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The South African experience with ingestion injury in children
A B van As1, N du Toit, L Wallis
1Trauma Unit, Child Accident Prevention Foundation of Southern Africa, Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, 7701 Cape Town, South Africa. abvanas@ich.uct.ac.za
Insights
Foreign body ingestion in children is common, with coins, balls, and bones being frequent culprits. Most cases present with mild or no symptoms and require surgical removal, typically without complications.
Area of Science:
- Pediatric Trauma
- Accident Prevention
- Foreign Body Ingestion
Background:
- The Red Cross Children's Hospital in South Africa manages a high volume of pediatric trauma cases.
- A comprehensive database of pediatric trauma patients has been maintained since 1991.
- This study focuses on foreign body ingestion within this pediatric population.
Purpose of the Study:
- To analyze the hospital's experience with ingested foreign bodies in children.
- To identify common objects, anatomical sites, and outcomes associated with foreign body ingestion.
- To inform child accident prevention strategies.
Main Methods:
- A retrospective analysis of the Child Accident Prevention Foundation of Southern Africa (CAPFSA) database.
- Inclusion criteria: children under 13 treated for ingested or aspirated foreign bodies.
- Data extraction from 3677 patient records, with 241 folders analyzed.
Main Results:
- The peak incidence of foreign body ingestion occurred at age 3.
- Coins (28%), balls (20%), and bones (8%) were the most common ingested items.
- The nose (41%) and esophagus (20%) were the most frequent impaction sites; 42% of cases were asymptomatic.
Conclusions:
- Foreign body presentations are common, accounting for 4.2% of trauma cases.
- Most ingested foreign bodies result in mild or no symptoms and are successfully removed surgically.
- The study highlights the need for continued vigilance and prevention efforts regarding pediatric foreign body ingestion.
Introduction:
The Red Cross Children's Hospital is the only children's hospital in South Africa. It has a dedicated trauma unit for all children under the age of 13 and serves a population of approximately 2 million inhabitants. As part of the Child Accident Prevention Foundation program we have kept a database of all children treated for trauma in our hospital since 1991. Presently, we have over 88,000 entries in our database.
Aim:
To study our experience with ingested foreign bodies in children.
Materials And Methods:
A retrospective study was performed using the CAPFSA database of a total of 3677 patients presenting with foreign bodies. The hospital folders were searched using a standardised data extraction form. Only foreign bodies aspirated or ingested were included.
Results:
To date, 241 folders have been analysed.
Demographics:
Both sexes were equally affected (boys 49%). Age ranged between 0 and 12 years, although there was only one child under the age of 1. At the age of 3 years there was a peak in incidence (24% of all cases). Nature of ingested object: Although the objects were from a range of materials, most were metal (40%) or plastic (23%). The most commonly ingested object was a coin (28%), a ball (20%) or bone (8%). The size ranged from 0.1 to 3 cm (as measured by virtual ring), the most common size of an ingested foreign body was 0.5 cm. Anatomical site: The most common anatomical site of impaction was the nose (41%), followed by the oesophagus (20%), the stomach (14%) and bowel (11%). Other anatomical sites included hypopharynx, nasopharynx, bronchus, larynx and oral cavity. Severity of symptoms: Only 0.4% of our cases were assessed as being severe, 14% as moderate, and 44% as mild. Forty-two percent (42%) had no symptoms. Removal: Fifty-seven percent (57%) of ingested foreign bodies were removed surgically, 19% were left in situ, 14% spontaneously dislodged and only 1% was removed by Foley catheter manipulation.
Conclusion:
A presentation with a foreign body is quite common in our patient population, representing approximately 4.2% of all our cases. The majority of ingested foreign bodies produced mild or no symptoms, needed surgical removal and had no complications.
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