Scribd Logo
Upload

Welcome to Scribd!

  • 9 views

    Paediatric Guidelines Foreign Body Ingestion 2018 1

    Uploaded by

    Bîcă Ovidiu
    Ghid chir ped

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Paediatric Guidelines Foreign Body Ingestion 2018 1

    Uploaded by

    Bîcă Ovidiu
    9 views5 pages
    Ghid chir ped

    Original Title

    Paediatric-Guidelines-foreign-body-ingestion-2018-1

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Ghid chir ped

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    9 views5 pages

    Paediatric Guidelines Foreign Body Ingestion 2018 1

    Uploaded by

    Bîcă Ovidiu
    Ghid chir ped

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 5

    Paediatric Clinical Practice Guideline

    Ingestion of foreign bodies (FB)


    Author: Miki Lazner in collaboration with P Das / K Iliadis / R Hallows
    Approved by: Medicines Governance Group July 2021
    Publication date: July 2021. Version 4
    Review date: July 2023
    See also: foreign bodies, hand held metal detector protocol on Brighton microguide

    Background

     Most ingested foreign bodies are harmless and pass through the Gl tract uneventfully
     Radio-opaque foreign bodies such as metal or some types of bone can be visualised
    on XR
     Most metal objects can be detected by a metal detector.
     Paper / wood / plastic objects may not be visualised

    Hazardous objects such as


    - Button batteries and other batteries
    - Sharp objects, especially if long >6cm or wide >2cm
    - Magnets e.g. fake tongue piercings / neodymium magnets
    - Very large objects / filled balloons

    Can cause life-threating injuries such as:


    1. Obstruction above the gastro-oesophageal junction, the narrowest part of the GI tract
    2. Bowel perforation / rupture
    3. Erosion from leaked battery contents or electrical currents discharged from button
    batteries leading to perforation or aorto-oesophageal fistula or trachea-oesophageal
    fistula.

    Assessment

    Symptoms and signs associated with FB in oesophagus:


     Dysphagia (difficulty swallowing)
     Food refusal
     Drooling / gagging
     Vomiting / haematemesis
     Sensation of FB / chest pain / sore throat
     Stridor / cough

    Management

    1. Non-hazardous, ingested foreign bodies


    2. Hazardous, ingested foreign bodies

    RACH Clinical Practice Guideline – Foreign body ingestion Page 1 of 5


    Paediatric Clinical Practice Guideline

    Non-hazardous ingested foreign bodies

    Radio-opaque fish Is FB radio-opaque or metallic?


    bones:
    Cod, haddock, cole,
    gurnard, lemon sole,
    monk fish, grey
    mullet, red snapper
    YES NO or unsure

    Metal detector Did child cough or display


    neck / chest / any symptoms of respiratory
    abdomen problems since ingestion?

    FB below FB above NO YES


    diaphragm diaphragm or
    or no FB metal detector
    test equivocal

    Tolerating food Tolerating food Consider CXR


    and no worrying and no worrying and refer to ENT
    symptoms? symptoms?

    XR chest
    +/-
    YES NO abdomen NO YES
    +/- neck

    FB above diaphragm / worrying


    symptoms / not tolerating food? **Upper oesophagus:
    Refer to ENT or Paediatric refer ENT
    Surgery**
    **Lower oesophagus:
    Likely admit for endoscopy refer Paediatric Surgery
    under GA

    Discharge home with reassurance and leaflet.


    DO NOT instruct parents to inspect faeces for FB
    Clinical / radiological review if becomes symptomatic Do not send home a child who
    is coughing, choking or
    Safety net: refusing to eat / drink after a
    1. Vomiting or haematemesis suspected ingestion
    2. Abdominal pain
    3. PR bleeding

    RACH Clinical Practice Guideline – Foreign body ingestion Page 2 of 5


    Paediatric Clinical Practice Guideline

    Hazardous ingested foreign bodies

    Do not use metal detector for hazardous FB – the child will usually require x-rays
    Passage of hazardous FB into the stomach is NOT an indication that the child will not suffer
    any complications.

    1. Hazardous foreign body (Not button battery or super strong magnet)

    Management pathway
    See separate pathways for Button batteries and super strong magnets

    Hazardous foreign body

    CXR
    If not seen or symptoms
    dictate, consider AXR +/-
    lateral soft tissue neck XR

    Upper oesophagus Lower oesophagus and


    stomach

    Refer ENT Refer Paediatric


    Surgery
    Keep NBM
    Admit for endoscopy Decision will be
    under GA made whether to
    allow to eat and re-
    XR in 24 hours, or
    remove immediately

    2. Button batteries

    XR is needed for all battery ingestions as the battery may be missed on a metal detector test

     Ingestion of button batteries can cause serious harm and death.


     Severe tissue damage results from a build-up of sodium hydroxide as a result of the
    electrical current discharged from the battery (not leaking of contents as is often
    thought).
    RACH Clinical Practice Guideline – Foreign body ingestion Page 3 of 5
    Paediatric Clinical Practice Guideline

     Tissue burns, often in the oesophagus, can cause fistulisation into major blood
    vessels, resulting in catastrophic haemorrhage.
     Symptoms suggestive include haematemesis, haemoptysis, and respiratory difficulties.
     Can manifest up to 28 days after ingestion.

    Urgent referral to ENT or Paediatric Surgery is mandated if button battery ingestion has
    occurred or is suspected. Consider this in all children presenting with haematemesis.

    Other types of batteries are less dangerous than button batteries but may leak from
    dissolution of seal in gastric acid. They can also attach to intestinal mucosa and cause
    erosion and perforation.

    3. Neodymium or ‘super strong’ rare earth magnets

    Extremely powerful magnetic attractions, widely available as toys, decorative items or fake
    piercings.
     Usually small in size and round in shape.
    Brand names include BuckyBalls™ and
    Neocube™

     When more than one magnet, or a


    magnet with a metallic object is
    swallowed, the magnetic force can bring
    two pieces of intestine tightly together,
    leading to ischaemia and pressure
    necrosis, the consequence of which can
    include:
    ulceration, necrosis, perforation, rupture,
    stricture, fistula, haemorrhage,
    mediastinitis, gastric outlet or bowel
    obstruction, volvulus, sepsis

    URGENT assessment and treatment is vital as although abdominal symptoms may not
    manifest for weeks after ingestion of magnets, intestinal injury can occur early, within 8-24
    hours following ingestion, despite the child often remaining well

    Consider the possibility of rare earth magnet ingestion or aspiration in patients with:
    stridor, wheezing or other noisy breathing;
    drooling; difficulty swallowing;
    coughing, choking or gagging when eating or drinking;
    vomiting; chest pain or discomfort;
    abdominal pain; decreased appetite or refusal to eat.

    RACH Clinical Practice Guideline – Foreign body ingestion Page 4 of 5


    Paediatric Clinical Practice Guideline

    Management

     Witnessed or suspected super strong magnet ingestion


     Magnet ingested with metal object
     Unexplained GI symptoms with availability of super strong
    magnets

    Urgent CXR and abdominal x-ray


    (patient lying down, ideally prone)

    If single magnet seen also get lateral


    abdominal x-ray

    Single magnet

    1. Symptoms or signs of Discharge criteria met?


    obstruction?
    2. Multiple magnets?  Single magnet ingestion
    3. Evidence of obstruction?  Accidental ingestion
     No co-morbidities
     Tolerating oral intake
     Presents within 24hr of
    ingestion
    Keep NBM No  Caregiver can provide close
    observation
    Refer to Paediatric Surgery
    Registrar for admission /
    treatment / repeat imaging
    Yes

     Patient advice leaflet


    Symptomatic at any time  Arrange follow up attendances to
    OR CED for repeat AXR at least 6-12
    Failure of magnet to hours apart until magnet is seen to
    progress but remains have passed through the stomach
    asymptomatic and is progressing through the small
    bowel or beyond.
     Ensure same position for the AXR
    on each occasion

    Progression of single magnet


    Discharge with safety netting (confirmed by radiologist)
    advice AND
    remains asymptomatic

    RACH Clinical Practice Guideline – Foreign body ingestion Page 5 of 5

    You might also like