Digestive Foreign Bodies in Children in Dakar: Should they be Systematically Extracted Download PDF

Journal Name : SunText Review of Pediatric Care

DOI : 10.51737/2766-5216.2021.025

Article Type : Research Article

Authors : Sabounji SM, Gueye D, Fall M and Ngom G

Keywords : Foreign bodies; Child; Ingestion; Coin

Abstract

Context: Ingestion of a foreign body (FB) is a frequent accident in children. These foreign bodies are very variable and the majority are expelled spontaneously. However, some of them can get stuck on their way and the management will depend on several parameters.

Aims: To identify the context in which FB ingestions occur, their nature and their management.

Settings and Design: The following parameters were studied: frequency, age, sex, history, consultation delay, circumstances, time, place, functional signs, physical examination data, radiographic findings, nature and location of the foreign body, management delay, nature of the treatment and evolutionary modalities.

Methods and Material: Our study was retrospective and descriptive on a series of 133 cases of foreign body ingestion recorded over a period of 5 years. The data were collected from the patients' files and the department's database. The analysis was done on Excel 2016.

Results: The frequency was 26.6 cases per year. The mean age was 4.9 years. The sex ratio was 1.46. These accidents occurred mainly in the family home (91.8%). The FBs were radiopaque in 96.2% of cases. Intestinal location was the most frequent (82.7%). Coins were the most frequently found (82%). Clinical-radiological monitoring was instituted in the majority of our patients (88.7%) until the natural expulsion of the FB. Evolution was without particularities in all our patients.

Conclusions: FB ingestion is most often a quasiasymptomatic domestic accident that occurs in children under 5 years of age. The majority of ingested FB are radiopaque. Spontaneous expulsion is the usual outcome.


Introduction

Foreign body ingestion (FBI) is more common in the pediatric population [1]. It occurs accidentally in children and especially in children under 5 years of age [2]. The preferred site of blockage of FBs is the upper esophagus [3]. There is a wide range of ingested FBs, which are not well documented [4]. Coins are by far the most frequent [5]. The majority of these FBs are expelled spontaneously [6]. Approximately 10% of ingested FBs require endoscopic removal and only 1% require surgical intervention [7]. The current trend in the literature is towards systematic extraction [8]. However, is it really necessary to extract them systematically. The aim of this study is to identify the context in which FB ingestions occur, their nature and their management methods.


Subjects and Methods

We conducted a retrospective and descriptive study on a series of 133 cases of foreign body ingestion in the pediatric surgery department of the Centre Hospitalier National d'Enfants Albert Royer (CHNEAR) over 5years, from January 1st, 2015 to December 31th, 2019. We excluded 09 cases of button battery ingestion whose management (immediate extraction) was done at the Otolaryngology Department. The following parameters were studied: frequency, age, sex, history, consultation delay, circumstances, time, location, functional signs, physical examination data, radiographic findings, nature and location of the foreign body, management delay, nature of the treatment, and evolutionary modalities.


Results

A total of 133 cases were collected over 5 years, representing a frequency of 26.6 cases per year and a prevalence of 5.6 ‰ of consultations. The age of our patients ranged from 2 months to 15 years with an average age of 4.9 years. The age group of children under 5 years was predominant (66.2%) followed by those between 5 and 10 years (25.5%) and finally those over 10 years (8.3%). The sex ratio was 1.46. No particular history was found in our patients. The average time between ingestion and consultation in our department was 20.8 hours with extremes of 30 min and 15 days. Most patients presented within the first 24 hours after ingestion (76.7%). More than half (51.1%) of the patients consulted a medical facility before admission without any extraction attempt. The ingestion was identified by the parents or relatives in 96.2% of cases. The place of occurrence of these accidents was mainly the family home (91.8%), followed by school (6%), then playing areas (2.2%). These ingestions occurred most often in the evening (92.8%) between 4pm and 11pm in school-aged children and at all times of the day, between 10am and 6pm in younger children. The 2pm to 7 pm time period was the most frequent (70.6%) (Figure 1).





















Figure 1: Time distribution of ingestion accidents.

The clinical presentation on admission was almost the same for the majority of patients (89.5%) who were asymptomatic. In nine patients (6.7%), the revealing symptoms were purely digestive, with hypersialorrhea in 7 cases (5.2%) and dysphagia in 2 cases (1.5%). Respiratory signs were present in 5 patients (3.8%), with cough in 3 cases and associated dyspnea in 2 cases. An initial thoracic or thoracoabdominal X-ray was performed in all of our patients to confirm the diagnosis, localise the FB on the gastrointestinal tract and to search for complications. Radiopaque FBs were visualized in 96.2% of cases. The most frequent initial location was intestinal (82.7%) (Figures 2,3).

                                                        

 



















Figure 2: X-ray showing two overlapping coins.















Figure 3: X-ray image of an ingested ring.


In 23 patients (17.3%), the initial radiograph showed an esophageal location of s, FBs with a predominant location in the lower third (52.2%) followed by the middle third (30.4%) and finally the upper third (17.4%) (Figure 4,5).

The number of FBs ingested was unique in 98.5% of cases. Two patients ingested 2 coins each. Clinical-radiological monitoring was initiated in the majority of our patients (88.7%). It consisted of radiographic monitoring on an outpatient basis with parental guidance. The radiographic control was done 48 hours after the initial radiography, then 72 hours afterwards, and then every week if the CE was not expelled. The average time to expulsion was 2.76 days with extremes of 1 day and 14 days.