|ECR 2019 / C-3297|
|Beware of what your child is eating!|
Findings and procedure details
We performed a retrospective search of pediatric patients with foreign bodies. Patients either presented in Emergency Department with history of foreign body ingestion / aspiration or were found to have ingested foreign body as an incidental finding in Radiological examinations done for other indications. Multimodality imaging spectrum also includes complicated cases of foreign bodies, foreign bodies in vagina as well as in soft tissues.
Radiography is the first imaging modality of choice. Frontal and lateral projections are crucial for exact localization. Imaging of the neck, chest and abdomen is preferred to look for possible multiple foreign bodies (Fig 25).
Imaging is required for detection and localization of foreign body as well as for identification of possible complications.
Ingested foreign bodies
Coins are among the most common and relatively safe ingested foreign bodies. On radiographs they have metallic density, flat surface and sharp edges. Recognition of the foreign body as coin, its localization and detection of complications is the prime role of radiologist in cases of foreign body ingestion. In our series of cases, children in whom the coins were present in esophagus were managed by endoscopy without any complications (Fig 1,3 & 4). In those cases (Fig 2) where the coins were seen to be in stomach or distal bowel loops in initial radiographs, children were just observed and followed up radiographs were prerformed, in almost all of them the coin passed in stools within next few hours without any symptoms or complications.
Among batteries, disk/ button batteries are most common and dangerous, requiring aggressive management. They have bilaminar structure, appearing as double ring on enface and with beveled edge on profile views. It is crucial to distinguish them from coins because of the associated high risk of comlications including erosion, stricture, perforation and fistula formations (Fig 5).
In our cases, the esophageal disk / batteries were managed by endoscopic removal (Fig 5). For batteries in stomach, small and large bowel loops the patients were kept under observation and follow up radiographs were done (Fig 6 & 7). If the battery was seen in same location, battery was immediately removed by endoscopy. However, if there was distal passage of battery on follow up radiograph, prompt managemant was not suggested as the battery was expected to pass in stools in those cases.
These include pieces of toys legos, hooks, screws and mettalic caps and clips (Fig 10, 12, 13, 14, 15 & 16). For those in esophagus, requires prompt removal however, distal to the esophagus, observation and follow up radiograph can help to decide the managment either conservately or by endoscopic removal.
Aspirated/ Inhaled foreign bodies
The management depends on the clinical status of the patients however, most of the cases require prompt removal (Fig17,18,19,20,21).
Subcutaneous or deep tissues foreign bodies
These are usually seen in cases of trauma and may go un-noticed until the patient develops pain and swelling at the site.
Radiography is the first imaging modality of choice (Fig. 22, 23 & 24) However in cases of foreign bodies in superficial subcutaneous tissues, ultasound can play an important role for the detection of foreign body as well as also for looking of possible complications (Fig. 25).
Vaginal foreign bodies
It is rarely seen in small girls and needs a high index of suspicion by mothers and pediatricians. Ultrasound can play diagnostic role in cases of suspected vaginal foreign bodies, eliminating the risk of radiation exposure to gonads(Fig. 27).
Thematically related posters
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Detection of non-metallic foreign bodies of gastrointestinal tract in emergency pediatric practice.
ECR 2019 / C-3238
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