CAPS Original paper
Esophageal foreign bodies in the pediatric population: our first 500 cases

https://doi.org/10.1016/j.jpedsurg.2006.01.022Get rights and content

Abstract

Background

Children with esophageal foreign bodies are frequently seen by pediatric surgeons. Choking and dysphagia are common presentations; however, esophageal perforation has been reported. Historically, rigid esophagoscopy with extraction of the foreign body has been the recommended treatment. Alternatively, Foley balloon extraction is a safe and effective approach.

Methods

Over a 16-year period, 555 children presented with an esophageal foreign body. Retrospective analysis of the medical record was undertaken. Statistics were by univariate analysis.

Results

Two hundred ninety-eight boys and 257 girls presented with a mean age of 3.24 years. Dysphagia (37%) and drooling (31%) were the most common symptoms. Foreign bodies were lodged in the superior esophagus in 73%, and 88% of the objects were coins. Balloon extraction with fluoroscopy was performed in 468 children. Eighty percent of the objects were successfully removed with a mean fluoroscopy time of 2.2 min, and 8% were advanced into the stomach. The overall success rate was 88%, with failures necessitating rigid esophagoscopy under general anesthesia. Children younger than 1 year were the most likely to fail (25% failure rate). Airway aspiration never occurred. Significant savings in patient charges were observed with this approach.

Conclusions

Balloon extraction of pediatric esophageal foreign bodies is a safe and cost-effective procedure. This technique is applicable for infants, children, and adolescents. Experienced practitioners should be able to achieve greater than 80% success rate.

Section snippets

Methods

Over the 16-year period from January 1988 to October 2004, 555 children presented to the emergency department at Children's Mercy Hospital, Kansas City, Mo, with a foreign body lodged in the esophagus. After institutional review board approval, the medical records were queried for patient demographics and presenting symptoms. Imaging studies were reviewed. When available, fluoroscopy time was noted. Patient charges for balloon extraction and operative rigid esophagoscopy were compared.

Results

A total of 555 children (298 boys and 257 girls), aged 2 months to 19 years, were included in the study. The mean age was 3.24 years (2 months to 19 years). Dysphagia, drooling, and choking were the most common presenting symptoms (Fig. 1). Chest roentgenograms were obtained in 93% of the children. Additional imaging included dedicated neck radiographs (29%), abdominal films (27%), and esophagrams (6%). Foreign bodies were most commonly identified in the superior esophagus (Fig. 2). Although

Discussion

In 1966, Bigler [14] reported a method of extracting smooth esophageal foreign bodies using a Foley balloon catheter. In his original article, Bigler reported the successful removal of a coin and a jack from 2 children. He hypothesized that distension of the Foley balloon inferior to the foreign body would dilate the esophagus, free the impaction, and allow safe extraction of the foreign body. Over the following 40 years, esophageal foreign bodies have become a relatively common problem shared

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  • Cited by (0)

    Presented at the 37th Annual Meeting of the Canadian Association of Paediatric Surgeons, Quebec, Canada, September 22-25, 2005.

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