A prospective study of foreign-body ingestion in 311 children

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Abstract

Objective: To determine the preferable management protocol of foreign body ingestion in pediatric patients. Methods: All pediatric patients aged less than 12 years who presented with suspected foreign body ingestion in a hospital setting over a period of 3 years were prospectively studied. The usefulness of symptoms and various diagnostic procedures to identify the impacted foreign bodies were analyzed. Results: Of 311 children aged 4 months to 12 years, 115 foreign bodies were encountered. The presentations in children aged younger than 5 years were markedly different from the older children, who behaved more like adults. All sharp foreign bodies (107 cases or 93%), mostly fish bones (90.4%), were found in the oropharynx under direct vision using either tongue depressor (57%), Macintosh laryngoscope (6%), indirect laryngeal mirror (2%) or transnasal flexible endoscopy (28%). Coins (eight cases or 7%) were the only foreign body impacted at or below the level of cricopharyngeus. A plain cervical X-ray has a low sensitivity (15.9%) and a high specificity (99.5%) in identifying the foreign bodies. Conclusions: As the majority of the foreign bodies were sharp bones and situated in the oropharynx, a management protocol involving examination with a tongue depressor, transnasal laryngoscope, selective lateral soft tissue neck X-ray, chest X-ray and watchful observation is usually adequate. Removal of these foreign bodies can be accomplished using a tongue depressor and Macintosh laryngoscope. Patients with a suspected coin ingestion have to be evaluated by X-ray, and a rigid pharyngo-oesophagoscopy should be the mainstay of treatment.

Introduction

Foreign-body ingestion is a common emergency in otorhinolaryngology practice. The presentation and the management of this clinical condition vary not only in different ethnic populations but also in different age groups [1], [2], [3].

The diagnosis and management of foreign body ingestion in most children are a challenge because of the difficulty in communication and examination, when compared to adults. As there is some difficulty in making a diagnosis, the decision for active intervention is often difficult. Since there is a need for an effective management protocol, we carried out a prospective study to evaluate the clinical features, diagnosis and treatment of foreign body ingestion in children.

Section snippets

Materials and methods

All consecutive patients, 12 years of age or below, presenting with a history of foreign body ingestion at the Emergency and Accident Department, Prince of Wales Hospital, Hong Kong, between October 1993 and October 1996, were recruited into this study. The patients were managed by otorhinolaryngologists according to a protocol recommended in the hospital (Fig. 1).

A full history, clinical examination and appropriate radiographs of the neck, chest and abdomen were undertaken on every child in

Results

A total of 311 children (181 boys, 130 girls) with a history or suspicion of foreign body ingestion were recruited into the study. Their mean age was 5.18 years (S.D.: 4.1 years; range: 4 months to 12 years). Foreign bodies were encountered in 115 children (36.9%), of whom 62 (53.9%) were younger than 5 years, while 53 (46.1%) were 5 years or older. The majority of the foreign bodies swallowed were fish bones (90.4%). The nature of the foreign bodies is summarized in Table 1.

Discussion

Foreign-body ingestion is a common clinical problem in both adults and children. The proportion of foreign-body ingestion cases occurring in children varies from 6.5 to 80% with a marked ethnic variation between Oriental and Western populations [1], [4], [5], [6]. In the Oriental population, there is a lower incidence of the ingested foreign body in children compared to adults. In Singapore and Hong Kong, pediatric patients constituted between 6.5 and 14.32% of all reported cases of ingested

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