‘Keep it away from children’
An instructional sentence that is seen every now and then on all items that can be fatal or harmful for children. Some objects don’t have this instruction engraved or written over, but it doesn’t make those items any less dangerous. For example, jewelry items.
A 3-year-old girl was brought to the emergency department after she had ingested a metal pendant. There were no associated signs and symptoms. The physical examination was also normal.
Chest Xray revealed a heart-shaped foreign body in the proximal thoracic esophagus.
Serial radiographs were obtained to monitor any change in the position of the metal pendant. The girl underwent rigid endoscopy, and the foreign body was removed. However, the esophageal mucosa showed minor abrasions.
The postoperative course was smooth, and the patient was soon discharged.
Most cases of foreign body ingestion are seen in children between 6 months and 3 years of age. Serious morbidity is seen in less than 1% of the cases.
Swallowed foreign bodies may produce no symptoms at all; therefore, it is imperative for the physicians to have a high index of suspicion. Although most foreign bodies may pass out of the gastrointestinal tract, some require immediate medical help. Some foreign bodies can lead to complications such as perforation, laceration, obstruction, etc.
An ingested object that requires immediate attention includes esophageal button batteries, which should be promptly removed regardless of the symptomatology.
Coins, magnets, impacted food, and sharp foreign bodies should be removed within 2 hours if producing symptoms. The removal can be delayed to 24 hours if the patient remains asymptomatic.
In general, all esophageal foreign bodies should be considered for endoscopic removal if they do not pass through the GIT within the first 24 hours of ingestion.
FBs in the small intestines tend to pass through the small bowel to be ultimately excreted with the feces. If there isn’t spontaneous excretion of the foreign body, then Xray should be performed to know the exact position of the FB.
Plain radiographs are the initial investigation of choice. For radiolucent ingested objects, not visible on radiography, some suggest performing barium swallow.
In general, if any ingested object is associated with severe signs and symptoms such as fever, abdominal pain, vomiting, etc. then immediate removal is advised.
References
Shelby Leuin, M.a. (2019, February 14). Heart of Gold. Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm1716103
Conners GP, Mohseni M. Pediatric Foreign Body Ingestion. [Updated 2019 Nov 26]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430915/
