The South African experience with ingestion injury in children

Abstract

Introduction: The Red Cross Children’s Hospital is the only children’s hospital in South Africa. It has a dedicated trauma unit for all children under the age of 13 and serves a population of approximately 2 million inhabitants. As part of the Child Accident Prevention Foundation program we have kept a database of all children treated for trauma in our hospital since 1991. Presently, we have over 88,000 entries in our database. Aim: To study our experience with ingested foreign bodies in children. Materials and methods: A retrospective study was performed using the CAPFSA database of a total of 3677 patients presenting with foreign bodies. The hospital folders were searched using a standardised data extraction form. Only foreign bodies aspirated or ingested were included. Results: To date, 241 folders have been analysed. Demographics: Both sexes were equally affected (boys 49%). Age ranged between 0 and 12 years, although there was only one child under the age of 1. At the age of 3 years there was a peak in incidence (24% of all cases). Nature of ingested object: Although the objects were from a range of materials, most were metal (40%) or plastic (23%). The most commonly ingested object was a coin (28%), a ball (20%) or bone (8%). The size ranged from 0.1 to 3 cm (as measured by virtual ring), the most common size of an ingested foreign body was 0.5 cm. Anatomical site: The most common anatomical site of impaction was the nose (41%), followed by the oesophagus (20%), the stomach (14%) and bowel (11%). Other anatomical sites included hypopharynx, nasopharynx, bronchus, larynx and oral cavity. Severity of symptoms: Only 0.4% of our cases were assessed as being severe, 14% as moderate, and 44% as mild. Forty-two percent (42%) had no symptoms. Removal: Fifty-seven percent (57%) of ingested foreign bodies were removed surgically, 19% were left in situ, 14% spontaneously dislodged and only 1% was removed by Foley catheter manipulation. Conclusion: A presentation with a foreign body is quite common in our patient population, representing approximately 4.2% of all our cases. The majority of ingested foreign bodies produced mild or no symptoms, needed surgical removal and had no complications.