A prospective study of foreign-body ingestion in 311 children.
OBJECTIVE
To determine the preferable management protocol of foreign body ingestion in pediatric patients.


METHODS
All pediatric patients aged less than 12 years who presented with suspected foreign body ingestion in a hospital setting over a period of 3 years were prospectively studied. The usefulness of symptoms and various diagnostic procedures to identify the impacted foreign bodies were analyzed.


RESULTS
Of 311 children aged 4 months to 12 years, 115 foreign bodies were encountered. The presentations in children aged younger than 5 years were markedly different from the older children, who behaved more like adults. All sharp foreign bodies (107 cases or 93%), mostly fish bones (90.4%), were found in the oropharynx under direct vision using either tongue depressor (57%), Macintosh laryngoscope (6%), indirect laryngeal mirror (2%) or transnasal flexible endoscopy (28%). Coins (eight cases or 7%) were the only foreign body impacted at or below the level of cricopharyngeus. A plain cervical X-ray has a low sensitivity (15.9%) and a high specificity (99.5%) in identifying the foreign bodies.


CONCLUSIONS
As the majority of the foreign bodies were sharp bones and situated in the oropharynx, a management protocol involving examination with a tongue depressor, transnasal laryngoscope, selective lateral soft tissue neck X-ray, chest X-ray and watchful observation is usually adequate. Removal of these foreign bodies can be accomplished using a tongue depressor and Macintosh laryngoscope. Patients with a suspected coin ingestion have to be evaluated by X-ray, and a rigid pharyngo-oesophagoscopy should be the mainstay of treatment.
Division of Otorhinolaryngology, Department of Surgery, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong.
M
M
Wai Pak
W
W
Chung Lee
H
H
Kwok Fung
C A
CA
van Hasselt
D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D005547:Foreign Bodies / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007828:Laryngoscopy; D007830:Larynx; D008297:Male; D010614:Pharynx; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution