History Of Foreign Body Ingestion Research Articles

Ensuring that ingested fishbones that migrate to the neck are located, diagnosed, and removed early.

The aim of this retrospective study was to explore the clinical characteristics of and diagnostic and therapeutic strategies for the removal of fish bones that migrate to the neck. We reviewed the clinical data of 30 patients over the past 12years who underwent neck surgery in our otorhinolaryngology department for the migration of fish bones from the throat. The location of fish bones and the positivity rate of different examination methods (neck CT and B-ultrasound) were evaluated statistically. The diagnosis and treatment strategy for fish bone migration to the neck was also summarized. A total of 24 patients had a history of foreign body ingestion. The duration from foreign body ingestion to the appearance of symptoms in the neck ranged from 26 to 151 days, with a median of 50days (interquartile range, 32-86days). Among the 24 patients with fish bones located in the front or side of the neck, 50% (12/24) and 100% (24/24) of whom had positive neck CT and B-ultrasound results, respectively. Additionally, for 6 patients with fish bones in the retropharyngeal space, the positive rate for neck CT was 100%, whereas neck B-ultrasound showed negative results due to the air and depth in the trachea and esophagus. A strong correlation was observed between the length of fish bones detected by B-ultrasound and CT and the actual length. Indeed, no significant difference was observed between the length of fish bone determined by B-ultrasound and the actual length. In patients with fish bones located in the anterior and lateral neck regions, the foreign bodies were successfully removed by a lateral cervical approach operation (23/24). For the 6 cases with fish bones located in the retropharyngeal space, all (6/6) were removed by incising the posterior pharyngeal wall with assistance from transoral endoscopy. The techniques of B-ultrasound and CT have advantages for the diagnosis of migratory foreign bodies in the neck. Although B-ultrasound is more accurate for estimating the length of migratory fish bones in the neck, a combination of both methods can improve the preoperative positive rate of diagnosis. Therefore, a variety of surgical approaches should be employed to manage the different locations of cervical foreign bodies.

Unusual Intra-Thyroid Migration of Ingested Fish Bone: A Case Report and Literature Review.

Trans-esophageal migration of foreign bodies is a rare but serious complication of vulnerable foreign bodies. This clinical case is about a 37-year-old female patient, with a history of foreign body ingestion eight (08) months ago, received for anterior cervical swelling evolving since about seven (07) months ago. The diagnosis of thyroid nodule was evoked on clinical examination and explored by neck ultrasound which confirmed the thyroid nodule and highlighted the presence of an intra-thyroid fish bone. The extraction was carried out by cervicotomy under general anesthesia after fine needle markup and the evolution under medical treatment was favorable after 03 weeks. Extra-digestive migrations of ingested foreign bodies constitute often a source of diagnostic wandering and therapeutic difficulties due to their polymorphous clinical manifestations. This was the case in our context where it was confused with an authentic thyroid pathology. Its take of care often imposed neck surgery which could be avoided by earlier endoscopy. Vulnerable foreign bodies of the esophagus must imperatively be extracted for avoiding trans-esophageal migrating.

Pediatric Foreign Body Ingestion - Expectations and Outcomes

BACKGROUND
 Lockdowns, travel restrictions, and homeschooling during the COVID-19 period contributed to an increased number of foreign bodies being swallowed by children. This single-center study was initiated to determine the incidence of foreign body ingestion in the pediatric age group during the 2-year period of COVID-19 and compare it with an earlier 3-year period in Saudi Arabia.
 METHODS
 Medical records and abdominal radiographs of children under 14 were reviewed for the history of foreign body ingestion. The frequency of foreign body ingestion, size, shape, type, and outcomes during the COVID-19 pandemic was compared with similar events in the 3 years before the COVID-19 pandemic from November 2016 to November 2019.
 RESULTS
 Of the n = 161 records, n = 86 cases were reported during the COVID-19 pandemic, and n = 75 in the pre-pandemic period. Most of the ingested foreign bodies were less than 2 cm in size (57.8%), with the prevalence of non-metallic objects (87.6%) and the outcome being spontaneous expulsion (83.2%). There was a significant association between spontaneous expulsion cases and the size of the objects (p = 0.001), number of objects (p = 0.0005), and shape (p = 0.01). An analysis of demographic data showed that more boys than girls were registered, with a predominance of children under the age of five.
 CONCLUSIONS
 Treating children who have swallowed foreign bodies require a multi-professional approach with the participation of physicians, nurses, poison control specialists, radiologic technologists, ambulance personnel, and others to provide continuous, child-friendly care and follow-up. Parents and caregivers should be aware of how to keep children away from small items that can be harmful if swallowed, especially coins, disc batteries, small magnets, and other high-risk items.

A Missed Nasopharyngeal Foreign Body.

Nasopharyngeal foreign bodies are exteremely rare and early diagnosis and prompt removal is of paramount importance. A 31years old woman presented with serous otitis media and nasal stiffness. After imaging and nasal endoscopy a missed chicken bone was removed from the nasopharynx. She had a previous history of foreign body ingestion with an unsuccessful esophageal endoscopy 5years ago. Although rare, we should evaluate the whole upper aerodigestive tract in the endoscopy for foreign body swallowing.

Foreign Body Ingestion: A Common Presentation Among Pediatric Age Group in the City of AlAhsa Eastern Province, Saudi Arabia.

Background Foreign body ingestion is a prevalent issue among children and presents considerable morbidity and mortality rates. Due to children's increased accessibility to electronic toys and equipment, foreign body ingestion has become a common reason for presenting to pediatric emergency departments worldwide. In this context, this research aims to determine the prevalence of foreign body ingestion among children in AlAhsa, Saudi Arabia. Methodology This observational retrospective descriptive study was conducted at Maternity and Children Hospital, AlAhsa, Saudi Arabia, from 2017 to 2021. The study included children (less than 14 years old) who presented to the emergency department with a history of foreign body ingestion. The biographical data, clinical presentation, type of foreign body, and X-ray findings were documented. Results A total of 91 cases of foreign body ingestion or aspiration in children under 14 years of age were included. Approximately half of the patients were under the age of three, and 62.2% of them were male, while 37.8% were female. The clinical presentation revealed that only 24% were symptomatic. Coins were the most commonly ingested foreign bodies (28.9%), followed by metallic objects (20%), and batteries were the least frequently ingested foreign bodies, recorded in eight cases. Conclusion Early detection and treatment of foreign body ingestion is crucial to prevent consequences. In this study, the most frequent foreign bodies detected were coins among children up to three years old. Raising parents' awareness about the prevention of foreign body ingestion is an important step toward reducing its incidence.

S3622 Idiopathic Culture-Negative Suppurative Gastritis With Gastric Abscess

Introduction: Suppurative gastritis is an uncommon infectious process involving the gastric wall from direct mucosal injury caused by a foreign object, reflux of proximal intestinal bacteria, and hematogenic or lymphatic spread from a distant infection. Intramural gastric abscess is rare with high mortality and morbidity if left untreated. Immediate management is required once there is clinical suspicion. Case Description/Methods: A 23-year-old female with unremarkable medical history presented to the emergency department with epigastric pain for 1-week. She endorsed chills, nausea, and non-bilious vomiting. There was no history of foreign body ingestion, prior endoscopy, proton pump inhibitor, tobacco, or recreational drug use. Patient reported drinking two bottles of wine a week over the month before her illness due to stress and constant use of non-steroidal anti-inflammatory drugs (NSAIDs) for relieving menstrual pain. On exam, she had mild epigastric tenderness. Laboratory work was significant for mild leukocytosis. Computed tomography revealed a lobulated mural thickening and submucosal edema involving distal gastric body & antrum, with a 4.3 cm rim-enhancing intramural collection suggestive of an abscess (a) The patient was started on empiric broad-spectrum antibiotics & Pantoprazole and intravenous fluids. Endoscopy showed a cratered ulcer in the antrum with a central sinus tract leading to the gastric wall. There was no pus exuding, and the abscess appeared to have drained spontaneously (b) Mucosal biopsies were negative for Helicobacter pylori. On endosonography, there was wall thickening of the distal stomach, measuring 20 x 35 mm, with a central hypoechoic sinus tract. The lesion originated from the deep mucosal layer (c) Fine needle biopsy revealed acute inflammation with pus in the gastric wall compatible with abscess. Cytology was negative for malignant cells. The patient was discharged on oral amoxicillin-clavulanate to complete ten days of therapy. Upon repeating endoscopy, two months later, the distal gastric ulcer healed completely, and the patient was doing very well (d). Discussion: Intramural gastric abscess is rare. Foreign body ingestion, systematic spread of infection, or prior endoscopic intervention have been described as etiologic factors. NSAIDs could be a potential contributing factor. Prompt recognition, endoscopic drainage, and antibiotic therapy are essential to improve the outcome.Figure 1.: EUS Finding of gastric mural abscess with a visualized sinus tract inside the thick antral wall.

Consultations for Foreign Bodies in Aerodigestive Tract: Assessment of Diagnostic Modalities.

To evaluate test characteristics of various diagnostic modalities in the workup of foreign body (FB) sensation in the aerodigestive tract. Database containing all inpatient otolaryngology consultations between 2008 and 2020 was used. Cases of FB sensation were identified by documented encounter diagnosis or hospital problem of FB or globus sensation. Variables including basic patient demographics, clinical presentations, diagnostic imaging modalities, procedures, and outpatient follow-up were collected. One hundred and six patients were included in the study. A FB was visualized in 55 patients (52%) and removed in 52 patients (49%); 3 patients had a FB that was visualized initially but not found in the operating room. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found to be 41%, 50%, 58%, and 33%, respectively, for X-ray (XR); 91%, 61%, 70%, and 87%, respectively, for computed tomography (CT). Sensitivity and NPV were 25% and 57%, respectively, for flexible fiberoptic laryngoscopy (FFL). Seventy-one of 106 patients (67%) underwent invasive interventions during their workup for FBs. Ten out of 11 (91%) chicken bones were found in the digestive tract compared to 7 out of 19 (37%) fishbones (p=0.0046). In patients with history of FB ingestion, CT may be more beneficial than XR as a screening tool for locating foreign bodies and guiding further management. FFL alone is inadequate for ruling out a FB in the aerodigestive tract given FB's high likelihood of being in the esophagus or buried in soft tissue or mucosa. 3 Laryngoscope, 133:1361-1366, 2023.

Management of foreign body ingestion and food impaction: A case series

Background: Foreign body ingestion, and food impaction, in adults are common emergency department problems. Endoscopic intervention is required for potential therapy to minimize the risk of complications
 Aim: To describe the endoscopic findings and interventions for patients with a history of unintentional foreign body ingestion, and food impaction, referred to the adult gastrointestinal endoscopy service.
 Methods: Endoscopy reports for all patients referred to adult gastrointestinal service with a history of non-intentional foreign body ingestion, or food impaction were retrieved from the electronic records in the Endoscopy Department at the Benghazi Medical Center, from March 2010 to December 2019, using relevant keywords.
 Results: A total of 20 patients (7 males and 13 females), were referred to the adult endoscopy service with a history of either food impaction or non-intentional foreign body ingestion, during the period from March 2010 to December 2019.
 Eleven patients had a history of foreign body ingestion, with a foreign body identified and removed in 6 (54.5%) patients.
 Nine patients presented with a history of food impaction, while a food bolus was identified and managed in 7 (77.7%) of them.
 The most common type of impacted food in the study series was a piece of meat stuck in the esophagus (4 patients). In three patients, the piece was removed and in the fourth, it was pushed into the stomach.
 Conclusions:The number of referred cases to our Endoscopy Department is relatively small. In more than half of the patients, foreign body or food bolus or material could be identified, and in all of them, endoscopic management was successful with no reported complications.

Unusual radiological finding in foreign bodies ingestion: three esophageal coins


 Case description:
 A 5-year-old girl presented to the emergency department with a history of foreign body ingestion. A cervico-thoracoabdominal radiograph demonstrate a foreign body in the esophagus, which seemed to show a double rim sign suspecting a button battery. After an emetic episode and expelling a coin, the child became asymptomatic. Close inspection of the X-ray demonstrated that the image was formed by superimposition of 3 circumferential objects of different sizes. Another X-ray observed the persistence of two superimposed objects.
 
 
 Clinical findings:
 The girl presented with sialorrhea, odynophagia, and nausea. Vital signs and physical examination were normal. There was no significant medical history.
 
 
 Treatment and Outcome:
 With the suspicion of multiple impacted esophageal objects, the patient was then taken to the operating room. During the flexible esophagoscopy 2 coins were found in the esophagus, both were removed without difficulty. The patient had an uneventful postoperative recovery and there have been no long-term complications.
 
 
 Clinical relevance:
 Unusual radiographic findings regarding esophageal foreign bodies have been reported, however, we describe the first case of a child with 3 coins impacted in the esophagus and a new radiological finding in foreign bodies ingestions that allow to avoid misdiagnosis and improve outcomes.

Case report of fatal deep neck abscess: a complication of aerodigestive foreign bodies

Background: Ingestion of a foreign body is a typical emergency in the field of health services otorhinolaryngology head and neck surgery. Pharyngooesophageal perforation, aorto-oesophageal fistula, and deep neck infection are all serious consequences, albeit uncommon. Several risk factors for complications that aggravate this condition include time of therapy (> 24 hours after the onset of symptoms), sharp foreign objects such as fish bones, mental illness, and diabetes mellitus are risk factors for complications. Although deep neck abscesses have decreased due to the availability of antibiotics, these infections still occur with high morbidity and mortality rates if the patient is not managed properly. Aim: to report case of fatal deep neck abscess and aerodigestive complications of foreign agency in Dr. Soetomo Teaching Hospital, Surabaya Indonesia. Method: A retrospective report of 4 cases of ingestion of foreign bodies with complications of deep neck abscess resulted in death in Dr. Soetomo Academic Hospital, Surabaya between the year 2018 and 2020. This case report describes clinical symptoms, result of physical and diagnostic examinations, and therapy of each subject until death. Results: Between 2018 and 2020, there were four cases at Dr. Soetomo Teaching Hospital, Surabaya with a history of foreign body ingestion that escalated to severe neck abscesses. In all four cases, the subjects died as a result of deep neck abscess complications. Conclusion: Four cases were recorded, each of which had a history of ingestion of foreign bodies causing complications of deep neck abscess. In addition, the co-morbidities of diabetes mellitus increase the risk of death for the patient.

Esophageal Injury Secondary to Severely Embedded Denture: A Case Report

The incidence of esophageal impacted denture is proportionately increasing as there is increasing number of people wearing denture in current days. Impacted denture has to be removed as soon as possible because the delay can lead to complications. The successful removal of impacted denture in the esophagus in a patient is reported, with a review of the literature. A 52-year-old Malay lady complained of dysphagia with no history of foreign body ingestion. Following unsuccessful attempts of removal via a rigid esophagoscope, open surgery was performed. Without further delay, the impacted denture was removed by cervical esophagotomy, and the patient recovered uneventfully. Esophageal foreign bodies are usually removed by endoscopy. However, in situations where this appears potentially hazardous, such as with impacted denture, open surgical extraction that is promptly performed is a safer option.International Journal of Human and Health Sciences Vol. 05 No. 03 July’21 Page: 362-365

Infected laryngeal foreign body: A case report

Foreign body aspiration is a major cause of accidental death in children. Laryngeal foreign bodies in some cases, especially when it is narrow cause little airway obstruction and may even present like upper airway infection. This can delay the diagnosis and even may be mis-treated as laryngitis. A child presented to the department of ENT with throat pain and hoarseness of voice but gave a history of foreign body ingestion 1 week before. Though the child presented with laryngitis like symptoms, considering the foreign body ingestion history, diagnostic work-up was done to rule out foreign body in larynx. On X-ray, a radio-opaque foreign body was seen in the larynx above the glottis. He was taken to the operation theatre and under general anaesthesia, foreign body was seen and was piercing the posterior pharyngeal wall. It was carefully removed and pus was seen leaking from the removal site. After a course of antibiotics, the child was apparently normal then.A Laryngeal foreign body shows a wide variety of presentations depending on its size and shape. Hence, the children with laryngitis like symptoms should be investigated for foreign body aspiration irrespective of the symptoms if a history of foreign body ingestion was given.

Intestinal Rupture Due to a Non-Perforating Foreign Body

Background: Intestinal obstruction by a foreign body is a common occurrence in domestic animals, needing the attention of veterinarians and owners, given that a serious complication of this condition is intestinal rupture, with consequent peritonitis. Perforating objects are the ones most often associated with rupture, but any object that obstructs the intestinal tract, if not removed properly, can lead to intestinal rupture, generating a poor prognosis. This article reports a case of intestinal rupture caused by a non-perforating foreign body in a dog. Case: A 1-year-old Chow-Chow dog was taken by its owner to the Portal Pet private clinic, with a history of foreign body ingestion and emesis. The owner reported that he took the animal to veterinary care in another establishment on the day he noticed vomiting, with no other abnormality being detected. An injectable medication was administered, but the owner did not know what it was, and the dog was discharged. After 15 days, the owner sought care at the clinic initially mentioned, due to the persistence of emesis, in addition to the onset of diarrhea and apparent apathy. On physical examination, the dog was apathetic, with pale mucosa and pain on abdominal palpation. A firm structure was felt, located in the epigastric region, compatible with a foreign body. The dog was referred for hospitalization and an abdominal ultrasound was requested, in addition to blood samples for hematological and serum biochemical tests (urea, creatinine, alanine aminotransferase, and alkaline phosphatase). Serology for parvovirus was also performed. The blood count revealed leukopenia (4,800 thousand/mm3) and biochemical analysis showed an increase in alkaline phosphatase (895.5 U/l). The results for parvovirus were negative. Ultrasonography confirmed the presence of a foreign body. The animal was referred for exploratory laparotomy, in which the foreign body was found in the abdominal cavity as a result of intestinal rupture, and peritonitis was observed. The foreign body was removed, the abdominal cavity washed, intestinal raffia made, and an abdominal drain inserted. The foreign body was identified as a silicone makeup sponge. Three days later, the drain was removed. The patient had good post-surgical clinical evolution and was discharged. The prescription given was as follows: omeprazole 1 mg/kg (VO, every 24 h in the morning, for 2 weeks); dipyrone25 mg/kg (VO, TID, for 4 days); cephalexin 25 mg/kg (VO, BID, for 10 days); mineral vitamin supplement based on probiotics and prebiotics 1 tablet/10 kg (VO, every 24 h, for 10 days); vermifuge based on milbemycin oxime and praziquantel 5-25 mg (VO, in a single dose, with repetition after 15 days); enrofloxacin 50 mg 10 mg/kg (VO, every 24 h, for 7 days); immunoglobulinbased on blood plasma, vitamins and minerals 1 tablet/10 kg (VO, BID, until new recommendations); and metronidazole 40 mg/mL oral solution at a dose of 25 mg/kg (VO, BID, for 7 days). As topical treatment, an antiseptic spraybased on laurel, diethylene glycol ether, sodium sulfate, and povidine iodinewas prescribed for surgical wound cleansing, until the suture removal, and the use of a surgical collar was requested. A reassessment was scheduled after 10 days, during which the suture was removed. At this point the dog had fully recovered.Discussion: Intestinal obstruction by a foreign body is a common cause of veterinary emergencies. As observed in the reported case, rupture of the intestinal wall and peritonitis can result. Although the prognosis of the affected animals is guarded, diagnosis prior to the worsening of septicemia as well as immediate surgical intervention were essential for recovery.

Tracheo- bronchial foreign bodies presentation, diagnosis management at tertiary care center

Tracheo- bronchial foreign bodies presentation, diagnosis management at tertiary care center - IJOAS- Print ISSN No: - 2582-4147 Online ISSN No:- 2582-421X Article DOI No:- 10.18231/j.ijoas.2019.004, IP Journal of Otorhinolaryngology and Allied Science-J Otorhinolaryngol Allied Sci

An Unusual Presentation of Impacted Laryngeal Foreign Body in an Adult

Introduction: Foreign body is a rare occurrence in adults, and the larynx is the least common site of a foreign body to be impacted. Furthermore, the usual presentation includes dysphagia, chronic cough, hoarseness or dyspnea. This is an ENT emergency requiring prompt diagnosis and treatment. However, we report a case in which an adult patient had an impacted laryngeal foreign body with very benign symptoms of 1-month duration.Case report: We present a case of a 53-year-old Orang Asli with the chief complain of sore throat for a month duration. He had history of foreign body ingestion about a month ago. Otherwise, he has no odynophagia, dysphagia, change of voice or shortness of breath. Flexible nasopharyngolaryngoscope revealed a fish bone embedded at the right false cord. Airway was not compromised. The foreign body was successfully removed under general anaesthesia without any complications.Conclusion: Foreign body in airway is a life-threatening event. It can cause upper airway obstruction. Impacted laryngeal foreign body may present with commonplace symptoms, as seen in our case. A complete history is important in order to make a diagnosis and eventually come into prompt management

Spectrum of imaging findings in trans-gastric migration of accidently ingested metallic foreign bodies

Background: An accidently ingested foreign body may get lodged within the lumen of gastrointestinal tract, pass uneventfully with feces or may migrate extraluminally into the surrounding tissues in which case it may lead to suppurative or vascular complications. The aim of the endeavor was to study the spectrum of imaging findings in patients with accidental ingestion of foreign bodies with trans-gastric migration of metallic foreign bodies.Methods: Total 33 patients with history of accidental ingestion of foreign bodies were subjected to preliminary radiograph of neck, chest and abdomen followed by upper gastrointestinal endoscopy. Failure to retrieve/ localize foreign body endoscopically from upper gastrointestinal tract with check radiograph reiterating the presence of foreign body in upper abdomen were subjected to computed tomography of abdomen.Results: A total of 33 patients comprising of 27 females and 6 males with mean age of 23.76 years with history of foreign body ingestion were studied. Ingested foreign bodies were lodged in pharynx (n=7), esophagus (n=3), stomach (n=13) or duodenum (n=3). In 7 patients in whom endoscopy failed to locate and/or retrieve foreign body, computed tomography confirmed the presence of trans-gastrically migrated foreign body in the surrounding structures. The location of migrated foreign bodies was in lesser sac (n = 2), greater omentum (n = 3), lesser omentum (n = 1) and transmural (n = 1). Two patients had evidence of collection formation around the migrated foreign bodies.Conclusions: Sharp or pointed metallic foreign bodies may migrate trans-luminally with various implications. Though radiography is the preliminary workhorse for the confirmation of ingested foreign bodies, computed tomography owing to its volumetric data acquisition helps in exact localization of migrated foreign bodies and should precede any therapeutic intervention for retrieval of migrated foreign bodies.

Ingested foreign bodies in children: Do they really pass spontaneously from the gastrointestinal tract? A single-centre experience with 1000 cases.

Foreign body (FB) ingestion is frequently encountered in all departments that treat children. FB may bring about significant anxiety for parents and physicians. The present study aims to determine the appropriate approach for FB ingestion in children. The records of 1000 children with a history of FB ingestion between the years 2005 and 2017 were reviewed retrospectively in this study. Of 1000 children, 53.8% were male. The most common types of FBs were coins (35%). X-ray was negative in 49% of the patients, and 86% of these patients received no intervention. Of the 504 (51%) X-ray-positive patients, the oesophagus (68%) was the most common location. Life-threatening complications were tracheo-oesophageal fistula (1), Meckel's diverticulum perforation (1), and perforation due to rigid endoscopy (1). We demonstrated that coins, which are the most commonly ingested FBs, have various types and sizes according to their countries of origin, and this affects spontaneous passage. We found that only 48% (quite low compared to the literature) of the coins passed spontaneously. In asymptomatic patients with a gastric button battery, we suggest a "watchful waiting" approach. The patients should be observed and managed at home. In our study, we found that 85% of the button batteries that reached the stomach passed spontaneously.

Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children.

Coins are the most common ingested metallic foreign bodies among children. The goal of this protocol is to assess the accuracy and feasibility of using a handheld metal detector to detect ingested metallic foreign bodies in children. We propose that by introducing handheld metal detector screening early in the triage process of children with high suspicion of metallic foreign body ingestion, the number of radiographs being ordered to localize the metallic foreign body can be reduced in this radio-sensitive population. The study protocol requires the screening of the participants for history of foreign body ingestion and exclusion of patients with respiratory distress or metallic implants. The patient changes to hospital gown and items that could contain metal like eyeglasses, earrings, pendants, and ornaments are removed. The patient is positioned in the center of the room away from other metallic interferences. The working status of the handheld metal detector is first confirmed by eliciting a positive audio-visual signal. Then the screening is done in an erect position with head in extension to expose the neck, from the level of the chin to the level of the hip joint, to cover the anatomical areas from neck to pelvis in a zig-zag manner both anteriorly and posteriorly. A positive audio-visual signal is carefully noted during the scanning for the presence of metallic foreign body. Relevant radiographs are ordered as per the area detected on the metal detector screening. The handheld metal detector was able to precisely identify all the coins among the ingested metallic foreign bodies in our study. The handheld metal detector could not consistently detect non-coin metallic foreign bodies. This protocol demonstrates the accuracy of handheld metal detector in the identification and localization of coins and coin like metallic foreign bodies.

Transmesocolic double gastro-enteric fistulas due to ingestion of 28 magnets

Abstract Introduction Accidental ingestion of magnetic foreign bodies has become more common due to increased availability of objects and toys with magnetic elements. The majority of them traverse the gastrointestinal system spontaneously without complication. However, ingestion of multiple magnets may require surgical resolution. Magnet ingestion usually does not cause serious complications, but in case of multiple magnet ingestion or ingestion of magnet and a metal object, it could cause intestinal obstruction, fistula formation or even perforation. Case report We report case of a transmesocolic double gastro-enteric fistula formation following ingestion of 28 small magnets in a 17 months old boy. No history of foreign body ingestion could be obtained from parents therefore the patient was treated conservatively in a pediatric clinic for vomiting, dehydration, upper respiratory tract infection and suspicion of upper digestive tract bleeding. After 48 h he was sent in our clinic for surgical evaluation. Intraoperatively double transmesocolic gastro-enteric fistula was found. After separation of de gastric and enteral walls, resection of gastric wall and intestinal segment containing the two perforations was performed, followed by gastric suture in two layers and entero-enteric anastomosis. A total of 28 magnets were removed from the stomach and small intestine. Conclusion Single magnet ingestion is treated as non-magnetic foreign body. Multiple magnet ingestion should be closely monitored and surgical approach could be the best option to prevent or to cure its complications.

Handheld Metal Detector for Metallic Foreign Body Ingestion in Pediatric Emergency.

Foreign body ingestion is a common problem for which children present to the emergency department. The most common ingested foreign bodies among children are coins. Metal detector is an equipment, which measures a change in inductance of a coil when an electroconductive material is placed near it and produces an audio-visual signal. The present study was conducted to determine the effectiveness and feasibility of HMD in the local Pediatric population. This was a prospective study conducted in the pediatric emergency department among children presenting with history of foreign body ingestion. The outcome measured was presence or absence of metallic foreign body detected on handheld metal detector examination. During the study period, 36 patients with history of foreign body ingestion presented to the emergency department. Among these, 28 were metallic foreign body ingestions. Coins were the most common type of foreign body ingested. Among the metallic foreign bodies ingested, all the coins were accurately identified by the handheld metal detector. Non-coin metallic foreign bodies like metallic screw, needle and stapler pin were not identified by the handheld metal detector. The study demonstrates that handheld metal detector can be safely and reliably used as a screening tool in the process of detecting ingested coins. The plain radiograph still appears to be superior as it accurately localizes sharp metallic objects as well as cell batteries (button batteries) which need to be detected early and removed in order to prevent complications. Handheld metal detector is an effective tool that can be used in the follow up of patients to confirm whether the coin like metallic foreign body has been expelled. Handheld metal detector examination is more sensitive than traditional X-ray examination to detect radiolucent metallic foreign bodies like aluminium.