Foreign Body in Upper Digestive Tract A.M. Shivakumar, Ashok. S. Naik, K.B. Prashanth, B.S. Yogesh and Girish F. Hongal Department of E.N.T., Bapuji Hospital J.J.M. Medical College, Davangere, Karnataka, India Abstract. Objective : Foreign body ingestion is a common clinical problem, encountered in children. Methods : A total number of 104 patients with ingested foreign body admitted in our hospital are reviewed. Endoscopic removal was done for all foreign objects impacted in esophagus. Result : In 84.6% cases, history of having swallowed the foreign body was most common symptom. Majority of patients (81.53%) presented within 24 hours after ingestion of foreign body. Coins were the most frequent offending agents in children (87.5%). Seventy six cases of coins were impacted in the postcricoid region. Complications of retropharyngeal abscess was seen in two cases (1.92%), which was associated with sharp foreign body. Conclusion : Early removal of these sharp foreign bodies must be considered to reduce the risk of this complication. [Indian J Pediatr 2004; 71 (8) : 689-693] E-mai/: drprashanthkb@recfiffmai/.com Key words : Foreign body; Pharynx; Esophagus Foreign body ingestion is common in children. Foreign body are ingested accidentally, especially in children and occasionally homicidal. Most common foreign bodies in paediatric age group are coins I but, marbles, safety pins, button batteries and screws are also reported 2. Foreign bodies with smooth edges usually do not pose much problems but sharp foreign object which is not retrieved at the earliest may penetrate the wall and cause complications. Most of the foreign bodies which have gone beyond the esophagus will pass uneventfully through the intestinal tract. Radiologic localization of these foreign bodies is mandatory? With advances in endoscopic techniques, foreign bodies can be removed safely in younger children which is done under general anaesthesia. The authors are reporting their experience of one hundred and four foreign bodies seen in the unit at Bapuji Hospital. MATERIALS AND METHODS Children who were brought with history of ingestion of foreign body between January 1998 to December 2002 are included in this study. A total of 104 cases of upper gastrointestinal foreign body in children were treated in our unit at Bapuji Hospital. Children with history of ingested foreign bodies were clinically examined. Routinely neck and chest X-rays were obtained for these cases. In cases of blunt foreign body, esophagoscopy was done within 24 hours, but in case of sharp object it was done as an emergency procedure. In such cases of sharp foreign body, endoscopy was deffered only until Correspondence and Reprint requests : Dr. A.M. Shivakumar,E.N.T. Surgeon, A.V.K.College Road, 2nd Main, EJ. Extension,Davangere- 577 004,Karnataka, India. preoperative studies were performed and the patient was prepared optimally for the operation. All the patients underwent esophagoscopy in the operating room under general endotracheal anaesthesia with intravenous succinylcholine muscle relaxant. Rigid esophagoscope of appropriate size depending upon the age was used. Different types of foreignbody forceps were utilized to remove the foreign body. After removal, oesophagoscope was reinserted and site of foreign body lodgement was examined for any mucosal erosion or for a possible second foreign body. After the procedure, cases were monitored in ICU. RESULTS Of the 104 patients, 68 were males and 36 were females (Table 1). Age of the patient ranged from 10 months to 14 years. Foreign body was commonly seen in children between the age group 2-6 years (60.5%). Most of cases TABLE 1. Age And Sex Distribution Age in years Male Female 0-1 3 3 1-2 5 7 2-3 18 4 3-4 9 4 4-5 13 3 5-6 7 5 6-7 1 1 7-8 3 2 8-9 2 2 9-10 3 3 10-12 2 1 12-14 2 1 TOTAL 68 36 Indian Journal of Pediatrics, Volume 71--August, 2004 689