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Aerodigestive Foreign Bodies in Children 331

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between the two magnets; therefore, it may be advisable to retrieve the Practical Hints and Tips
magnets while they are still accessible in the oesophagus or stomach. The endoscopist must be aware of the following situations:
When the ingested foreign bodies are not retrieved, patients and 1. There may be more than one foreign body. This situation is more
parents are advised to look for foreign bodies in the stool. If not egested common and relevant with tracheobronchial foreign bodies such
in a week to 10 days, repeat check x-rays are taken, and if no further as aspirated food items, nuts, and seeds. Therefore, a thorough
distal movement of the foreign body is demonstrated beyond the stomach assessment of the airway is important.
(see Figure 52.1), it is best retrieved endoscopically. Laparoscopic, or
laparotomy-assisted, retrieval may be indicated very rarely, except for 2. The suction device “tip” should not be used to remove the object
the situation of a secondary complication of obstruction or perforation. because it is not strong enough to hold the object during transit to the
One reason to attempt a proactive laparoscopic or laparotomy retrieval external world.
is the risk of a secondary complication outweighing the chances of 3. The dangerous end of sharp foreign bodies should be carefully
spontaneous passage of the foreign body. covered by the scope (in case of a rigid scope) or a flexible endoscope
Most of the endoscopic interventions are done as day procedures. protective sheath prior to removal (Figure 52.2).
Postinterventional care is straightforward and should be tailored to 4. Good haemostasis should be maintained.
the specific need. Antibiotics are administered only if complications 5. Repeat inspection of the airway or digestive tract for any evidence
are suspected.
of secondary or iatrogenic injury once the foreign body is retrieved.

Key Summary Points

1. Inhalation or ingestion of a foreign body by a child is a 4. Of utmost importance are a good history and clinical suspicion.
common accident that may cause significant morbidity or even 5. The treatment of choice remains endoscopic retrieval under
mortality.
general anaesthesia.
2. The situation worsens when the foreign bodies are initially 6. Success is ensured by careful assessment of the airways or
missed and then later the patient presents with pneumonia, oesophagus as well as foreign body size and shape prior to
atelectasis, abscess, or bleeds.
skilled endoscopy retrieval. 21
3. Radiography, fluoroscopy, bronchogram, CT, and MRI have all
been used to make a confirmatory diagnosis.

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