Common Foreign Bodies Research Articles

The Ingestion Question: Public Knowledge of Safe Food Introduction in Children.

National guidelines advise delaying initiation of solid foods until after 4-6 months of age and avoiding "high-risk" foods under the age of 4 years. However, foreign body aspiration of food remains a common preventable pediatric emergency. Our primary aim was to investigate public knowledge regarding the safe age of introduction of different foods to children and determine if demographic factors affect this knowledge. An online survey was designed following a literature review and consultation with an expert panel. This was distributed via social media platforms. A review of our institutional data of bronchoscopy/foreign body retrievals was performed to identify trends. There were 1000 survey responses: 79.4% of respondents cared for children and 21.5% were medical professionals; 37.7% of respondents (n = 385) would offer high-risk foods to children <2 years of age and 56.9% (n = 582) to children <3 years. At our institution nuts (65.7%) were the most common food-related foreign body retrieved from a total of 265 over 21 years. Notably, 80% of respondents (n = 800) would offer whole nuts to children <4 years. Respondents with medical training were more likely to hold off on introducing nuts to children until a later age. Although the public has an overall appreciation of food safety, a significant proportion would feel comfortable offering high-risk foods to children under 2 and 3 years. There is a poor understanding of the danger of nuts and the appropriate age of introduction. Further research into effective public education strategies on safe food introduction in children are warranted. V Laryngoscope, 2024.

FP7.17 - Appendiceal Foreign Bodies in Adults: A Systematic Review of Case Reports

Abstract Adults can accidentally swallow foreign bodies (FBs) with food. In rare occasions, these can lodge in the appendix lumen causing inflammation. This is known as foreign body appendicitis. We conducted this study to review different types and management of appendiceal FBs. A comprehensive search on PubMed, MEDLINE, Embase, Cochrane Library and Google Scholar was performed to detect appropriate case reports for this review. Case reports eligible for this review included patients above 18 years of age with all types of FB ingestion causing appendicitis. A total of 64 case reports were deemed to be eligible for inclusion in this systematic review. The patient mean age was 44.3 ± 16.7 years (range, 18-77). Twenty-four foreign bodies were identified in the adult appendix. They were mainly lead shot pellet, fishbone, dental crown or filling, toothpick, and others. Forty-two percent of the included patients presented with classic appendicitis pain, while 17% were asymptomatic. Moreover, the appendix was perforated in 11 patients. Regarding modalities used for diagnosis, computed tomography (CT) scans confirmed the presence of FBs in 59% of cases while X-ray only managed to detect 30%. Almost all of the cases (91%) were treated surgically with appendicectomy and only six were managed conservatively. Overall, lead shot pellets were the most common foreign body found. Fishbone and toothpick accounted for most of the perforated appendix cases. This study concludes that prophylactic appendicectomy is recommended for the management of foreign bodies detected in the appendix, even if the patient is asymptomatic.

Epidemiological Investigation of the Foreign Body in the Ear, How to Treat It and Its Complications in the Hospital Kamkar-Arabnia in Qom in 2019

Background: A foreign object in the ear is a relatively common emergency, and failure to remove it properly or using incorrect methods can cause irreparable damage. Objectives: This study aimed to investigate the epidemiology of foreign bodies in the ear, their treatment, and associated complications at Kamkar-Arabnia Hospital in Qom in 2019. Methods: This descriptive study used a census method to include 102 patients referred to Kamkar-Arabnia Hospital with complaints of foreign bodies in the ear. Data were collected using a checklist that included demographic and hospital information, and then analyzed using SPSS 18 with descriptive and analytical statistics. Results: The study included 102 participants with an average age of 12.41 ± 7.11 years. Most participants were male (58.9%, n = 60), and the age distribution was as follows: 0 - 6 years (49%, n = 50), 6 - 12 years (30.4%, n = 31), 12-18 years (13.7%, n = 14), and over 18 years (6.9%, n = 7). The most common foreign body was seeds (35.2%, n = 36). Complications were observed in 41.4% of cases, with the majority occurring in the age group of 0-6 years. In this age group, seeds were the most common foreign body, whereas in the age groups 6 - 12 years and 12 - 18 years, seeds were also prevalent. For individuals over 18 years, common foreign bodies included matchsticks, cotton, and plastic. Only 22 patients required anesthesia for removal. Among the age groups 0 - 6, 6 - 12, and 12 - 18 years, most foreign bodies were removed without complications, whereas 5 individuals over 18 years experienced canal bleeding. Conclusions: The study highlights the need for effective preventive measures to avoid the entry of foreign substances in children, emphasizing the importance of proper management to prevent complications.

Unusual Airway Foreign Bodies in Children: Demographics and Management.

The aim is to study the demographics and management of unusual airway foreign bodies (UAFBs) in children. A retrospective observational study (2000-2020) of children with UAFBs, who underwent bronchoscopic removal. The demographics, types of foreign bodies, clinical and radiological features, management, and outcomes were collated and analyzed. Common foreign bodies, such as nuts, seeds, and vegetable aspirations, were excluded. Among 531 children who had bronchoscopic retrieval of airway foreign bodies, 74 (59 males/15 females) had unusual foreign bodies. These included pen caps, whistles, plastic objects, pins, coal piece, stones, clay, pencil, gold ornament, and glass bangle. Thirty-one children presented within 1 day of aspiration, 37 within 1 month and 6 till 6 months. Thirty-nine were below 5 years, and the rest were between 5 and 15 years. Cough, respiratory distress, fever, choking, and noisy breathing were common presentations. Others are stridor, whistling, cyanosis, loss, and change of voice. Chest X-ray showed ipsilateral hyperinflation (23), haziness (21), radio-opaque foreign body (17) and was normal in 14. The left main bronchus, followed by the right main bronchus and trachea, were the sites of impaction. Four children required additional procedures (tracheotomy and thoracotomy). There was one mortality in the study cohort. Aspiration of unusual foreign bodies is not uncommon in children. Most aspirations are witnessed and predominant in boys. The left bronchus is the common site of impaction, and X-ray clinches the diagnosis. Presentation is delayed, and bronchoscopic retrieval, though challenging, has favorable outcome.

Managing Foreign-body Injuries in Individuals with Diabetes: A Diagnostic Challenge

Abstract Introduction: Diabetes often leads to diabetic foot infections, resulting in hospitalizations and amputations. Foreign-body (FB) injuries in diabetes present significant diagnostic challenges. This study aims to unravel the complexities of FB injuries, focusing on implications, diagnostic hurdles, and management strategies due to their association with delayed detection and complications. Methods: A retrospective analysis was performed on 28 patients who visited the Chellaram Diabetes Institute, Pune, between June 2014 and August 2021, with a history of FB injury. We collected their clinical, radiological, microbiological and biomedical data including clinical outcomes. Results: The study included 28 subjects (71.43% males, 28.57% females) with a mean age and duration of diabetes of 65.07 ± 7.26 and 17.89 ± 9.15 years respectively. Peripheral neuropathy was observed in 95.83% of subjects. Imaging was used in 21 subjects: X-ray (n = 21; 5 had FBs) and ultrasound (n = 13; 6 had FBs). FBs were retrieved in 18 cases, with imaging detecting them in 9 cases (X-ray only: 3, X-ray + USG: 2, USG only: 4). In 12 subjects, FBs were removed bedside as accidental findings. The most common FB was a stone (n = 9), followed by wooden splinters (n = 6) and thorns (n = 6). Removal procedures were performed on both hospitalized and nonhospitalized subjects, highlighting undiagnosed injuries. Conclusion: This study underscores the importance of radiological modalities in detecting FBs and assessing the extent of infection they cause, aiming to enhance future FB management.

Foreign Bodies in Pediatric Otorhinolaryngology: A Review.

Foreign bodies (FBs) in pediatric otorhinolaryngology represent up to 10% of cases in emergency departments (ED) and are primarily present in children under five years old. They are probably the result of children's curiosity and tendency to explore the environment. Aural and nasal FBs are the most common and accessible, and the removal methods differ depending on the exact location and type of FB, which can be organic or inorganic. A fish bone stuck in one of the palatine tonsils is the most common pharyngeal FB. Laryngopharyngeal FBs can obstruct the upper respiratory tract and thus become acutely life-threatening, requiring an urgent response. Aspiration of FBs is common in children between 1 and 4 years old. A history of coughing and choking is an indication of diagnostic and therapeutic methods to rule out or confirm a tracheobronchial FB. Regardless of the availability of radiological diagnostics, rigid bronchoscopy is the diagnostic and therapeutic method of choice in symptomatic cases. Radiological diagnostics are more significant in treating esophageal FBs since most are radiopaque. Flexible or rigid esophagoscopy is a successful method of removal. A delayed diagnosis, as with tracheobronchial FBs, can lead to fatal consequences.

Foreign body cases in obstetrics and gynecology practice

The article presents cases that took place in obstetrics and gynecology practice, the detection of a foreign body after surgical operations, childbirth through the natural birth canal.Patient safety is one of the most pressing issues in healthcare. Promoting safety requires that all those involved in health care recognize that the potential for error exists and that teamwork and communication are essential to preventing errors.Retention of surgical objects such as a gauze pad, instrument, or needle after surgery or an invasive procedure is a rare but potentially serious phenomenon associated with significant morbidity and mortality.Gauze swabs and napkins are the most common finds, while surgical instruments and needles are rare.We will present cases of foreign bodies in the practice of obstetrician-gynecologists.In the first case, the foreign body was left in the anterior abdominal wall. Two cases of napkins being left in the abdominal cavity after gynecological and surgical operations. In the fourth case, a needle was left in the cervix after delivery through the natural birth canal and suturing of soft tissue tears in the birth canal. Moreover, the needle was not detected either after childbirth, or outside of pregnancy, or during pregnancy, but was detected during examination of the cervix in mirrors in the early postoperative period.The problem of finding a foreign body after surgery remains unsolved. According to statistics, one patient per year in each hospital suffers from a forgotten foreign body. A foreign body left behind can give rise to a lawsuit for damages against the surgeon and medical staff.Pre- and post-operative object counting is the most common foreign body screening method used in the world.Careful surgical technique should be routinely followed, which includes counting sponges, tampons, napkins, and instruments aimed at preventing postoperative foreign material in body cavities. A patient with significant gastrointestinal symptoms and a history of surgery should have a high index of suspicion for postoperative foreign body retention. Perioperative counting of equipment and materials is the most common method of foreign body screening.

Gastrointestinal devices: common and uncommon foreign bodies.

Devices for the gastrointestinal tract are widely available and constantly advancing with less invasive techniques. They play a crucial role in diagnostic and therapeutic interventions and are commonly placed by interventional radiologists, gastroenterologists, and surgeons. These devices frequently appear in imaging studies, which verify their proper placement, identify any complications, or may be incidentally detected. Radiologists must be able to identify these devices at imaging and understand their intended purpose to assess their efficacy, detect complications such as incorrect positioning, and avoid misinterpreting them as abnormalities. Furthermore, many patients with these devices may require MRI, making assessing compatibility essential for safe patient care. This review seeks to provide a succinct and practical handbook for radiologists regarding both common and uncommon gastrointestinal devices. In addition to textual descriptions of clinical indications, imaging findings, complications, and MRI compatibility, the review incorporates a summary table as a quick reference point for key information and illustrative images for each device.

Clinicodemographic Profile and Treatment Outcomes of Patients with Upper Aerodigestive Tract Foreign Bodies in the Southern Philippines Medical Center: A Five-Year Retrospective Review

Objective: This study aims to describe the clinicodemographic profile of patients with foreign bodies in the upper aerodigestive tract and their treatment outcomes. Methods: Design: Retrospective review of records Setting: Tertiary Government Training Hospital Participants: Records of 304 patients diagnosed with aerodigestive foreign bodies Results: Three hundred-four (304) patients were included. The median age was 5.26 years in the pediatric age group and 42.53 years in the adult age group, with a male-to female ratio = 1.97:1. Foreign bodies were ingested in 291 (96%) patients while aspiration occurred in 13 (4%). Overall, 211 (69%) of cases involved the pediatric population (&lt;19 years) and 93 (31%) the adult population. The most common foreign bodies reported were coins (63.5%), food (18.1%), and dentures (11.5%). Most esophageal foreign bodies (244/291; 83%) were seen at the cricopharyngeal level in all age groups. The foreign body was removed successfully in 288/291 (98%) of ingestion cases. All 13 cases of foreign body aspiration were successfully removed by bronchoscopy. All patients were discharged improved. Conclusion: Most upper aerodigestive tract foreign bodies involved the pediatric age group. Predisposing conditions were mainly due to accidental ingestion and aspiration while playing in the pediatric population and negligence in eating among adults. Almost all ingestion cases were successfully treated with esophagoscopy, while all aspirations were treated successfully with bronchoscopy. Most intraoperative and postoperative complications who were managed conservatively by observation, although some cases required referral to other surgical departments and were treated surgically. All patients were discharged improved

Lost and found: surgical adventures in migratory foreign body cases.

This observational study investigates migratory foreign bodies in the upper aerodigestive tract, emphasising clinical presentation, assessment and factors contributing to extraluminal migration. Conducted across multiple medical centres in India, the study included 15 patients aged 11 to 70 years. Detailed observations, demographic information, clinical history, radiological findings and intra-operative outcomes were compiled. Fifteen patients presented with varied symptoms. Fish and chicken bones, along with metal wires, were common foreign bodies. Computed tomography scans played a crucial role in diagnosis, confirming extraluminal migration. Neck exploration successfully retrieved foreign bodies in most cases, with varied sites of impaction. Migratory foreign bodies, although rare, pose significant challenges for otolaryngologists. Early recognition, thorough diagnosis and meticulous neck exploration, is crucial for effective management, preventing severe complications. This study adds valuable insights to the understanding of migratory foreign bodies, contributing to the existing literature in otolaryngology practice.

Foreign Body Ingestion in Children: An Experience of 99 Cases in a Tertiary Care Center in Delhi.

Accidental ingestion of foreign bodies in children is critical, as the inability to effectively communicate can potentially lead to devastating consequences. We aimed to determine the epidemiology of foreign body ingestion and variability according to age, gender, type, and location of foreign body, and describe its management. The aim was to study the various types of foreign body ingestions in children admitted to pediatric surgery and their management. A retrospective study was conducted from January 2020 to June 2022 on children under the age of 12 years with a confirmed diagnosis of foreign body ingestion. Patients were clinically and radiologically assessed, after which standard protocols were followed wherein patients were followed by either observation or emergent management. Emergent management included removal of the foreign body by either endoscopy or surgery. Comparisons among multiple age groups, gender, type of foreign body, location of foreign body, and their management were analyzed. Out of 99 subjects in our study, there were 76 boys and 23 girls. The median age of presentation was 5 years. Most children were asymptomatic at presentation. The most frequently ingested foreign body was a coin in all age groups. The majority of the foreign bodies were suspected to be in the small bowel. The foreign bodies that had crossed the duodenojejunal flexure (n = 74, 74.7%) were managed conservatively with the observation of a variable period of a minimum of 24 h and a maximum of 48 h. 21 cases were managed by endoscopic removal, while three cases required surgical intervention. Overall, the most common gastrointestinal foreign body was a coin in all age groups. Button battery is the most worrisome foreign body; however, depending on its position, it can be managed conservatively. Upper GI foreign bodies can be safely removed endoscopically. Parental counseling is very important for the prevention of ingestion of foreign bodies.

Study on Prevalence and Associated Risk Factors of Indigestible Foreign Bodies in Rumen and Reticulum of Cattle Slaughtered at Selected Districts of East Ararge Zone Municipal Abattoirs

Ingestion of indigestible foreign bodies by ruminants is becoming a common worldwide problem which is the associated with a shortage of feed as well as increased pollution of grazing lands with indigestible materials. A cross-sectional study was conducted from April 2023 to March 2024 with the aim of assessing the prevalence of indigestible foreign bodies and associated risk factors in cattle slaughtered at Selected districts of east Ararge municipal abattoirs. A total of 384 cattle were selected randomly and examined to check for the presence of indigestible foreign bodies in the rumen and reticulum of study animals. Among them, 109(28.39%) were found positive for the occurrence of indigestible foreign bodies in rumen and reticulum. Age, body condition and origin of the animals were determined during ante mortem examination while animals were examined for indigestible foreign bodies during postmortem examination. Age, body condition score and origin of animals had significant (P&lt;0.05) effect on the prevalence of foreign bodies. Foreign bodies were highest in cattle old age groups 58(36.71%) followed by young 28(23.53%) and adult 23(21.50%). The prevalence rate recorded in poor, medium, and good body condition of cattle were 62(68.89%), 34(32.69%) and 13(6.84%), respectively. The significantly (P=0.000) higher foreign bodies in rumen and reticulum were found in cattle originated from Babile 58(60.42%) followed by kombolcha 24(25.00%) and Girawa 17(17.71%) and the lower prevalence were observed in Gorogutu 10(10.42%). Out of 109 (28.39%) total positive cases of foreign bodies 56(14.58%), 35(9.11 %) and 18(4.69 %) prevalence rate of foreign bodies were observed in rumen, reticulum and both rumen and reticulum, respectively. Rumen harbored mostly non-metallic foreign materials while reticulum was the major site for the retention of metallic objects. Plastic 38(9.90%) were recovered as the most common foreign bodies followed by rope 16(4.17%), cloth and plastic 16(4.17%), Nail 13(3.39%), wire 12 (3.13%), cloth 7(1.82 %), and rope and plastic 7(1.82 %). Presence of the foreign bodies in the rumen and reticulum of the current study area was expose cattle to health associated problems and contribute for reduction in production. Consequently, appropriate solid waste disposal system need to implement in the study area to prevent health risk of ruminants and also to protect the environment.

Incidence of Esophageal Foreign Body and its Complication at Tertiary Care Hospital

OBJECTIVE: The aim of this research is to investigate the types of foreign body ingestion in esophagus and its complications in tertiary care hospital. Design: Prospective study Setting and duration: This study was carried out in department of E.N.T and Head and Neck surgery Abbasi Shaheed Hospital from 3rd February 2016 to 30th September 2021. METHODOLOGY: During this period, 305 patients were selected for this study after fulfil the inclusion and exclusion criteria. RESULTS: Male were 177 (58%), male and female ratio was 1.3:1. 162 (53%) patients came with foreign body in esophagus were between the ages of 0-10 years followed by 11-20 years of age 35 (11.4%) cases. Commonest site of foreign body impaction was cricopharynx, noted in 59% patients. Commonest foreign body in esophagus was coin, 122 (40%) cases followed by meat bolus 34 (11%) and bone chip 33 (10.8%). Below 10 years of age, the most common foreign body was coin found in 110 (36%) patients. Above 71 years, denture found in 16 (5.24%) patients. The overall incidence of complications was noted in 17 (5.5%) patients and the most common complication was bruise, 13 (4.2%) patients. In 8 cases (2.6%) bruise was noted in cervical part of esophagus, while in 1 case perforation was noted in thoracic part of esophagus.0.3%. CONCLUSION: Esophageal foreign body is very common in ENT practice especially in children. It can be harmful to children if they swallowed. Foreign body should remove as earliest to prevent complications.

Assessment on Indigestible Foreign Bodies of Cattle and Associated Risk Factors at Selected Slaughtere House of East Hararghe Zone, Ethiopia

A cross-sectional study was conducted from April 2023 to March 2024 with the aim of assessing the prevalence of indigestible foreign bodies and associated risk factors in cattle slaughtered at selected districts of east Ararghe municipal abattoirs. A total of 384 cattle were selected randomly and examined to check for the presence of indigestible foreign bodies in the rumen and reticulum of study animals. Among them, 109(28.39%) were found positive for the occurrence of indigestible foreign bodies in rumen and reticulum. Age, body condition and origin of the animals were determined during ante mortem examination while animals were examined for indigestible foreign bodies during postmortem examination. Age, body condition score and origin of animals had significant (P&lt;0.05) effect on the prevalence of foreign bodies. Foreign bodies were highest in cattle old age groups 58(36.71%) followed by young 28(23.53%) and adult 23(21.50%). The prevalence rate recorded in poor, medium, and good body condition of cattle were 62(68.89%), 34(32.69%) and 13(6.84%), respectively. The significantly (P=0.000) higher foreign bodies in rumen and reticulum were found in cattle originated from Babile 58(60.42%) followed by kombolcha 24(25.00%) and Girawa 17(17.71%) and the lower prevalence were observed in Gorogutu 10(10.42%). Out of 109 (28.39%) total positive cases of foreign bodies 56(14.58%), 35(9.11 %) and 18(4.69 %) prevalence rate of foreign bodies were observed in rumen, reticulum and both rumen and reticulum, respectively. Rumen harbored mostly non-metallic foreign materials while reticulum was the major site for the retention of metallic objects. Plastic 38(9.90%) were recovered as the most common foreign bodies followed by rope 16(4.17%), cloth and plastic 16(4.17%), Nail 13(3.39%), wire 12 (3.13%), cloth 7(1.82 %), and rope and plastic 7(1.82 %). Presence of the foreign bodies in the rumen and reticulum of the current study area was expose cattle to health associated problems and contribute for reduction in production. Consequently, appropriate solid waste disposal system need to implement in the study area to prevent health risk of ruminants and also to protect the environment.

Images of Common Foreign Body at an Uncommon Site

Images of Common Foreign Body at an Uncommon Site

The development of a systematic ultrasound protocol facilitates the visualization of foreign bodies within the canine distal limb.

Ultrasonography is an excellent investigative tool that can assist with the diagnosis of soft tissue conditions. In human medicine, ultrasonography is a fundamental diagnostic tool for the investigation of suspected vegetal foreign bodies (VFB), with protocol-based ultrasonography providing increased accuracy compared to lesion-focused examinations. Protocol-based ultrasonography is an emerging tool within the veterinary field, however, compared to human medicine is not routinely employed. The objective of this study was to develop a systematic ultrasound protocol to examine the distal limb for the visualization of vegetal foreign bodies (SUEDVEG). A 12 MHz linear and an 18 MHz high-frequency small-footprint linear array transducer was used on cadaver forelimbs (n = 6) and hindlimbs (n = 6) with images obtained from three common foreign body locations within the distal limb; 1; the interdigital webbing, 2; the palmar/plantar aspect of the phalanges and metacarpus and 3; the dorsal region of the phalanges and metacarpus. From these images, a 13-step systematic musculoskeletal protocol was developed and utilized on eight clinical cases or 10 limbs that had signs typical of distal limb VFB to preliminarily validate the proposed method. Vegetal foreign bodies were successfully identified and retrieved in seven (n = 8) clinical cases with method steps 9 and 11 (orthogonal views) identifying the majority of VFBs. The described ultrasound method appears highly useful for visualizing soft tissue locations of the canine distal limb known for tracking foreign bodies. Further studies are required to validate the described systematic examination method as the preferred clinical protocol over currently used lesion-focused exploration techniques.

Analysis of 108 flexible bronchoscopies for the removal of foreign bodies from the airways.

To describe the clinical, bronchoscopic, diagnostic, and therapeutic aspects between children and adults. This retrospective study compared the clinical and bronchoscopic characteristics of adults and children who underwent bronchoscopy for suspected foreign body aspiration. Data on sex, outpatient or emergency origin, bronchoscopy results, characteristics of the aspirated foreign body, and complications were analyzed. In total, 108 patients were included in the analysis, with foreign body aspiration diagnosed in 69% of patients (30 children and 44 adults). In 91% of patients, there was a clinical history suggestive of aspiration. The mean age of the adults was 65.89 (±19.75) years, and that of the children was 2.28 (±1.78) years. Most of the children were under 3 years of age (80%), while adults were mostly 70 years of age or older (54.5%). Emergency care was more common among children than adults. The most common foreign bodies found in both age groups were organic bodies, primarily seeds. The most frequent locations of foreign bodies were the lobar bronchi in adults and the main bronchi in children. Flexible bronchoscopy is the primary method for diagnosis and treatment. Transient hypoxemia occurred particularly frequently in children (5%). Foreign body aspiration, particularly that involving seeds, is more common in the extremes of age. A clinical history suggestive of aspiration is crucial in determining the need for bronchoscopy, which should be performed as early as possible. Flexible bronchoscopy is an effective and safe diagnostic technique.

328 Meat, sweets, and fruit are the most common foreign bodies removed with an anti-choking device: Preliminary data analysis

328 Meat, sweets, and fruit are the most common foreign bodies removed with an anti-choking device: Preliminary data analysis

Outcome of interhospital pediatric foreign body transfers

BackgroundChildren with foreign bodies are often transferred from general emergency departments (EDs) to children's hospitals for optimal management. Our objective was to describe the outcomes of interhospital pediatric foreign body transfers and examine factors associated with potentially avoidable transfers (PATs) in this cohort. MethodsWe conducted a retrospective cohort study of children aged <18 years transferred to our hospital for the primary complaint of foreign body from January 1, 2020, to September 30, 2022. Data collected included demographics, diagnostic studies and interventions performed, and disposition. A transfer was considered a PAT if the patient was either discharged from the pediatric emergency department (PED), or from inpatient care within 24 h, did not require procedural sedation and any procedural intervention by a pediatric sub-specialist (other than a pediatric ED physician). Logistic regression analysis was performed to evaluate factors associated with PATs. ResultsA total of 213 patients were analyzed based on eligibility criteria. The majority of patients were male (51.2%), pre-school age (59.2%), symptomatic (55.8%), and transferred from academic EDs (61%). Coins were the most common foreign bodies (30%), with the gastrointestinal tract (63.8%) being the most common location. Half of the non-respiratory and non-gastrointestinal foreign bodies were successfully removed in the PED. Over half (57.3%) of the patients were discharged from PED. Operative intervention was required in 82 (38.5%) patients, most commonly for coins (50%). 41.8% of transfers were deemed PATs. Presence of foreign body in the esophagus or respiratory tract (OR: 0.071, 95% CI: 0.025–0.200), symptoms at presentation (OR: 0.265, 95% CI: 0.130–0.542), magnet ingestions (OR: 0.208, 95% CI: 0.049–0.886) and transfers from community EDs (OR: 0.415, 95% CI: 0.194–0.885) were less likely associated with PATs. Button battery-related transfers were more likely associated with an avoidable transfer (OR: 6.681, 95% CI: 1.15–39.91). ConclusionsPATs are relatively common among children transferred to a children's hospital for foreign bodies. Factors associated with PATs have been identified and may represent targets for interventions to avoid low value pediatric foreign body transfers.

Endoscopic removal of ingested foreign body in children: experience of a tertiary care hospital of Bangladesh

Purpose: Foreign body ingestion is a common incident in children &amp; majority of ingested foreign body removed spontaneously, few percentages (10%) remain in GI tract. The timing of endoscopy depends on some clinical &amp; radiological parameters. The aim of this study to is to observe clinical profile of foreign body ingestion in children in Bangladesh. Methods: This cross-sectional descriptive study was conducted from February 2016 to December 2019 in the department of Paediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. A total of 29 cases of upper GI tract foreign bodies were studied. Patients with history of ingested foreign body, were clinically examined. Asymptomatic foreign body ingestion was frequently observed. Routine neck and chest X-ray in both AP and lateral views were obtained for these cases. Flexible endoscopy for foreign body extraction with suitable foreign body retriever was used to remove the foreign bodies. Data were expressed as percentage &amp; number. Results: Foreign body was commonly seen 22 (75.9%) in 1-5 years of age. Sex distribution of foreign body ingestion cases, where 15 (51.7%) were male child. Among the ingested foreign bodies only 3 (10.3%) were removed within 24 hours of ingestion, 10 (34.5%) cases were removed between 24-48 hours and the remaining 16 (55.2%) were removed after 48 hours. Coin was the most common foreign body 19(65.5%). Other foreign bodies were metallic chain 3 (10.3%), button battery 2 (6.9%), others 5 (17.2%). Conclusion: The study showed that foreign body ingestion is more common in 1-5 years age group, coin was the most commonly ingested foreign body.