Approach to foreign body ingestion, method determines outcome.

Foreign body ingestion is a frequent presentation in pediatric population. However lack of a standardized protocol and varying approaches often lead to divergent outcomes in emergent cases. Presenting acutely, it is a source of significant patient and family distress as well as a variety of serious complications. With various management protocols advocating diverse strategies, formulation of a sound individual approach is imperative towards adequate patient handling. The dilemma is demonstrated by the course of two children we recently managed. One twenty one month old boy presented with severe respiratory distress and massive subcutaneous emphysema after a failed forceps removal following a coin ingestion the previous day (Figure 1). Contrast enhanced computed tomography showed a tear on the right side of the oropharynx leading to emphysema. The child was intubated and transferred to the intensive care unit where he was mechanically ventilated. On stabilization, a rigid esophagoscopy was performed which revealed a uvular tear and cricopharyngeal perforation that was discharging pus. Despite the successful removal of the coin with the esophagoscopy, the child developed mediastinitis and required two further weeks of broad-spectrum antibiotic therapy in intensive care before stabilization.