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Foreign bodies in the aerodigestive tract in pediatric patients
Ryuzaburo Higo1, Yu Matsumoto, Keiichi Ichimura
1Department of Otolaryngology, Faculty of Medicine, University of Tokyo, 3-1, Hongo 7-chome, Bunkyo-ku, 113-8655, Tokyo, Japan. rhigo-tky@umin.ac.jp
Insights
Pediatric aerodigestive tract foreign bodies are common, especially in toddlers. Fish bones in the pharynx and toys in the nose are typical, with increasing disk-type battery ingestions posing a serious risk.
Area of Science:
- Pediatric Otolaryngology
- Gastroenterology
- Emergency Medicine
Background:
- Foreign body ingestion and aspiration in children present unique challenges.
- Understanding common foreign bodies and their locations is crucial for effective management.
- The aerodigestive tract is a frequent site for pediatric foreign body impaction.
Purpose of the Study:
- To investigate pediatric foreign body cases in the aerodigestive tract.
- To identify characteristic foreign body problems in Japan.
- To analyze the relationship between foreign body type and impaction site.
Main Methods:
- Retrospective chart review of 310 pediatric patients (age ≤15).
- Data collected from two major Japanese medical university hospitals.
- Statistical analysis of collected patient and foreign body data.
Main Results:
- Most common age group: 1-4 years (67.7%).
- Predominant sites: nose (39.4%), pharynx (38.4%), esophagus (12.9%), trachea-bronchi (6.5%).
- Common foreign bodies: fish bones (30.7%), toys (13.6%), coins, food, batteries. Fish bones in pharynx, toys in nose, coins in esophagus noted. Increasing disk-type battery ingestion reported.
Conclusions:
- Fish bones (pharynx) and toys (nose) are characteristic pediatric foreign bodies in Japan, linked to eating habits and common objects.
- Disk-type battery ingestion in the esophagus is an emerging serious concern.
- Prevention through public education is paramount for managing foreign body incidents.
Objective:
To investigate pediatric foreign body cases in the aerodigestive tract, and to elucidate the characteristic problems in Japan.
Methods:
A total of 310 pediatric patients (age 15 or below), gathered from two medical university hospitals (University of Tokyo and Jichi Medical School), were included in this study. Data were collected by retrospective chart review and were statistically analyzed.
Results:
Two-year-olds were the most common patients, and the range from age 1 to age 4 included 67.7% of all the patients. The most involved sites were the nose (39.4%) and the pharynx (38.4%), followed by the esophagus (12.9%) and the trachea-bronchi (6.5%). Fish bones and toys were the representative foreign bodies (30.7 and 13.6%, respectively). Other foreign bodies often encountered included coins, food, candy, peanuts and nuts, and batteries. The type of foreign body was closely related to the site in which foreign bodies were lodged: 77.3% of foreign bodies in the pharynx were fish bones, and toys were the most common impacted foreign body in the nose. In the esophagus, representative impacted foreign bodies were coins (35.7%), but disk-type battery ingestion has been increasing in recent years. Although most foreign bodies in the esophagus were safely removed, one case of a disk-type battery had a serious sequela. In the trachea-bronchi, peanuts, food, cotton, and coins were impacted. A rigid bronchoscope was basically used to remove foreign bodies, but in some cases, a fine flexible endoscope, with a channel for fiber forceps, was useful, because it could be inserted into narrow bronchi. Advance of a flexible endoscope will make it an excellent tool for diagnosis and management of the trachea-bronchial foreign body.
Conclusions:
Fish bones in the pharynx, which were closely related to Japanese eating habits, and toys in the nose, were the typical foreign bodies encountered in this study. In the esophagus, an increased incidence of disk-type battery ingestion has become a serious problem in recent years. Since prevention is the most essential way to manage foreign body cases, feedback from studies to public education should be encouraged.
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