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Lead foreign body ingestion in children
J A Fergusson1, G Malecky, E Simpson
1Department of Surgery, Canberra Hospital, Australian Capital Territory, Australia.
Insights
Children ingesting lead foreign bodies risk acute lead poisoning. A management plan involving hospital observation and acid reduction is proposed to prevent lead absorption from the stomach.
Area of Science:
- Pediatric Surgery
- Toxicology
- Gastroenterology
Background:
- Foreign body ingestion is common in children, with most items passing naturally.
- Lead foreign bodies pose a unique risk due to potential lead absorption and intoxication.
- The acidic gastric environment facilitates lead dissolution and absorption.
Observation:
- A 4-year-old child ingested a lead sinker.
- The lead sinker was successfully removed from the stomach via emergency endoscopy.
- This case prompted a literature review and management plan development.
Findings:
- Lead foreign bodies in the stomach can dissolve and cause lead poisoning.
- Emergency endoscopy is an effective method for removing gastric lead foreign bodies.
- A management plan is crucial for addressing lead foreign body ingestion in children.
Implications:
- Hospital observation and acid suppression (e.g., with protein pump inhibitors) are key to managing lead foreign body ingestion.
- This approach aims to prevent lead absorption while the foreign body passes or is removed.
- Standardized management protocols can improve outcomes for children with ingested lead foreign bodies.
Abstract:
Foreign body ingestion is seen commonly in paediatric surgical practice and the vast majority of ingested foreign bodies will pass spontaneously once they have made their way into the stomach. Lead foreign body ingestion in children represents a special case in view of the potential for acute lead intoxication secondary to dissolution and absorption of the ingested lead. Lead dissolves poorly in physiological solutions with the exception of the acid environment of the stomach. We report a case of a 4-year-old child who ingested a lead sinker which was removed from the stomach by emergency endoscopy. This case stimulated a review of the relevant literature and the formulation of a management plan for lead foreign body ingestion in children. The principles of this management plan are observation of the child in hospital and use of a protein pump inhibitor until the foreign body has passed out of the stomach.