Endoscopic management of ingested foreign bodies in children: A retrospective review of cases, and review of the literature

Background: Foreign body (FB) ingestion by children is a common problem worldwide. Management may include endoscopic removal. This paper describes the clinical findings, sites and types of FBs, and outcomes in children who underwent endoscopic management of ingested FBs at our institution. The published literature regarding the management of FB ingestion in children is also reviewed. Methods: We retrospectively reviewed the records of all patients aged <14 years who underwent endoscopic management of gastrointestinal FBs between July 2002 and June 2012 (47 patients) and tracheobronchial FBs between December 2010 and June 2012 (17 patients) at our institution. Patient characteristics, clinical findings, sites and types of FBs, and outcomes were recorded. Results: The 47 patients with gastrointestinal FBs included 29 males and 18 females with a mean age of 3.5 years. The most common symptoms were difficulty with swallowing and vomiting in 16 patients (34%), chest pain in 10 (21%), and coughing and breathing difficulty in 7 (15%). The most common FB site was the esophagus (36 patients). Most gastrointestinal FBs were metallic, with coins being the most common. Endoscopic removal was successful in 43 patients. The 17 patients with tracheobronchial foreign bodies included 9 males and 8 females with a mean age of 3.2 years. The most common symptoms were breathing difficulty in 12 patients (71%) and coughing in 3 (18%). The most common tracheobronchial FBs were nuts (10 patients). Bronchoscopic removal was successful in all 17 patients. Conclusions: Coins were the most common gastrointestinal FBs, and nuts were the most common tracheobronchial FBs. Clinical presentations were variable, and a high index of suspicion is necessary. Endoscopic removal is safe and effective, and early diagnosis and management result in favorable outcomes.