FOREIGN BODY INGESTION IN CHILDREN - AN EMERGENCY CONDITION REQUIRING IMMEDIATE EVALUATION

Accidental foreign body ingestion is common in pediatric practice. Young children, especially those under five years, tend to put different kinds of small objects from their environment into their mouths. Sometimes due to the still immature reflexes, they are unintentionally swallowed. Most often these are coins, followed by magnets, button batteries, toys or jewelry, but also many others. Luckily, in most cases, these foreign bodies pass through the gastrointestinal tract without causing any symptoms or injuries. Some of them don’t even get noticed or registered. However, it is estimated that in 10 to 20 percent of the cases there is a need for medical intervention. A critical condition is lodgment in the esophagus because it requires extraction as soon as possible. Most often it occurs in its upper third. At this location the object is able to cause serious clinical discomfort, requiring rapid approach. Even dyspnea by compressing the trachea is possible. Injuries of the tissues, particularly after delayed diagnosis and treatment, might be a further dangerous consequence. Especially lodged button batteries cause critical damage of the esophageal wall in a very short time due to an electrolysis reaction on the site of the negative pole. This generates an alkali burn that might lead to life-threatening complications as perforation, fistulas to the trachea or to major blood vessels. Lethal outcomes are reported. Studies have demonstrated the development of significant injuries even only two hours of impaction. This emphasizes the importance of initiation of the extraction immediately. Thus, in spite of the overall good prognosis clinicians have to be extremely alert when confronted with a child after foreign body ingestion. Immediate and profoundly evaluation is necessary in order to detect or exclude lodgment in esophagus- a condition requiring quick intervention. Especially when button batteries are involved time is crucial in order to prevent devastating complications.