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Chronic esophageal foreign bodies in pediatric patients: a retrospective review
Robert Sean Miller1, J Paul Willging, Michael J Rutter
1Department of Otolaryngology/Head and Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, PO Box 670528, 45267-0528 Cincinnati, OH, USA. linusnavypilot@hotmail.com
Insights
Pediatric chronic esophageal foreign bodies (CEFB) often present with respiratory symptoms. Rigid esophagoscopy is the recommended removal method, with most cases having good outcomes.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Otolaryngology
- Pediatric Surgery
Background:
- Chronic esophageal foreign bodies (CEFB) carry significant morbidity and mortality risks in adults.
- Limited data exists on the specific presentation, management, and outcomes of CEFB in pediatric populations.
Purpose of the Study:
- To describe the clinical presentation, management strategies, and outcomes of chronic esophageal foreign bodies in children.
- To identify key differences in presentation and management compared to acute esophageal foreign bodies in pediatric patients.
Main Methods:
- Retrospective chart review of pediatric patients with CEFB admitted to a children's hospital.
- Inclusion criteria: Foreign body present for over one week.
- Data collected on symptoms, foreign body type, diagnostic findings, interventions, and outcomes.
Main Results:
- 41 (8%) of 522 pediatric esophageal foreign bodies were chronic; coins were most common.
- Respiratory symptoms (76%) predominated over gastrointestinal symptoms (22%); one patient was asymptomatic.
- Esophageal perforation occurred in 18 patients (17 technical, 1 classic); no deaths or permanent morbidity were reported.
Conclusions:
- Respiratory symptoms are a more frequent presentation of pediatric CEFB than gastrointestinal symptoms.
- Rigid esophagoscopy is the preferred removal method; conservative management is suitable for technically perforated esophagi.
- Pediatric CEFB generally have favorable outcomes with appropriate management.
Objective:
Chronic esophageal foreign bodies (CEFB) are associated with a high incidence of morbidity and mortality in adults. However, the presentation, management and outcome of chronic esophageal foreign bodies in children are not well described.
Methods:
We performed a retrospective chart review of children with chronic esophageal foreign bodies admitted to the Children's Hospital Medical Center, Cincinnati, OH, between May 1990 and January 2002. A chronic esophageal foreign body was defined as a foreign body estimated to have been present for over 1 week.
Results:
Over the inclusion period, 522 children were admitted with esophageal foreign bodies, 41 (8%) of which were chronic. The most common foreign bodies were coins. Seventy-six percent of patients presented with a primary complaint of respiratory symptoms, with respiratory distress being the most common followed by asthmatic symptoms and cough. Twenty-two percent of patients had primarily gastrointestinal symptoms including nausea/vomiting and dysphagia. One patient was asymptomatic on presentation. A perforated esophagus was identified in 18 patients, with 17 of these being a technically perforated esophagus and one case being a classic esophageal perforation. There were no deaths or permanent morbidity in this series.
Conclusions:
Respiratory symptoms are more common than gastrointestinal symptoms in pediatric patients with chronic esophageal foreign bodies. Removal by rigid esophagoscopy is recommended. A small proportion of cases require open removal of the foreign body. Conservative management is appropriate for the technically perforated esophagus. A good outcome should be anticipated for the majority of cases.
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