Ingestion and Aspiration of Foreign Bodies in South African Children

Abstract

The Red Cross War Memorial Children's Hospital is the only children's hospital in South Africa. It has a dedicated trauma unit for children under the age of 13 and serves a population of 2 million. A database of all children treated for trauma in this hospital has been maintained since 1991. There are currently over 110 000 entries in the database. This study documents the authors' experiences with ingested and aspirated foreign bodies in children. A retrospective study was performed using the database of a total of 3677 patients presenting with foreign bodies. The hospital folders were reviewed using a standardised data extraction form. Only foreign bodies aspirated or ingested were included. Three-hundred-and-forty (340) cases were analysed. Both sexes were equally affected. The ages of children included in the study ranged between 0.9 and 12 years, with a mean of 3 years. At the age of 2 years there was a peak in incidence (25% of all cases). Although the objects were from a range of materials, most were metal (44%) or plastic (21%). The most commonly ingested objects were a coin (30%), a bead (8%), a fishbone (6%) and a pin (5%). The size ranged from 0.1 to 3 cm (as measured by virtual ring), the most common size of an ingested foreign body being 0.5 cm. The most common anatomical site of impaction was the nose (41%), followed by the oesophagus (20%), stomach (17%) and bowel (10%). Other anatomical sites included hypopharynx, nasopharynx, bronchus, larynx and oral cavity. Only 0.6 % of the cases were assessed as being severe, 14% as moderate, and 49% as mild. Thirty-six percent (36%) had no symptoms. Fiftyseven per cent (57%) of ingested foreign bodies were removed surgically, 19% were left in situ, 14% spontaneously dislodged and only 1% were removed by Foley catheter manipulation. A presentation with a foreign body is fairly common in the hospital's patient population, representing approximately 4.2% of all cases. The majority of ingested foreign bodies produced mild or no symptoms, required surgical removal, but had no complications.