Accidental Ingestion Research Articles

EGS SO25 - Ingestion of Sharp Foreign Bodies- Emerging Trends in a Large UK NHS Trust

Abstract Background Foreign body (FB) ingestion is a common medical problem. The type of object ingested depends on age, sex, socio-economic factors, geographical area, and nutritional habits. Accidental ingestion of hijab pins as a phenomenon has not been widely reported in the UK previously. Method Retrospective cohort study on all patients presenting with foreign body ingestion from July 2010 to January 2024. Patient medical records were reviewed, and data collected including mode of presentation, demographics, FB type and mode of ingestion (accidental/deliberate), admission details, radiology, management (conservative, endoscopic, surgery), morbidity and mortality and readmission rate. Data was recorded and analyzed using Microsoft Excel. Results 94 patients presented with FB ingestion of whom 39 ingested hijab pins. Median age was 19 (11-50) years. Median time from ingestion to presentation was 5 hours (0.5-120). All patients had abdominal Xray. The most common hijab pin location on presentation was in the stomach; n=27 (69%). Data on management was available in 38 patients, of whom 29 (76%) were managed conservatively, 6 (15%) had endoscopy and 3 (8%) had flexible nasal endoscopy (FNE). The reintervention rate was 3% with one patient managed conservatively subsequently having endoscopy. No complications, readmissions or mortality was observed. One OGD was therapeutic Conclusion We report increase in the incidence of FB ingestion with a significant proportion involving hijab pins. Young girls hold pins between their lips while styling their hijabs which can result in accidental ingestion. Although we report low morbidity and readmission rates, there is a 22% intervention rate. We believe there may be a causal link between increased accidental ingestion and popularity of social media content on elaborate hijab styling, some with millions of views each. There is a need to increase awareness on dangers of holding pins in the mouth whilst styling hijabs and alternate options such as hijab magnets

A ring-shaped gas sign: a case of the accidental ingestion of a press-through package

AbstractThis case report presents a common but instructive clinical scenario of accidental ingestion of a press-through package. Despite an initial negative chest X-ray and mild symptoms, the diagnosis was confirmed with additional computed tomography. The patient was eventually went through the successful endoscopic removal of the press-through package. Furthermore, a retrospective re-reviewing of the X-ray revealed a faint ring-shaped gas sign, characteristic of press-through package ingestion. This case underscores the intractableness to diagnosis of accidental ingestion of press-through package by only X-rays in real time and the potential role of computed tomography in ensuring timely diagnosis and treatment.

Ecological factors associated with fox feces density in an Echinococcus multilocularis endemic zone in Japan

IntroductionHuman alveolar echinococcosis caused by Echinococcus multilocularis is an important zoonotic disease in the northern hemisphere. The life cycle of E. multilocularis is maintained primarily in wild animals and requires an intermediate host (mainly small mammals). Human can become an intermediate host through accidental ingestion of E. multilocularis eggs. Hokkaido Prefecture is the only area of Japan in which human alveolar echinococcosis is endemic. The purposes of this study were to elucidate the land use ecological factors associated with the density of red fox feces along paved roads and the relationship between the distributions of red fox (Vulpes vulpes) populations and fox feces, which determine the level of hazard from eggs.MethodsA series of surveys was conducted in the central part of the Nemuro Peninsula of Hokkaido, excluding urban areas, over a total of 4 years in May–June in 2014 and 2016–2018 when red foxes remain with their cubs around the dens. Transects of 500 m were set up on paved roads, and feces within the transects were counted. Univariable and multivariable analyses were performed to examine ecological factors including the principal components (PCs) of five land use–type occupancy proportions within 500 m and 1 km, respectively, as explanatory fixed-effect variables. The number of feces in each transect was examined as the response variable using integrated nested Laplace approximation with negative binomial errors with a spatio-temporal autocorrelations structure to separate the effects of similarities of neighboring locations and annual variation. The multivariable models with the lowest widely applicable information criterion values were selected.ResultsThe feces density was explained by the PC of the 500- m buffer (−0.27, 2.5th and 97.5th percentiles: −0.44, −0.10) characterized by mixed forests (−0.82) and scarcity of residential areas (0.29) and the proximity to the nearest livestock farm house (−0.35, 2.5th and 97.5th percentiles: −0.53, −0.17). This suggested that foxes defecate in the areas where prey is abundant, avoiding humans.DiscussionPolicy discussions regarding bait distribution design targeting these conditions should be initiated.

Reports of tropane alkaloid poisonings and analytical techniques for their determination in food crops and products from 2013 to 2023

AbstractFood safety is crucial to attaining food security and sustainability. Unsafe foods for human and animal consumption lead to product recalls and rejection, negatively impacting the global economy and trade. Similarly, climate change can adversely affect the availability of safe and nutritious food at the table. The changing climatic conditions and global food trade and transport can make the movement of toxic plants possible, resulting in food crops being increasingly invaded by some species of plants that produce toxic secondary metabolites, such as tropane alkaloids (TAs). Datura stramonium from the Solanaceae plant family is an invasive and virulent plant that produces high amounts of two TAs, atropine and scopolamine. Various food poisoning events following accidental or deliberate ingestion of foods contaminated by atropine and scopolamine from seeds of D. stramonium have been recorded in different locations globally. Due to these incidents, regulatory agencies require the development of plant toxin detection methods that can be used in the food chain as early as possible. This systematic review thus focuses on the TA determination techniques in food and feeds published between 2013 and 2023. A particular focus was given to the sample preparation methods, the improvements of each technique claimed, and data to support the performance of each method, especially the ability to measure at or below the maximum level. The review concludes with other technological advancements, including rapid spectroscopy, electrophoresis, and colorimetric methods, as well as the possibility of coupling with smartphones for use in on‐farm detection and the challenges in applying them.

Preventing battery ingestion in children: public health strategies and technological innovations

Abstract Background Accidental ingestion of button batteries can cause severe and sometimes fatal injuries, such as chemical burns, esophageal perforations, and long-term complications. In response to this challenge, prevention strategies have evolved. A recent example of safety-targeted technological innovation includes new coin lithium batteries with more secure packaging, a non-toxic bitter coating to deter ingestion, and a ‘color alert technology’ that activates a blue dye upon contact with saliva. These features are designed to discourage ingestion and facilitate the rapid identification of an injury, allowing for timely medical intervention. Methods This abstract reviews the public health strategies proposed or implemented to prevent this serious type of injury, augmented by an analysis of data from the Susy Safe registry, which identified 1,115 cases of battery ingestion in children, and an additional 94 cases from the literature, totaling 1,209 injuries. Results The review of existing prevention strategies highlights various approaches, including public awareness campaigns, enhanced product regulations, and the implementation of stricter safety standards for batteries and devices. Analysis of Susy Safe data helps characterize the issue, underscoring the frequency and circumstances of battery ingestions and provides an empirical basis to assess the effectiveness of existing prevention strategies and to guide the development of new policies. The combination of technological improvements and legislative initiatives could represent a significant breakthrough in preventing these dangerous injuries. Conclusions While technological innovations are promising, effective prevention of battery ingestion will require a multifaceted approach that integrates technology, education, public policy, and regulatory oversight. Collaboration among manufacturers, lawmakers, health professionals, and the community is essential to reduce the incidence of these medical emergencies. Key messages • Accidental ingestion of button batteries can cause severe and sometimes fatal injuries. • The combination of technological improvements and legislative initiatives could represent a significant breakthrough in preventing button batteries in children.

Accidental Ingestion of Arch Bar During Intermaxillary Fixation for Maxillofacial Fracture: A Report of a Case

Accidental Ingestion of Arch Bar During Intermaxillary Fixation for Maxillofacial Fracture: A Report of a Case

Ameliorative Effects of N-Acetyl Cysteine and Zinc Sulfate on Reproductive Dysfunction Induced by Short-Term Crude Oil Exposure in Male Wistar Rats

Background: Crude oil contamination by accidental or voluntary ingestion is prevalent in the Niger Delta region of Nigeria. One of the possible impacts of crude oil contamination is reproductive toxicity leading to infertility. The present study evaluated the potential protective effects of N-Acetyl Cysteine (NAC) and Zinc Sulfate (ZnSO4) in mitigating reproductive dysfunction caused by short-term Bonny Light Crude oil (BLCO) exposure in male Wistar rats. Materials and Methods: Fifty (50) male Wistar (180 – 200g) were used for the study. They were divided into ten (10) groups of five (5) animals each. Groups I and II served as the control and negative control and received distilled water and BLCO (600mg/kg) respectively while groups III to X served as the experimental groups and received NAC (100 and 200mg/kg) and ZnSO4 (0.5mg/kg and 1mg/kg) orally for three (3) weeks. Animals were euthanized, and blood and semen were collected for biochemical and seminal analysis. Results: The results of this current study show that BLCO exposure caused a disruption in reproductive functions in rats by decreasing reproductive hormones and semen quality parameters in Wistar rats. NAC and ZnSO4 administration significantly improved semen quality parameters by improving sperm count, sperm motility and morphology in experimental rats. Conclusion: Evidence from the present study suggests that NAC and ZnSO4 protected the testes, preventing reproductive alterations linked to BLCO exposure.

Accidental Organophosphate Poisoning in a Child: A Case Report Highlighting the Importance of Early Recognition and Treatment

Background: Organophosphate (OP) poisoning is a significant global health concern, especially in developing countries where these chemicals are widely used in agriculture and household pest control. Children are particularly susceptible to accidental OP poisoning due to their inquisitive nature and immature physiology. This case report presents a child with acute muscarinic symptoms following accidental ingestion of an OP insecticide, emphasizing the importance of early recognition and treatment. Case presentation: A 9-year-old boy presented to the emergency department with vomiting, decreased consciousness, and respiratory distress 6 hours after accidentally ingesting an OP insecticide (Baygon) stored in a drinking bottle at home. He exhibited classic muscarinic symptoms, including miosis, hypersalivation, hyperlacrimation, stridor, and wheezing. The patient was treated with atropine and supportive care, resulting in the complete resolution of his symptoms. Conclusion: This case highlights the importance of early recognition and prompt management of OP poisoning in children. Atropine remains the cornerstone of treatment for muscarinic symptoms, and supportive care is crucial to prevent complications. Public health interventions aimed at educating parents and caregivers about the safe storage and handling of OP insecticides are essential to prevent accidental poisoning in children.

Hyoscyamus niger poisoning in Sudan: A case report.

Hyoscyamus niger, commonly known as henbane, contains potent alkaloids that can cause anticholinergic toxicity when ingested. This case report describes a 35-year-old male gardener who presented with confusion, hallucinations, dry mouth, and dilated pupils after consuming parts of the plant. The patient was treated with rehydration, activated charcoal, and physostigmine, leading to rapid clinical improvement. This case highlights the importance of recognizing plant-based poisonings and the efficacy of physostigmine in managing anticholinergic syndrome. Public awareness and education on the dangers of unfamiliar plants are essential to prevent accidental ingestions.

A case of esophageal squamous cell carcinoma with epidermization showing a unique morphology.

An 80-year-old woman with a history of endoscopic balloon dilation for esophageal stricture caused by accidental ingestion of caustic soda during infancy presented with dysphagia. Upper gastrointestinal endoscopy revealed a 10-cm-long, highly white, elevated lesion with a feathered appearance. This lesion was determined to be the cause of dysphagia and was completely resected via endoscopic submucosal dissection. Histopathological examination revealed a thick keratin layer on the surface of the stratified squamous epithelium, with a prominent granular layer underneath and some areas showing nuclear atypia. The lesion was diagnosed as a well-differentiated squamous cell carcinoma, pT1a-LPM, derived from epidermoid metaplasia. Cancer genome analysis revealed mutations in TP53 as well as amplification of MYC, FGFR1, chromosome 7, and chromosome 20q. This case suggests that epidermoid metaplasia caused by chronic irritation from an esophageal stricture may have been exacerbated by the dilation procedure.

Case Series Of Accidental Toothbrush Ingestion: Successful Endoscopic Management Of Foreign Bodies In The Stomach

Case Series Of Accidental Toothbrush Ingestion: Successful Endoscopic Management Of Foreign Bodies In The Stomach

Epidemiological Study of Pediatric and Adolescent Poisoning Cases in a Rural Tertiary Care Centre in South India

Pediatric poisoning covers the entire spectrum of cases from accidental ingestion in toddlers to intentional abuse in teenagers. Epidemiological surveillance of oral ingestion of poisonous substances in children and adolescents in a particular area is necessary to determine the extent and characteristics of the problem, according to which related preventive measures can be taken. This was a retrospective, observational study including all pediatric poisoning patients (between the age of 0 to 19 years) received at the Trichy SRM Medical college & Research Centre, Irungalur, Trichy during the 2 year period from May 2021 to April 2023. A total of 52 cases were received in the casualty department of our hospital during the study period. Out of this, Male patients were predominant (53.85%). Most of the cases belonged to the age group between 16- 19 Years . Most of the cases were from the Rural areas (82.69%).Accidental Poisoning (61.54%) is more common followed by suicidal poisoning (38.46%). The substances involved in Poisoning are Kerosene(19%),Rat Killer (10%), Paracetamol(10%), Oleander(8%), ant-killer (8%), Organo-phosphorus Poisoning(6%) among many others. Most of the time the poisoning happened inside Home(65%) followed by area surrounding home(17%). Oral route (88%) was the most common way of taking poison. Most cases took less than 4 hours (71%) to reach the hospital. Vomiting was the most common symptom in most of the cases. 23 cases (44%) were requiring intensive care of which only 8 cases (15%) needed more than 3 days of ICU care.

A Case of Ratol Poisoning Review of Literature

We report a case of a 17 year old lady who presented with severe abdominal pain for 4 days. Patient developed fulminant hepatitis and disseminated intravascular coagulation during her hospital stay. History of Ratol (3% yellow phosphorus) ingestion was revealed on the second day of admission. She was managed with NAC infusion for 3 days along with supportive treatment and was discharged on the 10th day of admission. Accidental ingestion of Ratol is common in rural India. Early diagnosis and management of yellow phosphorus can improve the outcome of the patient. It is important to identify predictors of outcome of patients with toxin-induced liver injury.

Clinical characteristics and toxicological spectrum analysis of 493 cases of acute poisoning in children

ObjectiveThis retrospective study aimed to analyze the clinical characteristics and toxicological spectrum of acute poisoning in children treated at our pediatric intensive care unit. The findings provide a basis for the treatment and prevention of acute poisoning in children.MethodsClinical data of hospitalized children aged 0 to14 years with acute poisoning, treated between January 2015 and December 2023, were collected and analyzed. The analysis included the types of poisoning, sex and age distribution of children, routes and causes of poisoning, time from poisoning to medical consultation, length of hospital stays, and treatment outcomes.ResultsAmong the 493 cases of acute poisoning in children, pesticide poisoning (n = 252, 51.1%) was the most common type, followed by medication poisoning (n = 182, 36.9%). Chemical poisoning accounted for 7.7% (n = 38), while food poisoning and inhalation of harmful gases accounted for 3.0% (n = 15) and 1.2% (n = 6), respectively. The main route of poisoning was oral ingestion (n = 477, 96.8%), while accidental ingestion accounted for a large proportion (n = 379, 79.4%), and adolescents aged 11 to 14 years accounted for 20.6% (n = 98).Apart from the predominance of girls attempting suicide by self-administering antipsychotic medications (n = 88, 75.9%) due to depression, there was no significant difference in sex distribution among other types of poisoning children. The highest incidence of poisoning except children who self-administer antipsychotic drugs occurred in children aged 1–3 years (n = 267, 54.2%) and 8–14 years (n = 135, 27.4%), with the highest proportion in the preschool age group. The average time from poisoning to medical consultation was 33.4 ± 54.9 h, and majority of children received treatment within 48 h after poisoning (n = 423, 85.8%). The overall effective treatment rate was 96.8%.ConclusionAcute poisoning in children has complex and diverse causes, with accidental ingestion being the main route. Prevention should be emphasized, including strengthening child safety education and improving parental supervision. Moreover, psychological health education is crucial for adolescents during their puberty. In the event of acute poisoning, prompt medical consultation and appropriate treatment are necessary to mitigate adverse outcomes.

Current Opinion in Clinical Management of Human Cystic Echinococcosis in the Liver

Cystic echinococcosis remains a serious and threatening disease in countries on all continents where it is endemic. It is a zoonosis that continues to be neglected, despite all the efforts of the teams working on it and the WHO. Therefore, it is never too much to remember the clinical management of this disease in humans. This is what we intend in this manuscript. The disease is caused by the larval stages of cestodes (tapeworms) of the genus Echinococcus found in the small intestine of carnivores, which infects humans due to accidental ingestion of eggs of these parasites. The most frequent and most widespread across all continents is cystic echinococcosis, caused by Echinococcus granulosus (sensu lato). The annual incidence of CE can range from less than 1 to 200 per 100,000 inhabitants in various endemic areas. In China and Central Asia, the population risk is more than 40 million people, with a mortality rate of about 2% - 4%. Objectives: One of the objectives of this manuscript is to recall the parasite cycle and the form of contamination, a very important public health aspect, and draw attention to this neglected zoonosis that affects millions of people, particularly in the countries of Central Asia, the Mediterranean basin and South America. Last but not least, we intend to draw attention to the correct nomenclature in relation to the terms that define the disease, the different stages, and the proper designations, particularly with regard to therapeutic modalities. Method: The manuscript also aims to describe the form of contamination of the disease, the diagnostic methods, in particular the use of ultrasound, and the therapeutic modalities, some of which, particularly the invasive ones, must be carried out in Centres dedicated to the study and treatment of this zoonosis. Conclusion: Despite these important data and the socioeconomic impact Echinococcosis remains a neglected disease. Given this situation, all forms of echinococcosis remain serious public health threats, particularly in South America, the Mediterranean basin, and Central Asia, which must deserve the attention of the states of these continents and the WHO.

Chemical Pneumonia with Complications Due to Accidental Inhalation of Hydrocarbon in a Child: A Case Report

Hydrocarbon poisoning, particularly from accidental ingestion, is a significant risk for children and often lead to chemical pneumonitis and severe respiratory complications. This case report describes a 12-year-old boy with intellectual disability who ingested petrol, leading to chemical pneumonia complicated by pleurisy detected through chest CT scans. This case underscores the importance of timely imaging in managing hydrocarbon poisoning and highlights the need for preventive strategies to reduce such incidents in children.

Prevalence of antibiotic-resistant enterobacteriaceae in domestic wastewater and associated health risks in reuse practices

The use of wastewater for non-potable purposes is an important alternative for addressing water scarcity, especially in developing regions. However, minimizing the risks, particularly those associated with emerging contaminants that may induce resistance among pathogens in wastewater, is crucial. This study assessed the occurrence of antibiotic-resistant bacteria in untreated wastewater used for agricultural purposes and evaluated the quantifiable health risks associated with this practice in Tamale, Ghana. The resistance of some Enterobacteriaceae, such as E. coli, Klebsiella, and Salmonella-Shigella, to four commonly used antibiotics in Ghana was assessed using a conventional microbiological culture approach and the Kirby Bauer disk diffusion method. A Quantitative Microbial Risk Assessment (QMRA) was performed to estimate the health risks associated with two distinct scenarios of wastewater reuse: (1) accidental ingestion of contaminated wastewater and soil, and (2) consumption of vegetables irrigated with wastewater. This approach applied a Monte Carlo simulation based on 10,000 interactions and identified E. coli O157:H7 as the reference pathogen. Among Enterobacteriaceae, Klebsiella pneumoniae, Salmonella-Shigella and E. coli were isolated, in concentrations exceeding the limit recommended by the World Health Organization (103 CFU/100 ml). All the isolated bacteria were resistant to metronidazole (5 μg). Thirty-three per cent of Klebsiella pneumoniae isolates were intermediate/moderately susceptible, and all other bacteria were resistant to amoxicillin (30 μg). All Klebsiella pneumoniae and the majority of Salmonella-Shigella (69.8 %) isolates were resistant to trimethoprim-sulfamethoxazole (25 μg) and tetracycline (30 μg). When assessing health risks, the mean annual probability of infection associated with consuming vegetables irrigated with wastewater varied between 5.14 × 10−2 and 9.79 × 10−1 per person per year. Conversely, for the accidental ingestion scenario, the probability was 1.00 per person per year. In these scenarios, the probability of illness ranged from 1.29 × 10−2 to 2.4 × 10−1 and 2.5 × 10−1 per person per year. The health risks posed by these findings surpass the maximum threshold prescribed by the World Health Organization, thereby emphasizing the need for prompt mitigation strategies.

Airway obstruction due to ingestion of sodium polyacrylate: a case report

BackgroundSuper-absorbent polymers (SAPs) possess the ability to absorb large amounts of water and are widely used in medical settings. Commonly used in vomit bags to contain fluids, reduce spillage, and enhance bedside hygiene, SAPs are generally regarded as safe and non-toxic. However, we report a tragic incident where the accidental ingestion of SAPs led to fatal asphyxiation, highlighting a critical safety concern.Case presentationA 76-year-old female suffering from advanced Alzheimer’s dementia was brought to the emergency department following a fall with cervical trauma. Following a complaint of nausea, she was given a vomit bag containing a sachet of approximately 9 g of SAP. Thirty minutes later, she was found deceased in the waiting area, with a grayish, half-hardened gel blocking her oropharynx and remnants of a chewed SAP sachet. Pathological analysis confirmed death by asphyxiation caused by the SAP expanding in her oropharynx upon contact with saliva.ConclusionsThis case emphasizes the potential dangers of SAPs when accidentally ingested and it is imperative that such products are kept out of reach of vulnerable populations. In cases of airway obstruction, there are no specific treatments available. Laryngoscopy may be impossible, necessitating the prompt consideration of an emergency tracheotomy. Experimental data suggest the use of an aerosol of warm alkaline hydrogen peroxide solution to dissolve these obstructive foreign bodies, but further studies are needed to validate its use in emergency situations.

Sacral neuromodulation for Organophosphate-induced delayed neuropathy neurogenic lower urinary tract dysfunction: a case report

BackgroundOrganophosphate-Induced Delayed Neuropathy (OPIDN) is a rare neurological disorder triggered by exposure to organophosphorus compounds. These compounds exert their neurotoxic effects by impacting the nervous system, leading to systemic manifestations. Urinary system symptoms are infrequently observed in clinical settings. Currently, effective therapeutic interventions for OPIDN-related urinary symptoms are lacking. Sacral nerve modulation therapy, an FDA-approved approach for managing lower urinary tract symptoms, presents as a promising option. Herein, we present a case of OPIDN-induced lower urinary tract obstruction successfully treated with sacral nerve modulation therapy, resulting in substantial symptom relief.Case reportA 27-year-old male patient presented with severe bilateral hydronephrosis, attributed to low bladder compliance and accompanied by a fever persisting for 6 days. The patient’s medical history revealed accidental ingestion of organophosphate pesticide (Dimethoate) with no concomitant underlying diseases. In consideration of the potential for OPIDN, surgical intervention in the form of sacral neuromodulation (phase I) was undertaken. Subsequent evaluation one month post-surgery revealed notable improvements in both bladder compliance and bilateral hydronephrosis, necessitating sacral neuromodulation (phase II). Presently, following a 5-month follow-up period, the patient remains asymptomatic and in favorable health.ConclusionThis patient achieved long-term relief using sacral neuromodulation.

Sharp-pointed Foreign Body Ingestion in a Child: A Unique Case Report and Literature Review

Abstract: Accidental foreign body ingestion is commonly encountered in clinical practice, especially among children.Concern arises especially when the ingested foreign body is a sharp object due to the risk of perforation, mucosal injury, and impaction in the gut. Of inadvertently ingested foreign bodies, 10%–20% require endoscopic removal and <1% require open surgical intervention.Endoscopic management, though popular, still remains difficult due to the inaccessibility of certain points in the bowel. Here, we describe a 7-year-old male child who presented to us on March 31, 2024, with a history of accidental ingestion of an iron nail 2 days prior. Although colonoscopic retrieval was the first mode of management undertaken on the basis of impaction in the distal ileum, the same was not successful. Eventually, the child was placed on conservative management and the nail was passed per rectally spontaneously on defecation after 3 days of observation.