Abstract
Background: Most ingested foreign bodies (FBs) pass spontaneously through the gastrointestinal (GI) tract, but only limited data on transit time are available. We evaluated the relationship of FB size and shape with transit time.Methods: We retrospectively reviewed medical records collected over 15 years (January 2001 to December 2015) on pediatric patients with radiopaque FBs in the GI tract. We categorized the FBs as regularly (round or spherical) or irregularly shaped (ovoid, long, flake-like, or projecting) and measured their sizes radiographically. The diameter of regularly shaped FBs and the length of irregularly shaped FBs were correlated with transit time.Results: In total, 484 patients with GI FBs were surveyed, and 267 (55.1%) FBs were radiopaque. Among the 267 radiopaque FBs, 88 (33.1%) required endoscopic removal and 7 (2.6%) underwent surgical intervention. Eighty-seven patients with single FBs in the GI tract for whom precise details of transit time were enrolled into the analysis of transit time; their mean age was 3.48 ± 2.21 years. Of the 87 FBs, 61 (70.1%) were regularly shaped, and 26 (29.9%) were irregularly shaped. The diameter of regularly shaped FBs was positively associated with transit time, as revealed by Mann-Whitney U test; diameters >1.5 and >2 cm were significantly correlated with longer transit times (both p = 0.003). A trend toward an increased transit time for long irregularly shaped FBs was also apparent; the p-values for lengths of 1.5, 2, and 2.5 cm were 0.824, 0.153, and 0.055, respectively. Under receiver operating characteristic (ROC) curve analysis, the optimal cutoff diameter for regularly shaped FBs, and length for irregularly shaped FBs, to predict a transit time of longer than 72 h were 1.95 and 2.25 cm, respectively.Conclusions: The passage rate of ingested radiopaque FBs is 64.4%. Small FBs that have passed the duodenal curve should be managed conservatively via clinical observation and radiographic surveillance. Our results indicate that the larger an FB is, the longer the transit time will be.
Highlights
Most foreign body (FB) ingestions occur in children between the ages of 6 months and 3 years [1, 2]
Over 15 years (January 2001 to December 2015), all pediatric patients (
We found that FB ingestion is more common in males than females; some studies have reported male-to-female ratios of approximately 1.5 [18]; our ratio was 2.0
Summary
Most foreign body (FB) ingestions occur in children between the ages of 6 months and 3 years [1, 2]. 80–90% of FBs that reach the gastrointestinal (GI) tract pass spontaneously; 10–20% are removed endoscopically, and 1% by surgery [4,5,6,7,8]. Referral for endoscopic removal is indicated if the FB is located in the esophagus, if multiple magnets have been swallowed, if the FB is sharp or large, and if symptoms/signs of bowel obstruction are present [1, 9]. As most FBs pass spontaneously, surgical removal is considered only if no radiographic progression is evident by 3 days after ingestion or if the patient becomes symptomatic [10]. Most ingested foreign bodies (FBs) pass spontaneously through the gastrointestinal (GI) tract, but only limited data on transit time are available. We evaluated the relationship of FB size and shape with transit time
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