Review article
A systematic review of paediatric foreign body ingestion: Presentation, complications, and management

https://doi.org/10.1016/j.ijporl.2012.11.025Get rights and content

Abstract

Background

Foreign body ingestion is a common problem among paediatric populations. A variety of foreign bodies are ingested, some of which are particularly harmful and life threatening such as button batteries, magnets and bones. Common household items such as small toys, marbles, batteries and erasers are often ingested. The aim of this systematic review is to study the problem of foreign body ingestion among paediatric populations in terms of commonly ingested objects, and attempt to identify the link between location of impaction, associated symptoms, complications, spontaneous passage, methods and timing of removal.

Methods

A literature search of multiple databases including PubMed, Embase, Current Contents Connect and Medline were conducted for studies on foreign body ingestions. Based on strict inclusion and exclusion criteria, 17 studies were selected. A qualitative review of these studies was then performed to identify commonly ingested foreign bodies, symptoms, signs and complications of foreign body ingestion, rates of spontaneous passage and methods of retrieval of the ingested objects.

Results

Coins are the most commonly ingested foreign body. A variety of gastrointestinal symptoms such vomiting and drooling as well as respiratory symptoms such as coughing and stridor are associated with foreign body ingestion. The oesophagus, in particular the upper third, is the common site of foreign body obstruction. Objects in the stomach and intestine were spontaneously passed more frequently than at any other sites in the gastrointestinal system. Complications such as bowel perforations, infection and death are more commonly associated with ingestion of objects such as batteries and sharp objects such as bones and needles. Ingested objects are most commonly removed by endoscopic means.

Conclusion

Foreign body ingestion is a common paediatric problem. Batteries and sharp objects should be removed immediately to avoid complications while others can be observed for spontaneous passage. Endoscopy has a high success rate in removing ingested foreign bodies.

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

References (40)

  • J.E. Schunk et al.

    Pediatric coin ingestions: a prospective study of coin location and symptoms

    Arch. Pediatr. Adolesc. Med.

    (1989)
  • A. Nadir et al.

    Esophageal foreign bodies: 177 cases

    Dis. Esophagus

    (2011)
  • M. Waltzman et al.

    A randomized clinical trial of the management of esophageal coins in children

    Pediatrics

    (2005)
  • J.P. Dorst et al.

    Radiodensity of the proposed new penny

    Pediatrics

    (1982)
  • W.S. Crysdale et al.

    Esophageal foreign bodies in children: 15-year review of 484 cases

    Ann. Otol. Rhinol. Laryngol.

    (1991)
  • M.C. Uyemura

    Foreign body ingestion in children

    Am. Fam. Physician

    (2005)
  • J.P. Louie et al.

    Witnessed and unwitnessed esophageal foreign bodies in children

    Pediatr. Emerg. Care

    (2005)
  • L.B. Stack et al.

    Foreign bodies in the gastrointestinal tract

    Emerg. Med. Clin. North Am.

    (1996)
  • H. Hesham A-Kader

    Foreign body ingestion: children like to put objects in their mouth

    World J. Pediatr.

    (2010)
  • E. Panieri et al.

    The management of ingested bodies in children. A review of 663 cases

    Eur. J. Emerg. Med.

    (1996)
  • Cited by (135)

    • “Let anchoring bias go”: Not all stridor is croup

      2022, Visual Journal of Emergency Medicine
      Citation Excerpt :

      While viral croup is the most common cause of stridor in the pediatric population, it is important for the clinician to maintain an expanded differential diagnosis to ensure other possible etiologies are not overlooked. Viral croup typically presents with viral upper respiratory symptoms such as fever, cough, and congestion whereas foreign body ingestion, another common cause of inspiratory stridor in children, is typically associated with vomiting, drooling, and a lack of preceding viral symptoms.2,3 Stridor secondary to an ingested foreign body occurs due to external airway compression by an esophageal foreign body.3

    • “Necklace of magnets” in the abdomen: an unusual case with “multiple” bowel perforations

      2022, Medical Journal Armed Forces India
      Citation Excerpt :

      In the majority of cases, treatment is conservative.1 Among the varieties of foreign bodies, magnetic foreign body ingestion poses a significant problem, especially when more than one is ingested due to their ability of attraction toward each other across the intestinal layers, resulting in necrosis of bowel wall and perforation.2 Management of such cases depends on the duration of history, clinical presentation, number and location of ingested magnets, and complications.3

    View all citing articles on Scopus
    View full text