Only in the Warsaw Clinic of Gastroenterology and Nutrition for Children, at least one procedure is performed to remove a foreign body from a child’s gastrointestinal tract per day. Toddlers are curious and the number of dangerous items around them increases. On the other hand, parents often do not realize what the consequences of swallowing granules to push the sink, battery or a plastic key from the computer keyboard …
- Doctors have a large collection of items that they recovered from children’s bodies. These include, among others: coins, hairpins, toys and dental drills
- – When a child is choking and then it goes away, parents should check what they used to play – says prof. Peter Albrecht
- Not all swallowed objects appear on X-rays, e.g. we will not see: glass, wood and most plastics
- You can find more such stories on the TvoiLokony home page
Monika Zieleniewska, MedTvoiLokony: Can we determine the age of a child when he swallows small items most often?
Prof. Piotr Albrecht: Generally speaking, this is between one and a half and three to five years. However, there are the so-called accidental swallowing also in older children. We had a teenager from the psychiatric ward who unscrewed 3cm screws and then swallowed them. It happened that they went all the way to the large intestine, where they got stuck on some bend, so we took them out by colonoscopy. We also had a giant sewing needle accidentally swallowed. The girl who was sewing put it in her mouth, and her sister slapped her on the back and the needle flew … In this case, fortunately, she left the digestive system unchanged and without causing any harm.
What items are most often swallowed?
At the moment, various types of magnets and watch batteries are the most commonly swallowed, of course coins, needles, pins, plastic toys, hairpins, etc. We collect these items in two metal boxes. What is not there … There are dental drills, a rider without a horse, dozens of coins, numismatic items, for example, we have 50 groszy before the war.
Children crawl under the sofas under which the coins lie and swallow them with curiosity. Recently, I was taking a key from a computer keyboard for a 9-month-old child, specifically the letter «k».
In addition, they swallow various gels and washing capsules, but maybe this is not the most dangerous, because they usually contain no lyes or acids, and the main soap, but requires gastroscopy to assess whether the esophagus has been damaged (burned) .
- See also: First aid for chemical burns
It looks like the problem is still valid regardless of the passage of time.
We have far more cases of ingestion of foreign bodies and chemicals than in the past. This is because, on the one hand, there are more and more of these things in the child’s environment, and on the other hand, unfortunately, parents are insufficiently informed about the dangers ahead and do not pay attention to what the child puts in the mouth. Nobody warns them or warns them too seldom.
Yet it is known that just as a child can burn himself, he can also swallow something. Of course, everyone is different, there are children who put everything they can in their mouths and those who are not in the habit of doing it. The first ones just have to be guarded and remove small items from their reach.
There are things that are extremely dangerous to swallow. What is it and what is the risk?
Children can swallow a pellet of lye to clean out sinks, which is dramatically dangerous, or drink it. Batteries may have a voltage that will cause burns. Liquor may also overflow, which in turn causes leachate necrosis.
What is spread necrosis?
This necrosis is similar to that caused by burns, but it penetrates deep into the tissues. If we are burned with acid, the epithelium on top is damaged and the burn does not penetrate deeper. In the case of lye, on top you can hardly see anything on the top, but the substance penetrates deeply to the point that it can cause perforation. Burning the esophagus with lye can narrow it to the point that it is impossible to swallow. This is when surgery with stents or other techniques becomes necessary.
Even if nothing happens temporarily after a caustic burn in the esophagus, the risk of cancer (esophageal cancer) increases enormously. We had cases of esophageal cancer in children after just such a burn. It normally occurs in advanced adulthood and, after ingestion of lye at 2 years of age, developed in a 16-year-old. I would add that esophageal cancer is usually incurable.
And this 16-year-old actually died?
Tak.
Can parents identify when a child has swallowed an object?
If they do not notice this, they may notice that the baby is choking. However, if there are no symptoms and no one has seen anything, there is no way to go about it. When a child is choking and then getting over it, they should become suspicious and see what their play is. Unfortunately, parents tend to look at ceilings more than the floor, so they generally can’t see anything. And now the scale of this phenomenon resembles an epidemic, not a day goes by that we do not take out something.
How many such cases do you have a day?
One is already a lot, and sometimes there are two and three.
Perhaps parents should take some remedial measures at home when they discover that the child has swallowed something?
If you know that your child has swallowed lye or acid, you can give him or her plenty of water to drink to dilute these substances. However, care must be taken not to provoke vomiting, as whatever has entered the stomach will come back through the esophagus and burn it again. It is also not allowed to add acid to the lye, and vice versa, because it can cause more harm than good.
Does it happen that you have to repair the damage caused by parents who tried to help the child on their own or followed the advice of inexperienced doctors?
We had such a case recently. He was largely to blame for COVID-19 and treatment over the phone. We treated a child who had a battery in the esophagus for nearly a month. A small perforation appeared in the aftermath, which thankfully closed, but there was also an abscess between the esophagus and the trachea. There is secondary narrowing of the trachea and esophagus. I have 16 thousand behind me endoscopy, so I would not give such recommendations even over the phone. Here a lot also depends on how the interview is collected, what the child’s parent says. Many things can be learned if we ask questions well, experience is what counts.
In order to locate a foreign body, you take an x-ray.
Always X-rays should cover the distance from the teeth to the other end of the digestive tract. On its basis, we locate the object that shades, because it is the only object that appears in the photo.
What materials cannot be seen on the X-ray?
Glass in a small amount, wood, bone, most plastics, plastic toys. Therefore, we do not know if they have been swallowed for sure, are they still in the digestive tract, or if they have already been excreted …
So all parts of plastic toys are undetectable?
It is not without reason that there are trumpets about toys recommended for children, e.g. under 3 years of age and over. You can break the wheel from some cars and swallow them without any problems. There are also those that are much more difficult to undress. A good toy intended for a given age usually cannot be torn off with your fingers. Of course, you can also recommend that you buy your kids bricks that are shading so you can see them on an x-ray. We checked it on ourselves by covering the block with our hand and then taking a photo. It shades everything that is metal, such as paper clips, magnets, watch batteries, coins, keys, hair clips. The latter are often swallowed open, which makes it difficult to remove them because you can make a hole in the esophagus.
How do you remove what comes out on x-rays?
Endoscopically. On the other hand, if it travels further than the stomach, or, say, the initial part of the duodenum, it is gone. Either it comes out the other way or not, and then it can lead to perforation and surgery will be necessary.
Do such operations happen often?
Fortunately, rarely, generally swallowed, if it is not very large or sharp, sooner or later it comes out the other side. But magnets, for example, can get stuck somewhere in contact with the intestinal wall and lead to perforation.
How long does it take to remove a foreign body from a child’s digestive tract?
Now a long time because of the coronavirus pandemic. Of course, if there is no indication that it must be removed immediately, because it is in the esophagus. If there are no such indications, the procedure begins after receiving the results of the COVID-19 test.
Do you test all the little patients?
If we get infected, the next day or a few days later it may turn out that there will be no one to perform an endoscopy.
How long does it take to get my test result?
Sometimes a test is available that gives a result after four hours. And if we need to perform the procedure earlier, we do it in full gear. The anaesthesiologist, nurse, endoscopist must be dressed from head to toe. And put on two pairs of gloves. We had single positive patients from March to now, but now some childhood COVID-19 is encountered almost daily.
In what cases do you decide to perform the procedure immediately?
The rule is that if something is in the esophagus, it must be removed within 24 hours of ingestion, and preferably as soon as possible. If it’s in the stomach, we can wait a while. It depends of course what it is, because if it is a dangerous item, it can’t go any further. Then you also have to hurry, because no one will catch this object below the stomach. So we have to take out dangerous objects, that is long, sharp ones, as soon as possible.
Do you keep a little patient in the hospital after surgery?
The child usually stays in the hospital until the next day, unless we cannot find what she swallowed. Then we wait for the object to leave the digestive tract with the other side. The parent must sift the stool through a strainer and search.
If we know something has been swallowed and is shading, we check to see if it shifts. Every now and then we make x-rays, because if it does not move, there is a risk of perforation. If the item is already outside the stomach, we give laxatives. Sometimes the foreign body stops at the junction of the small intestine with the large intestine in the Bauhin valve. Then the endoscope comes in, and if it is higher, only the surgeon remains.
Prof dr hab. n med. Piotr Albrecht works at the Department of Gastroenterology and Nutrition for Children at the Medical University of Warsaw, where he removes foreign bodies swallowed by young patients on a daily basis. He has 16 endoscopies under his belt.
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