Review articleA systematic review of paediatric foreign body ingestion: Presentation, complications, and management
Introduction
Foreign body ingestion is a common problem in paediatric populations with up to 75% of cases occurring in children under 4 years of age [1], [2], [3], [4]. A variety of foreign bodies are ingested by children, some more harmful and life threatening than others. Typically, ingested foreign bodies include common household items such as small toys, marbles, batteries, erasers, etc. However, coins are reported to be the commonest type of object ingested by children, accounting for up to 70% cases of paediatric foreign body ingestion [5], [6], [7], [8], [9].
Most ingested foreign bodies either pass through the gastrointestinal system spontaneously [10], [11] and without complication, or they may become impacted, most commonly at one of the sites of anatomic constriction in the oesophagus [12]. The commonest site of impaction is in the upper oesophagus, at the level of the cricopharyngeus muscle, accounting for over 75% of all cases of foreign body impaction [13]. Less frequently, objects may become impacted in the mid oesophagus at the level of the aortic arch or left main bronchus, or in the lower oesophagus at the gastro-oesophageal junction [14]. Foreign bodies that pass beyond the gastro-oesophageal junction usually pass through the alimentary tract without complications [14]. In fewer than 10% of cases, foreign bodies may impact within the intestines [15].
Foreign body impaction may result in complications such as mucosal abrasions within the gastrointestinal tract, bleeding, gastric outlet obstruction, oesophageal or gastrointestinal perforation and secondary mediastinitis, peritonitis, abscess or fistula formation [16], [17], [18], [19]. Therefore, impaction is generally a strong indication for foreign body removal.
A variety of methods for identification and removal of an impacted coin have been studied and described such as the use of rigid and flexible oesophagoscopy, McGill's forceps, Foley catheter extraction and oesophageal bougienage [1], [6], [20], [21].
This systematic review is aimed at determining the significance of foreign body ingestion among paediatric populations in terms of location of impaction, associated symptoms or complications and methods of removal.
Section snippets
Search strategy
We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses PRISMA guidelines in performing our systematic review. A systematic search of the databases MEDLINE (from 1950), PubMed (from 1946), EMBASE (from 1949) and Current Contents Connect (from 1980) was conducted through to September 20, 2012, to identify relevant articles for the systematic review. The search used the terms ‘oesophageal’, ‘gastric’, ‘intestinal’, ‘ingested’, ‘foreign body’, ‘child’ and ‘paediatric’
Study characteristics
Seventeen studies were selected for our systematic review based on the inclusion and exclusion criteria applied. There were five studies from USA, three from Turkey, two from Hong Kong, two from Brussels and one each from Canada, United Kingdom, Greece, South Korea and South Africa. Fourteen of the 17 studies were retrospective case series and the remaining 3 were designed as a prospective cohort study. Only 2 of the 17 studies exclusively studied coin ingestion. Of the remaining 15, coins were
Discussion
A variety of foreign bodies are ingested by children, of which coins appear to be the most common. In some instances, where coin ingestion is witnessed or self-reported, the child may be asymptomatic on presentation. However among symptomatic children, a wide variety of clinical manifestations are reported. They vary from gastrointestinal symptoms such as dysphagia, vomiting and drooling, and respiratory symptoms such as coughing, choking and wheezing. Airway symptoms are less common with
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