Christopher P. Coppola, Alfred P. Kennedy, Jr. and Ronald J. Scorpio (eds.)Pediatric Surgery2014Diagnosis and Treatment10.1007/978-3-319-04340-1_38
© Springer International Publishing Switzerland 2014
Foreign Body Ingestion and Aspiration
(1)
Department of Pediatric Surgery, Janet Weis Children’s Hospital, 100 N. Academy Av. MC 21-70, Danville, PA 17822, USA
Abstract
Ingestion of foreign objects and substances is a danger to children once they become mobile in their environment through crawling and before they develop the knowledge to avoid putting non-food objects in their mouths. Some ingestions cause serious and lasting damage to the aerodigestive tract.
Ingestion of foreign objects and substances is a danger to children once they become mobile in their environment through crawling and before they develop the knowledge to avoid putting non-food objects in their mouths. Some ingestions cause serious and lasting damage to the aerodigestive tract.
1.
Pathophysiology:
(a)
Demographics and risk factors:
(i)
Uncommon in age less than 6-months-old because children usually cannot find objects to swallow until they are able to crawl around. An exception to this rule is when older siblings provide objects for younger children to ingest.
(ii)
The behavior is uncommon after age 2-years-old; however there are exceptions due to children acting out or taking dares with peers at older ages.
(iii)
In households where cleaning products or other caustic substances are stored in containers intended for food or drink, there is an increased risk of ingestion by children.
(b)
Ingestion of foreign objects:
(i)
Coins are the most commonly swallowed objects.
(ii)
Button batteries are particularly dangerous. They can cause tissue damage within a few hours. Potential injuries are burn, stricture, perforation, and fistula to vocal cord, trachea, esophagus, and arterial structures. Death is possible, in particular with aortoenteric fistula. All swallowed objects must be evaluated to determine if they are a button battery or similar injurious object.
(iii)
Swallowed magnets can be a danger. A solitary magnet will usually pass easily if it is small enough, but when multiple magnets are swallowed, they can cause perforation when magnets in neighboring loops of bowel cause pressure necrosis of the bowel walls between them. Magnets are present in household objects, jewelry, and some toys.
(iv)
Food impactions can lodge in the esophagus. This may be due to poor chewing, motility disorder or anatomic obstructions such as webs or strictures.
(v)
Children can swallow narcotic packets either through error when they are left in reach or through intentional exploitation of the child for drug smuggling.
(vi)
Any object that passes the lower esophageal sphincter will usually pass through the entire gastrointestinal tract.
(vii)
Sharp objects such as fish bones, pins, needles, and screws can lodge in the wall or cause perforation of the esophagus. If they pass to the stomach, most will pass through the gastrointestinal tract. Rarely can lodge in the appendix.
(c)
Ingestion of caustic substances:
(i)
Poison control should be contacted to determine components of ingested substances, determine potential for injury, and discuss treatment options.
(ii)
American Association of Poison Control Centers: 1-(800)222-1222.
(iii)
Acids:
1.
Battery acid, cleaning products.
2.
Cause coagulation necrosis of mucosa.
3.
Appears hemorrhagic or erythematous.
4.
Usually injure stomach more than esophagus.
(iv)
Alkalis:
1.
Lye, drain cleaner.
2.
Cause liquefaction necrosis.
3.
Injure esophagus more than stomach.
4.
Cause deeper injuries and are prone to scarring and stricture.
5.
Appear as pale tissue, sometimes with denuded ulcers.
(d)
Aspiration of foreign object:
(i)
Objects commonly aspirated are seeds, nuts, small toys, and coins.
(ii)
Represent a true emergency, and small movements in the position or orientation of the object can turn a partial airway obstruction into a complete asphyxiation.
(iii)
Blockage of the trachea is immediately apparent; blockage of a bronchial branch may not become apparent until pneumonia develops.
(iv)
Some objects with natural oils or chemicals can cause a chemical or allergic pneumonitis.
2.
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Clinical presentation:
(a)
Parents will usually present after witnessing child swallowing object.
(b)
Patient may present with difficulty eating, swallowing, or breathing.
(c)
Patient may present with recurrent pneumonias.
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