An audit of ingested and aspirated foreign bodies in children at a university hospital in South Africa: The Pietermaritzburg experience

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Background. The ingestion or aspiration of foreign bodies (FBs) by children is a common problem around the world. Our centre in Pietermaritzburg, South Africa, has a dedicated paediatric surgical service, and all patients with an ingested or aspirated FB are managed under the direct care of a paediatric surgeon. Objectives. To review our centre’s experience with this problem by means of a retrospective audit and use the data to develop and refine appropriate local management guidelines. Methods. Grey’s Hospital has a hybrid electronic medical registry (HEMR) that captures patient data on admission, after a procedure and on discharge. The HEMR was reviewed and all patients with an appropriate International Statistical Classification of Diseases and Related Health Problems , 10th revision (ICD-10) code indicating an ingested or aspirated FB were identified and retrieved for review. Results. A total of 105 cases of FB ingestion or aspiration in children <12 years of age from January 2012 to December 2014 were identified from the HEMR. The patients’ ages ranged from 4 months to 10 years (mean 3 years and 6 months), and 59.0% ( n =62) were male and 41.0% ( n =43) female. A total of 107 FBs were removed (two patients each had two coins removed). The commonest FBs were coins ( n =77, 71.9%), followed by batteries ( n =6, 5.6%), plastic toys ( n =5, 4.7%), buttons ( n =5, 4.7%), screws/washers ( n =3, 2.8%), seeds ( n =2, 1.9%), needles ( n =2, 1.9%), bones ( n =2, 1.9%), a marble ( n =1, 0.9%), a rubber eraser ( n =1, 0.9%), a curtain hook ( n =1, 0.9%), a nail ( n =1, 0.9%) and a wood speck ( n =1, 0.9%). Of the FBs, 67 (62.6%) were in the oesophagus, 17 (15.9%) in the respiratory system, 14 (13%) in the intestine and 9 (8.4%) in the oral cavity. The average time from ingestion/aspiration to presentation was <48 hours. Of the FBs, 67 (62.6%) were removed via rigid oesophagoscopy and 13 (12.1%) via rigid bronchoscopy, 13 (12.1%) were passed rectally, and 9 (8.4%) were removed via grasping forceps in the oral cavity, 4 (3.7%) via thoracotomy and 1 (0.9%) via emergency laparotomy. A total of 15 complications included mucosal ulceration/slough ( n =6, 40.0%), oesophageal perforation ( n =3, 20.0%), aspiration pneumonia ( n =3, 20.0%), and tracheal perforation, lung collapse and contact bleed ( n =1 each, 6.7%). No patient presented in respiratory distress or needed emergency airway management, and there were no deaths. Conclusions. The development of a dedicated paediatric surgery service and the implementation of management protocols have resulted in excellent outcomes for this problem.