeal foreign bodies (sharp bones) managed with direct visualization and removal tools (tongue depressor, laryngoscope).
- Coin ingestions require X-ray evaluation and rigid pharyngo-esophagoscopy.
- A protocol combining examination, selective imaging, and observation is effective.
Objective:
To determine the preferable management protocol of foreign body ingestion in pediatric patients.
Methods:
All pediatric patients aged less than 12 years who presented with suspected foreign body ingestion in a hospital setting over a period of 3 years were prospectively studied. The usefulness of symptoms and various diagnostic procedures to identify the impacted foreign bodies were analyzed.
Results:
Of 311 children aged 4 months to 12 years, 115 foreign bodies were encountered. The presentations in children aged younger than 5 years were markedly different from the older children, who behaved more like adults. All sharp foreign bodies (107 cases or 93%), mostly fish bones (90.4%), were found in the oropharynx under direct vision using either tongue depressor (57%), Macintosh laryngoscope (6%), indirect laryngeal mirror (2%) or transnasal flexible endoscopy (28%). Coins (eight cases or 7%) were the only foreign body impacted at or below the level of cricopharyngeus. A plain cervical X-ray has a low sensitivity (15.9%) and a high specificity (99.5%) in identifying the foreign bodies.
Conclusions:
As the majority of the foreign bodies were sharp bones and situated in the oropharynx, a management protocol involving examination with a tongue depressor, transnasal laryngoscope, selective lateral soft tissue neck X-ray, chest X-ray and watchful observation is usually adequate. Removal of these foreign bodies can be accomplished using a tongue depressor and Macintosh laryngoscope. Patients with a suspected coin ingestion have to be evaluated by X-ray, and a rigid pharyngo-oesophagoscopy should be the mainstay of treatment.