Foreign Body Ingestion: Two Cases With Different Management Approach

Abstract

IntroductionIngestion of foreign body (FB) is a common pediatric emergency. Although 80-90% FB pass through gastrointestinal tract without any problem, 10-20% require intervention. Here we discussed the protocol for management of FB ingestion with reference to two cases, one with ingestion of toxic FB in esophagus and second with ingestion of nontoxic FB in esophagus and stomach.Cases, Management and DiscussionAlgorithmic protocol for management of ingested radio-opaque FB has been described.[1] According to this protocol, any radio-opaque FB in esophagus requires endoscopic removal irrespective of its nature. Symptomatic FB, distal to esophagus, needs to be removed. Small, blunt asymptomatic FB distal to esophagus (<2 to 3 cm in children younger than 1 year) should be subjected to conservative management. Large, blunt asymptomatic FB (≥2 to 3 cm in infants, ≥3 to 5 cm in older children) and sharp FB requires conservative management only if it has crossed the duodenal sweep. All FB, failing conservative management, need to be removed. In our first case, it was round radio-opaque FB in esophagus. FB was removed on the day of diagnosis endoscopically and found to be disc battery. Disc batteries lodged in esophagus can cause severe tissue damage in just 2 hours while those which pass through the stomach run relatively benign course and are left to pass through the rest of the gut spontaneously.1,2 Our patient developed TEF, which required correction twice, and prolonged intensive care. Our second case was of witnessed ingestion of nontoxic round radio-opaque FB. It was localized in upper esophagus at the level of T3 in coronal orientation. Coronal and saggital orientation favours the upper esophageal and tracheal location respectively. So, upper gastrointestinal endoscopy had therapeutic and diagnostic indication in our case. It confirmed its position in upper part of esophagus but the FB got pushed down in stomach during attempted removal, which was confirmed on x-ray. We managed our second case conservatively by observing clinically, serial check x-rays and stool inspection without any complication.