Caustic Ingestions and Foreign Bodies Ingestions in Pediatric Patients

La ingestión de cuerpo extraño (CE) es un problema común en niños menores de 5 años, siendo una de las principales indicaciones para realizar endoscopias. El propósito de este estudio es describir las características clínicas, radiográficas y endoscópicas de pacientes con ingesta de CE, así como los factores asociados con la localización anatómica y el tipo de objeto ingerido.

Estudio transversal analítico del total de pacientes con ingesta de CE en el servicio de gastroenterología de enero de 2013 a diciembre de 2018. Los datos se analizaron con el programa SPSS®, y se obtuvieron frecuencias, porcentajes, medianas, rangos intercuartílicos y, además, se buscaron asociaciones mediante Chi-cuadrado.

Se incluyeron 85 pacientes, 52 varones y 33 mujeres, la mediana de edad fue de 4 años. El síntoma más común fue el vómito (29.4%). En el 72.9% de los casos se realizaron 2 proyecciones radiográficas, siendo el estómago el sitio donde se visualizó con más frecuencia (32.9%). Los objetos más comúnmente ingeridos fueron monedas (36%) con localización principalmente esofágica (p < 0.05), así como objetos con diámetro mayor a 2 cm (p < 0.05). En 76 pacientes (89.4%) se realizó algún procedimiento endoscópico para su extracción, encontrando eritema (28.9%), erosiones (48.6%), úlceras (10.5%) y perforación (1.3%).

En el abordaje por ingesta de CE en pacientes pediátricos, deben tenerse en cuenta numerosos factores, incluyendo tipo y tamaño del CE, tiempo transcurrido desde la ingesta, estado clínico y edad del paciente.

Foreign body (FB) ingestion is a common problem in children under 5 years of age and is one of the main indications for endoscopy. The aim of the present study was to describe the clinical, radiographic, and endoscopic characteristics of patients with FB ingestion, as well as the factors associated with the anatomic location and the type of object ingested.

An analytic cross-sectional study was conducted on all patients with FB ingestion seen at the gastroenterology service from January 2013 to December 2018. The data were analyzed using the SPSS program, obtaining frequencies, percentages, medians, and interquartile ranges. Associations were assessed through the chi-square test.

Eighty-five patients (52 males and 33 females) were included, with a median age of 4 years. The most common symptom was vomiting (29.4%). Two radiographic projections were carried out in 72.9% of the cases and the stomach was the site where the FB was most frequently visualized (32.9%). The objects most commonly ingested were coins (36%), with esophageal location (p < 0.05), as well as objects with a diameter larger than 2 cm (p < 0.05). An endoscopic procedure was performed on 76 patients (89.4%) for FB extraction, with findings of erythema (28.9%), erosion (48.6%), ulcer (10.5%) and perforation (1.3%).

Numerous factors should be taken into account in the approach to FB ingestion in pediatric patients, including type and size of the FB, time interval from ingestion to hospital arrival, and patient clinical status and age.

Poisoning by household cleaning products(HCPs) is common in children. Some HCPs are toxic and may cause severe complications. We assessed HCP poisonings treated in a pediatric emergency department(PED).

This was a retrospective study of patients aged under 18 years with HCP poisoning admitted to the largest PED in Taiwan from 2011 to 2020 were recruited.

The records over a 10-year period from 103 children admitted to the PED because of HCP poisoning(70 boys [68%] and 33 girls [32%]), mean age 3.54 years(standard deviation [SD] = 3.15 years) were evaluated. Most poisonings were unintentional(99%, n = 102) and occurred at home(96%, n = 99). The HCPs included alkaline(74%, n = 76), acidic(25%, n = 26), and neutral(1%, n = 1) agents. Most were orally ingested(86%, n = 89). Panendoscopy was performed in 25 patients(24%), and the endoscopic(Zargar) grade was used to determine the severity of injury. Medications(steroids [9%, n = 9], antibiotics [10%, n = 10], or antacids [30%, n = 23]) were prescribed. Alkaline HCP ingestion induced severe esophageal injury(p = 0.04) and esophageal stricture(p = 0.04). Five patients(5%) exhibited esophageal strictures and required balloon dilation. On multivariate analysis, alkaline HCP ingestion(p = 0.04), severe esophageal caustic injury(Zargar grade ≥ 3) (p < 0.001), and medications(steroids [p < 0.001], antibiotics [p < 0.001], and antacids [p = 0.001]) were associated with esophageal stricture.

Alkaline HCP ingestion and severe esophageal caustic injury(Zargar grade ≥ 3) were associated with esophageal stricture. Physicians tended to prescribe medications(steroids, antibiotics, or antacids) for patients with severe esophageal injuries to reduce the risk of esophageal stricture. The usefulness of these medications requires further study.

Foreign body ingestion and aspiration is a common cause of morbidity and mortality in the pediatric population. Aerodigestive foreign bodies usually occur in toddler age children and are often exploratory in nature. Coins are the most commonly ingested object, whereas food impaction is more prevalent in older children and adults. Coins and button batteries show subtle differences on radiographic imaging (single vs. double-halo). The distinction is important as button batteries require urgent removal. A detailed history and physical and a high index of suspicion despite negative imaging are required. Chronic pulmonary symptoms, such as cough or wheezing that persists despite maximal medical therapy, may be the only sign of a foreign body. Often, a diagnostic endoscopy may be required to definitively investigate the upper aerodigestive tract. Noncaustic esophageal foreign bodies can be observed for a short period of time to see if they are able to pass into the stomach. Caustic substances such as detergent, button batteries, and household cleaners require urgent endoscopy for removal or evaluation of soft tissue injury. Airway foreign bodies require immediate removal in the operating room. A team-based approach with cooperation between the anesthetist, surgeon, and operating room staff is required during these procedures. Early intervention can prevent acute and chronic complications, which can be devastating. Early complications include partial mucosal erosion, perforation, airway edema or obstruction, respiratory failure, infections, and even death. Late complications include tracheoesophageal or vasculature fistulas, strictures, mature airway stenosis, emphysema, and persistent pneumonias.

Foreign body and caustic ingestions in children are usually the most common clinical challenges for emergency physicians, general pediatricians and pediatric gastroenterologists.

Management of these conditions often requires different levels of expertise and competence.

Endoscopy is often necessary but there is a high risk of misusing this tool with incorrect timing and indications. The imprecise clinical history frequently leaves clinicians uncertain about timing and nature of the ingestion. Few clinical guidelines regarding management of these ingestions in children have been published, none of which from the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). An expert panel of Italian endoscopists was convened by the SIGENP Endoscopy Working Group to produce the present article that outlines practical clinical approaches to the pediatric patient with a variety of foreign body and caustic ingestions. The Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) has also endorsed the project since many adult endoscopists usually manage children with these conditions. Differently from the other published guidelines, the proposed one focuses on the role of the endoscopists (regardless of whether they are adult or pediatric gastroenterologists) in the diagnostic process of children with foreign body and caustic ingestions.

Eighty percent of caustic ingestions occur in children and esophageal neoplasms may develop as a late complication of such injury. The identification of biomarkers is a promising strategy to improve early diagnosis of esophageal cancer or caustic lesions that are at an increased risk of progression.

This study aimed at identifying global microRNA (miRNA) expression changes in esophageal mucosa from children with caustic stenosis. The study included 27 biopsy samples from 15 patients. Samples were divided into two groups, according to the time elapsed after injury (N = 15 in Group A, with less than five years of follow-up and N = 12 in Group B, with more than five years of follow-up). miRNA expression profiles were determined in each lesion, compared with normal esophageal tissues from control group. We used the TaqMan Human MicroRNA Arrays (Thermo Fisher) platform. Furthermore, bioinformatic algorithms were used to identify miRNA target genes and biological pathways including miRNAs and their target genes potentially associated with esophageal disease.

Thirteen miRNAs were significantly deregulated (9 over- and 4 underexpressed) in patients from Group A. In patients from Group B, two miRNAs were over- and two were underexpressed. Of note, miR-374 and miR-574 were deregulated in Group B patients and have been linked to esophageal tumorigenesis. We identified signal transduction and transcription factor networks with genes strongly related to development and progression of esophageal cancer.

miRNAs identified here contribute to a better understanding of pathways associated with malignant transformation from caustic stenosis to neoplastic lesions. This study may serve as a basis for validation of miRNAs, including miR-374 and miR-574, as potential biomarkers of early cancer detection.

Foreign body ingestions are a common occurrence in children. The initial presentation can vary from the child being completely asymptomatic to a variety of symptoms. Perforation of Meckel's diverticulum by foreign bodies is a rare cause of acute abdomen. It is usually diagnosed intraoperatively.

We herein report on an unusual case of a 3-year-old male child who came to the Emergency department with diffuse abdominal pain associated with bilious vomiting and diarrhea. The initial diagnosis was acute small bowel obstruction. After exploration, it turned out to be perforated Meckel's diverticulum caused by a swallowed chicken bone.