© Borgis - New Medicine 4/2009, s. 85-88
Lechosław P. Chmielik, *Magdalena Fršckiewicz, Mieczysław Chmielik
DIAGNOSTIC AND THERAPEUTIC DIFFICULTIES IN CASES OF FOREIGN BODY IN THE OESOPHAGUS IN CHILDREN TREATED IN THE PAEDIATRIC ENT CLINIC WUM IN 2005-2009. CASE REPORTS
Department of Paediatric Otorhinolaryngology, Medical University of Warsaw, Poland
Head of Department: Prof. Mieczysław Chmielik, MD, PhD
Summary
Foreign body in the oesophagus is a problem that may present many difficulties, both diagnostic and therapeutic. A retained foreign body in the oesophagus can cause many severe systemic complications.
Aim. Analysis of diagnostic and therapeutic proceedings in foreign body cases in children treated in the Paediatric ENT Clinic WUM.
Material. Children with a foreign body in the oesophagus treated in the Paediatric ENT Clinic WUM between January 2005 and June 2009.
Results. The authors analyzed diagnostic procedures and results of treatment regarding children with a foreign body in the oesophagus treated in the Paediatric ENT Clinic WUM.
Conclusions. 1. Every case of foreign body in the oesophagus should be verified by endoscopic methods. 2. Long-term retention of a foreign body in the oesophagus can cause serious consequences for the patient´s health and life. 3. In every case of foreign body in the oesophagus posterior-anterior and lateral chest X-ray should be carried out. 4. In cases of small non-radiopaque foreign bodies, radiogram of the oesophagus with cotton is necessary. 5. In children foreign body in the oesophagus can be a result of an unfortunate accident or criminal actions. 6. An extremely dangerous foreign body in the oesophagus is a button-type battery.
INTRODUCTION
Ingestion of foreign bodies among children is common (1) and is a problem that may present many difficulties, both diagnostic and therapeutic. Foreign bodies reach the oesophagus by accident, because of inattention during playing. They include coins, small toys, parts of toys, buttons and batteries. They can also be food elements, e.g. hard food pieces, animal bones and fish bones. It can also happen that the foreign body in the child´s oesophagus is a result of criminal actions (fig. 1).
Fig. 1. Cotton swabs removed from the oesophagus of a 10-day-old infant.
Retained foreign bodies in the oesophagus are located mostly in anatomical narrowings, as follows (2):
– most frequently – narrowing I (oesophagus mouth) in 44.3%
– between narrowings I and II in 28.1%
– narrowing II (crossing of aorta and bronchus) in 19%
– between narrowings II and III in 6%
– narrowing III (hiatus of diaphragm) in 2.5%
Symptoms of foreign bodies in the oesophagus include difficulties in swallowing, odynophagia, vomiting, and sialorrhoea (2, 5, 6).
In diagnostics we should use radiogram of neck, chest and abdomen (exclusion of perforation), radiogram of oesophagus with barite or cotton, computed tomography, and endoscopic examination (2, 6).
To remove a foreign body from the oesophagus we perform the following procedures: rigid oesophagoscopy and surgical removal in cases of extensive bleeding if the foreign body is penetrating the oesophageal wall or cannot be otherwise removed (2, 5).
Complications resulting from the foreign body can be divided into two groups: early complications include ulceration, inflammation of the oesophageal wall, perforation, inflammation of the mediastinum, injury of the aorta, and respiratory distress (1, 2, 3, 4, 5); long-term complications include tracheoesophageal fistula, oesophageal fistulas, and oesophageal stenosis (2, 5).
AIM
Analysis of diagnostic and therapeutic procedures of foreign body cases in children treated in the Paediatric ENT Clinic WUM between 2005 and 2009.
MATERIAL AND METHODS
In the period from January 2005 to June 2009, 45 children with foreign body in the oesophagus, 17 boys and 28 girls with medium age 3 years and 11 months (the youngest 10 days, the oldest 14 years and 5 months) were hospitalized in the Paediatric ENT Clinic WUM.
RESULTS
Among analyzed patients 28 cases of foreign body in the oesophagus were confirmed. No foreign body was found in 10 cases. Foreign bodies in distal parts of the alimentary tract were found in 6 cases. A foreign body was vomited in one case during hospitalization.
Table 1. Kind of removed foreign body.
| Kind of foreign body | Number of cases |
| Coin | 20 |
| Jewellery (earring, ring, pendant) | 3 |
| Part of toy | 2 |
| Battery | 2 |
| Button | 2 |
| Hair-pin | 1 |
| Bone | 1 |
| Wasp | 1 |
| Pill | 1 |
| Needle | 1 |
| Cotton swabs (9 pieces) | 1 |
The following complications of foreign body retention in the oesophagus were observed:
– concentric burn of oesophageal wall at site of battery´s retention – child transferred to the surgical ward,
– granulation at site of foreign body´s retention – 2 cases,
– bed-sore at site of foreign body´s retention – 4 cases,
– injury of mucosa – 5 cases.
Medium period of hospitalization was 2 days.
Table 2. Location of foreign body in the oesophagus.
| Location of foreign body | Percentage of cases (%) |
| narrowing I (oesophagus mouth) | 25 |
| between narrowings I and II | 29 |
| narrowing II (crossing of aorta and bronchus) | 25 |
| between narrowings II and III | 8 |
| narrowing III (diaphragm hiatus) | 8 |
Case # 1
A 2-year-old girl was admitted to the hospital because of sialorrhoea and vomiting after ingesting a metal pendant (scorpion-like). During examination she was anxious, without dyspnoea; in the oral cavity and pharynx retention of saliva was noted; vesicular respiration was normal. In the chest X-ray a radiopaque foreign body in the cervical part of the oesophagus was confirmed. The foreign body (a metal scorpion-shape pendant) was removed during rigid oesophagoscopy with forceps from the second oesophageal narrowing under general anaesthesia. Injury of mucosa of anterior-lateral and posterior oesophageal wall was observed. Dexaven and Augmentin were administered intravenously. The child stayed on empty stomach. On the first day after the procedure a control chest X-ray was done – the result was normal; liquid diet was introduced then pasty diet; no disorders of swallowing were observed. She was discharged in a good condition on the second day after oesophagoscopy (fig. 2, 2a).
Fig 2, 2a. Chest X-ray before and after removal of foreign body (metal pendant).
Case # 2
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Piśmiennictwo
1. Bhayani MK, Smith AD, Baroody FM et al.: Distal esophageal foreign bodies: Is it a common occurrence post-fundoplication requiring immediate intervention? Inter J of Ped Otorhinolaryngol 2009; 73: 377-81. 2. Otolaryngologia Dziecięca (red.) D. Gryczyńskiej, 2007. 3. Waltzman ML, Baskin M, Wypij D et al.: A randomized clinical trial of the management of esophageal coins in children. Pediatrics 2005; 116(3): 614-9. 4. Soprano JV, Mandl KD: Four strategies for the management of esophageal coins in children. Pediatrics 2000; 105(1): 1-5. 5. Otorynolaryngologia praktyczna (red.) G. Janczewskiego, 2005. 6. Bluestone, Stool, Alper et al.: Pediatric Otorynolaryngology. 7. Hamilton JM, Schraff SA, Notrica DM: Severe injuries from coin cell battery ingestions: 2 case reports. 8. Samad L, Ali M, Ramzi H: Button battery ingestion: hazards of esophageal impaction. J Pediatr Surg 1999; 34: 1527-31. 9. Kost KM, Shapiro RS: Button battery ingestion: A case report and review of literature. J Otolaryngol 1987; 16: 252-7. 10. Al-Qudah A, Daradkeh S, Abu-Khalaf M: Esophageal foreign body. Eur J Cardiothorac Surg 1998 May; 13(5): 494-8.
