Esophageal Foreign Bodies In Children Research Articles

Impacted esophageal foreign bodies in children

Foreign body (FB) ingestion in children has varied presentation. When unwitnessed, it poses therapeutic and diagnostic challenges especially in the presence of pre-existing anatomical pathology. We aim to analyze the clinical course, management, and outcome of children with impacted esophageal FBs. Retrospective chart review (Jan 2000-Feb 2018) recruiting children with impacted esophageal FBs. FBs in cricopharynx and those that moved to stomach were excluded. Investigations/management were based on underlying anatomical pathology, duration of impaction, and difficult FBs. Clinical details, management, and outcomes were collated. Of 86 children, N1 = 31 had identifiable predisposing anatomic pathology and N2 = 55 had impactions in normal esophagus or difficult FBs. N1 group presented early (42months), had recurrent impactions (1-6), and needed multiple dilatations (0-8) and longer follow-up (avg 35months). Food matter was commonest impaction. Many had persistent symptoms. N2 group had commonly coin impactions and strictures developed in long standing or corrosive FBs. Most were asymptomatic. Abnormal esophageal anatomy predisposes to impaction with organic food bolus. Age of presentation is earlier with recurrent impactions requiring multiple dilatations/surgery and longer follow-up. Metallic FBs commonly impact in normal esophagus and are often innocuous. Atypical/multiple FBs may mirror an underlying psychiatric illness.

Abnormal calcification misdiagnosed as esophageal foreign body in children: report of two cases

食道异物是儿童急症的常见疾病之一。儿童食道异物多为硬币等金属异物或动物骨骼等骨性异物，而临近组织的异常钙化较易误诊为外源性的食道异物。本文报告了儿童茎突舌骨韧带和杓状软骨的异常钙化误诊为食道异物的2例病例，通过对儿童食道异物病史及影像学资料进行分析并复习相关文献，总结其误诊原因及诊治特点，有助于降低儿童食道异物的误诊率。.

CT imaging of esophageal foreign bodies in children: a pictorial essay.

Foreign body (FB) ingestion is common in children, particularly from 6months to 3years of age. As young children may be unable to provide a clinical history and the ingestion is often unwitnessed, imaging plays an important role in diagnosis, predicting outcomes and detecting complications that require surgical intervention. Since 2015, our institution's diagnostic algorithm for suspected airway foreign bodies has included a noncontrast airway FB CT (FB-CT) with the z-axis coverage spanning from the larynx to the proximal segmental bronchi of the lower lung zones. The effective dose of radiation from this FB-CT airway protocol is typically less than 1mSv, compared to an effective dose of just under 1mSv to up to 3mSv for a fluoroscopic esophagram in children under 10years of age and 1-3mSv for a routine pediatric CT chest. In using the FB-CT airway protocol at our institution, we observed that esophageal rather than airway FBs were sometimes encountered on these exams. However, the confidence among radiologists for definitively diagnosing an esophageal foreign body on noncontrast CT was variable. Consequently, we created a teaching module of positive cases for our group of 21 pediatric body radiologists to increase their diagnostic confidence. This pictorial essay illustrates our institutional experience and can help others to confidently diagnose esophageal foreign bodies using a dedicated CT foreign body imaging protocol. At a similar radiation dose to a fluoroscopic esophagram, CT provides the additional advantage of an expedited diagnosis without the need for a radiologist on site.

Chronic retained esophageal foreign body: a case report

Chronic esophageal foreign bodies (CEFB) are associated with a high incidence of morbidity and mortality in adults. However, the presentation, management and outcome of chronic esophageal foreign bodies in children are not well described. Seventy-six percent of patients presented with a primary complaint of respiratory symptoms, with respiratory distress being the most common followed by asthmatic symptoms and cough. Twenty-two percent of patients had primarily gastrointestinal symptoms including nausea, vomiting and dysphagia. We present a case report of 2year 6month old male with 3 months history of cough and vomiting later diagnosed to be a case of upper esophageal foreign body impaction.

Pediatric Esophageal Foreign Body: Possible Role for Digital Tomosynthesis.

Foreign body (FB) ingestion is a common reason for emergency department visits, affecting more than 80,000 children in the United States annually. Whereas most ingested FBs are coins or other radiopaque objects, some are radiolucent FBs such as food. Digital tomosynthesis (DTS) is a radiographic technique that produces cross-sectional images with in-plane resolution similar to that of traditional radiographs. Our pilot study evaluated the sensitivity and specificity of DTS to detect FB in comparison to esophagram and clinical impression. This was a retrospective review on patients aged 0 to 18 years with suspected esophageal FB who received an esophagram with DTS at our institution between January 2014 and June 2016. Digital tomosynthesis images were analyzed by 3 readers for identification of FB impaction and compared with esophagram and discharge diagnosis. This study was approved by our local institutional review board. A total of 17 patients underwent an esophagography with DTS for suspected esophageal FB, of which 9 (53%) were suspected of having an FB on esophagram. Compared with esophagram, DTS had a sensitivity of 44%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 62%. Compared with clinical impression, DTS had a sensitivity of 33%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 38%. This pilot study showed that chest DTS has a very high positive predictive value, compared with esophagram and clinical impression, in detecting radiolucent esophageal FBs in children. Chest DTS is a promising modality for ruling in the presence of a radiolucent esophageal FB.

Endoscopic Foley Catheter Technique for Removal of Esophageal Foreign Body

Impacted esophageal foreign body in children may pose a challenging clinical scenario to the gastroenterologists Early recognition and treatment is imperative as the complications can be life threatening The Foley catheter method of foreign body extraction has been used on some patients but endoscopy remains the treatment modality of choice Here we report an interesting case of a child with impacted stone in the esophagus in whom a combined endoscopic Foley catheter technique was successfully applied to extract the impacted foreign body

Influencing factors for complications of esophageal foreign bodies in children

Objective To investigate the influencing factors related to the complications of esophageal foreign body in children. Methods Data of 150 children with esophageal foreign bodies admitted to Xi′an Children′s Hospital from January 2012 to June 2015 were included in the retrospective analysis. Related clinical variables (gender, age, location, time, size, sharpness, quality, and severity of complications) were statistically analyzed. Results Spearman correlation analysis showed that the age of children was negatively correlated with esophageal foreign body complications (r=-0.187, P=0.022), incarceration time (r=0.456, P<0.001), sharpness (r=0.384, P<0.001) and quality (r=0.234, P=0.004) was positively correlated with the incidence of complications. Non-conditional Logistic regression analysis for polytomous ordinal response showed that incarceration longer than 8 h yielded complication risks 9.507 times as much as that less than 8 h (95%CI: 2.982-30.309). Obtuse or sharp foreign body yielded risk 142.751 times as smooth foreign body did (95%CI: 13.736-1 483.562). Conclusion Incidence and severity of complications of esophageal foreign body in children are closely related to the age of the children, incarceration time and the degree of sharpness. For patients of less than 1 year old, incarceration for more than 8 hours, with an obtuse or sharp foreign body, early diagnosis and treatment is essential. Key words: Child; Foreign body in esophagus; Complications; Correlation

Hopkins with pliers latent speculum treatment of esophageal foreign bodies in children

目的 探讨Hopkins带钳潜窥镜在小儿食道异物中的应用。 方法 回顾性分析我科自2012年1月至2014年5月共63例门诊诊断为食道异物的儿童，采用全身麻醉下Hopkins带钳潜窥镜取异物。 结果 61例异物术中成功取出，2例为硬币麻醉后掉入胃中，术中均未造成食管壁黏膜的再次损伤。 结论 Hopkins潜窥镜能清楚的显影异物边界及食道黏膜的损伤情况，能大大减少手术并发症，提高手术成功率。

Esophageal foreign bodies in children: Emphasis on complicated cases

Esophageal foreign bodies (EFBs) are a relatively common clinical problem in pediatric patients. The majority of EFBs pass harmlessly through the gastrointestinal tract; however, some EFBs can cause significant morbidities. This study was conducted to review our experience in managing esophageal foreign bodies in pediatric patients, with an emphasis on the management and outcomes of complicated cases. Between March 1995 and March 2013, the records of all children up to the age of 12years who were admitted to King Khalid University Hospital, Riyadh, Saudi Arabia, with a final diagnosis of EFBs were reviewed. The medical records were analyzed with respect to demographic data, presenting symptoms, workup investigation, management, complications, and outcomes. Seventy patients were identified (38 boys and 32 girls). The ages ranged from 5days to 12years (mean: 4.4years). Fifty-three (75.7%) patients presented within 24hours. Thirteen (18.6%) patients had underlying predisposing factors. The most common EFB, found in 30 (42.8%) patients, was a coin. Witnessed ingestion of a FB was documented in 52 (74.2%) patients. The most common symptoms were drooling of saliva in 42 (60%) patients, followed by vomiting in 36 (51.4%) patients. Four (5.7%) patients presented with complications secondary to FB impaction, including hypopharyngeal wall perforation, acquired esophageobronchial fistula, localized esophageal perforation with inflammation, and perforation with stricture formation. The follow-up period ranged from 2 to 12months, and all patients had complete recovery without any sequelae. EFBs are a relatively common problem in pediatric patients, and underlying predisposing factors to EFB impaction are not uncommon. Long-retained EFBs are associated with a higher incidence of complications. Rigid esophagoscopy was successful in extracting most of the EFBs and was shown to be a safe and effective procedure.

Clinical analysis of 71 children of foreign bodies in esophagus

Objective To explore and analyze the clinical characteristics and treatment strategy of severe complications caused by children's foreign bodies in esophagus. Methods The clinical data of 71 cases of esophageal foreign bodies in children with ENT admitted to our hospital were analyzed retrospectively from Jan 2009 to Dec 2014. Results Esophageal foreign bodies in children with 71 cases, of whom 42 males and 29 females; aged from 2 months to 14 years old, highest incidence of 1 to 3 years old.Foreign bodies in esophagus lasted 2 h to 15 d. Ingestion of metallic foreign bodies in 43 cases, 12 cases of plant-based foreign body, 9 cases of animal foreign bodies, 7 cases of chemical foreign bodies.Foreign bodies located in the upper esophageal was 51 cases, 9 cases of the middle and 7 cases of the under section, 3 cases of esophageal entrance, 1 case of falling into the stomach.In children with 71 cases, 9 cases had complications, 69 cases were cured, improved in two cases, and the cure rate was 97.2%, the average healing time was 4 d. Conclusion Early diagnosis and treatment, avoid esophageal perforation are the key to avoid the emergence of the complications in children with esophageal foreign bodies, timely and accurate treatment of esophageal perforation and other complications are the effective measures to improve the cure rate. Key words: Esophageal foreign bodies; Complication; Children,

Western view of the management of gastroesophageal foreign bodies

The best modality for foreign body removal has been the subject of much controversy over the years. We have read with great interest the recent article by Souza Aguiar Municipal Hospital, Rio de Janeiro, Brazil, describing their experience with the management of esophageal foreign bodies in children. Non-endoscopic methods of removing foreign bodies (such as a Foley catheter guided or not by fluoroscopy) have been successfully used at this center. These methods could be an attractive option because of the following advantages: Shorter hospitalization time; easy to perform; no need for anesthesia; avoids esophagoscopy; and lower costs. However, the complications of these procedures can be severe and potentially fatal if not performed correctly, such as bronchoaspiration, perforation, and acute airway obstruction. In addition, it has some disadvantages, such as the inability to directly view the esophagus and the inability to always retrieve foreign bodies. Therefore, in Western countries clinical practice usually recommends endoscopic removal of foreign bodies under direct vision and with airway protection whenever possible.

Trivial and fatal complications of esophageal foreign bodies in neonates

Esophageal foreign bodies in children are one of the most common GI emergencies and require prompt attention. Neonatal esophageal foreign bodies are relatively uncommon and pose significant challenge in detection and management, owing to lack of appropriate clinical history. We encountered two neonates with esophageal FBs, with a trivial dysphagia managed immediately with endoscopic retrieval and another case with multitude of complications, with critical illness. Absolute dysphagia, aspiration into respiratory tract, severe pneumonia, significant delay in detection and probably lack of awareness in primary care physician led to complications in second case. These cases highlight the importance of appropriate historical details and high index of suspicion in managing such patients.

Mo1182 Esophageal Foreign Body in Children: A Nationwide Analysis of Hospitalized Cases in the United States, 2005-2012

Mo1182 Esophageal Foreign Body in Children: A Nationwide Analysis of Hospitalized Cases in the United States, 2005-2012

Esophageal Foreign Bodies in Children: 2 Years Experience in a Country Hospital

Objective: Foreign body (FB) ingestion is one of the most common causes of emergency admissions in childhood. In our hospital FB’s of upper esophagus are removed with Magill forceps and the others with rigid esophagoscopy. The aim of this study is to present our patients treated with diagnosis of esophagial foreign body in Mus State Hospital for 2 years period, and analyze our treatment methods in the light of the literature. Methods: Patients diagnosed with esophageal foreign bodies who were admitted to Pediatric Surgery Clinic of Mus State Hospital between November 2013 and December 2015 were evaluated retrospectively. In our study 19 children with a diagnosis of esophageal foreign body were reviwed according to age, gender, clinical symptoms, radiological findings, the impaction site and the type of the foreign body Results: There were 10 male and 9 female patients. The youngest was 1.5 and the oldest was 15 years old. The most common location (52.5%) of FB detected in esophagus was the first narrowing. We used Magill forceps for removing FB in 52.5% of the patients and rigid esophagoscope in 38.9% of them the most common symptom was refusing feeding and difficult swallowing. Conclusion: A detailed history is essential in patients who has swallowed a foreign body. Pointed and sharp objects usually require emergency intervention. Foreign bodies located in the upper part of esophagus can be removed easily by Magill forceps but rigid esophagoscopy remains a golden standard of removing objects from the esophagus of pediatric patients.

Retrospective study of upper digestive tract foreign bodies in central India

Background: Variety of foreign bodies may enter the digestive tract accidentally. Many pass spontaneously, but some become impacted, causing symptoms of obstruction. The cricopharynx and esophagus are the most common site of impaction. Nearly, all impacted objects can be removed endoscopically but, occasionally open surgery may be required. Objectives: This study was conducted on 228 patients with the aim to describe age-sex incidence, socioeconomic and geographical distribution, types of foreign body ingested and management strategy. Methods: Retrospective study was conducted in tertiary care hospital of Central India on 228 patients who had undergone rigid endoscopic removal of digestive tract foreign body from January 2007 to January 2014. Results: Foreign body ingestion was found most commonly in the age group of 1-3 year. (133; 58.33%) with male predominance. 180 patients (78.94%) belonged to lower socioeconomic status. Out of them 160 patients came from rural areas. Definitive history was found in (212; 92.98%) patients with dysphagia to solid as the most common presenting symptom. Most of the foreign bodies were detected by plain X-rays (203; 89.03%). Coin was found to be the most commonly ingested foreign body (67.54%). Cricopharynx was the most common site of impaction (86.4%). Rigid endoscopic removal under general anesthesia was successful in all 228 patients. Conclusions: Higher incidence of ingestion of foreign body is in toddlers. The most common site of lodgement was at the cricopharynx and upper third of esophagus. Early detection and rigid endoscopic removal can prevent from morbidity associated with the complications of foreign body impaction. 1. Webb WA. Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc. 1995;41:39-51. 2. G. Paul Digoy. Diagnosis and management of upper aerodigestive tract foreign bodies. OCNA. 2008;41:485-96. 3. Prakash Adhikari, Bikesh Lal Shrestha, Dharma K. Baskota, Bimal K. Sinha. Accidental foreign body ingestion: analysis of 163 cases. Arch Otolaryngol. 2007;11(3):267-70. 4. Palta R, Sahota A, Bemarki A, Salama P, Simpson N, Laine L. Foreign-body ingestion: characteristics and outcomes in lower socioeconomic population with predominantly intentional ingestion. Gastrointest Endosc. 2009;69:426-33. 5. Litivitz EL, Schmitz BF. Ingestions of cylindrical and button batteries: an analysis of 2382 cases. Pediatrics. 1992;89:747-57. 6. Hachimi-Idrissi S, Come L, Vandenpias Y. Management of ingested foreign bodies in childhood: our experience and review of literature. Eur J Emerg Med. 1998;5:319-23. 7. Naid Dehghani. Ingested foreign bodies in children: BC children’s hospital emergency room protocol. BC Med J. 2008 June;5(5):257-62. 8. ASGE Standards of Practice Committee, Steven O. Ikenberry, Terry L. Jue, M. Anderson, V. Appalaneni, S. Banerjee, et al. Management of ingested foreign bodies and food impactions. Gastrointestin Endosc. 2011;73(6):1085-91. 9. Faigel DO, Stotland BR, Kochman ML, Hoops T, Judge T, Kroser J, et al. Device choice and experience level in endoscopic foreign object retrieval: an in vivo study. Gastrointestin Endosc. 1997;45:490-2. 10. Nixon GW. Foley catheter method of esophageal foreign body removal: extension of applications. Am J Radiol. 1979;132:441-2. 11. Bonadio WA, Jona JZ, Glicklich M, Cohen R. Esophageal Bougie technique for coin ingestion in children. J Pediatr Surg. 1988;23:917-8. 12. Chu KM, Choi HK, Tuen HH, Law SY, Branicki FJ, Wong J. A Prospective randomized trial comparing the use of the flexible gastroscope versus the broncoscope in the management of foreign body ingestion. Gastrointest Endosc. 1998;47:23-7. 13. Ferruci TJ, Long JA. Radiographic treatment of esophageal food impaction using intravenous glucagon. Radiology. 1977;125:25-8. 14. Trenkner SW, Maglinte D, Lehman GA, Chernish SM, Miller RE, Johnson CW. Esophageal food impaction treatment with glucagon. Radiology. 1983;149:40. 15. Schunk JE, Harrison AM, Corneli HM, Nixon GW. Fluoroscopic Foley catheter removal of esophageal foreign bodies in children: experience in 415 episodes. Pediatrics. 1994;94:709-14. 16. Gaigel DO, Fennerty MB. Miscellaneous disease of the esophagus. In: Gaigel DO, Fennerty MB, eds. Textbook of Gastroenterology. 1st ed. Philadelphia: Lippincott Williams and Wilkins; 1999: 1304-1325. 17. Cheng W, Tam PKH. Foreign body ingestion in children: Experience with 1265 cases. J Paediatr Surg. 1999;34:1472-6. 18. Schunk JE. Foreign body ingestion/aspiration. In: Schunk JE, eds. Textbook of Pediatric Medicine. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2006: 307-314.

Extraction of esophageal foreign bodies in children: rigid versus flexible endoscopy

Foreign body (FB) ingestion is a common and potentially serious problem in children. Both rigid (RE) and flexible (FE) endoscopic techniques are used for removal of esophageal FBs; however, there is no consensus amongst pediatric surgeons regarding the best method. This study reviewed our experience managing esophageal FBs using both techniques. A 12-year retrospective review of children admitted with an esophageal FB between 1999 and 2012 was undertaken. Clinical data, management techniques, and complications were abstracted. Differences between these two groups were compared with standard statistical methods. 657 children were treated for esophageal FB ingestion, of which 366 (56%) were treated with FE. The most frequently ingested item was a coin (84%), and FBs were most commonly lodged in the upper third of the esophagus (78%). There was a slightly younger population in the FE group (4.0 vs. 3.3 years, p < 0.01), but otherwise no significant differences were found between the groups. The FB was successfully removed with the initially chosen technique in 97% of patients. Esophageal FBs may be successfully removed with either RE or FE. Since treatment failures were managed with conversion to the other technique, both procedures should be included in the training curriculum.

Chronic Cervical Esophageal Foreign Bodies in Children

We reviewed the surgical management of chronic cervical esophageal foreign bodies (CCEFBs) in a pediatric population after failed endoscopic retrieval. A descriptive analysis via a retrospective chart review of patients with CCEFBs who failed initial endoscopic management was performed between 2008 and 2013. Details were recorded regarding presenting symptoms, time from symptom onset to diagnosis of the CCEFB, surgical approach, and complications. Three patients with CCEFBs unsuccessfully managed with endoscopy were identified. The range of ages at diagnosis was 14 months to 4.5 years. The foreign bodies (FBs) were present for at least 1 month before diagnosis (range, 1 to 10 months). Respiratory symptoms were predominant in all cases. Neck exploration with removal of the FB was performed in each case. Complications included esophageal stricture necessitating serial dilations (patient 1), left true vocal fold paresis that resolved spontaneously (patient 3), and tracheoesophageal fistula with successful endoscopic closure (patient 3). No long-term sequelae were experienced. A high index of suspicion is required to recognize CCEFBs in children with respiratory distress. Although endoscopic management remains the first-line treatment, it may fail or may not be possible because of transmural FB migration. In this setting, neck exploration with FB removal is a safe and effective alternative.

小児食道異物の診断と治療

小児食道異物の診断と治療

Esophageal foreign bodies in children and adults: 20 years experience

Esophageal foreign object ingestion is frequently seen in all ages. Failure to treat can cause serious complications such as esophageal perforation. The aims of this study were to characterize the clinical features related to foreign objects in the esophagus and to analyze the results of commonly used methods for their removal. We analyzed 20 years of records from Siyami Ersek Hospital, Istanbul and identified 512 cases of foreign objects enlodged in the esophagus. In pediatric patients, the majority were aged between 2-5 years (34.4%), while in adult patients, the majority were above 55 years (38.7%). Coins were the most common foreign object detected in children (68.8%), whereas meat impaction was most common in adults (87.4%). The most common location of the foreign object was the cervical esophagus in children (78.2%), and the thoracic esophagus in adults (66.4%). In 30.8% of adults, there was esophageal or systemic disease. Objects were removed with a Magill clamp in 48.3% of children. Rigid endoscopy was the main treatment in adult patients. Perforation due to endoscopy developed in three patients. Surgical repair was performed on these patients but all died due to mediastinitis. Underlying esophageal or systemic diseases may predispose adults to foreign object ingestion in the esophagus. Improved endoscopic experience and clinical management of thoracic surgeons led to reduced morbidity and mortality in recent years.

Chronic Esophageal Foreign Bodies and Secondary Mediastinitis in Children

The purpose of this study was to review the clinical presentation, diagnosis, and management of chronic esophageal foreign bodies complicated by mediastinitis in children. A retrospective study of children with a chronic esophageal foreign body and secondary mediastinal complications diagnosed at Rady Children's Hospital in San Diego over a 12-month period is reported. Three patients received a diagnosis of an esophageal foreign body, retained from 1 to 12 months, and mediastinitis. Each patient presented primarily with respiratory signs and had been treated previously for alternate diagnoses (ie, asthma, reflux, and upper respiratory tract infection) by emergency or pediatric providers. The diagnosis of a foreign body was made after a chest radiograph was examined. Operative airway evaluation confirmed tracheal narrowing in all patients, and a computed tomographic scan of the chest was performed after removal of the foreign body to confirm mediastinal involvement. After medical and/or surgical treatment, the patients were released from the hospital tolerating soft diets. There were no reports of long-term complications in our series of patients. It is critical to rule out esophageal and airway foreign bodies in pediatric patients with respiratory symptoms that do not respond to medical treatment. Timely recognition of an esophageal foreign body generally allows for removal with minimal morbidity, whereas the incidence of serious complications increases significantly when the diagnosis is delayed. Our series provides support for conservative management of mediastinal complications after removal of chronically retained esophageal foreign bodies in children.