Foreign Body Ingestion in Children

Abstract

Foreign body (FB) ingestion in children is common and most children are observed to be between 6 months and 3 years of age. Although most FBs in the gastrointestinal tract pass spontaneously without complications, endoscopic or surgical removal may be required in a few children. Thus, FB ingestion presents a significant clinical difficulty in pediatric gastroenterological practice. Parameters that need to be considered regarding the timing of endoscopic removal of ingested FBs in children are the children's age or body weight, the clinical presentation, time lapse since ingestion, time of last meal, type as well as size and shape of the FB, and its current location in the gastrointestinal tract. Esophageal button batteries require emergency removal regardless of the presence of symptoms because they can cause serious complications. Coins, magnets, or sharp FBs in the esophagus should be removed within 2 hours in symptomatic and within 24 hours in asymptomatic children. Among those presenting with a single or multiple magnets and a metallic FB that have advanced beyond the stomach, symptomatic children need a consultation with a pediatric surgeon for surgery, and asymptomatic children may be followed with serial X-rays to assess progression. Sharp or pointed, and long or large and wide FBs located in the esophagus or stomach require endoscopic removal.

Keywords: Child; Endoscopy; Foreign bodies.

Fig. 1.

Button batteries. (A) Button batteries of various sizes. (B) A radiograph showing the characteristic halo sign’ of a button battery lodged in the upper esophagus.

Fig. 2.

Management of coin ingestion in children. NPO, nil per os.

Fig. 3.

Endoscopic view of the upper esophagus in a 13-month-old infant who had ingested a button battery measuring 15 mm in size 24 hours prior to presentation. (A) Button battery lodged in the upper esophagus with an associated ulcer can be observed. (B) and (C) Esophageal injury after removal of the button battery. (D) A 15-mm sized button battery has been removed using endoscopy and a syringe used for measuring the battery size.

Fig. 4.

Management of button battery ingestion in children.

Fig. 5.

Multiple magnets ingested by a 10-year-old boy with mental retardation. (A) X-ray view: multiple magnets can be observed in the stomach (10 magnets) and duodenum (2 magnets in the right-sided abdomen). (B) Endoscopic view of the stomach: magnets can be observed lodged between the stomach and the duodenal bulb.