Learn about the types of gastrointestinal foreign bodies in children

Posted by Doctor Ta Que Phuong - Department of General Internal Medicine - Vinmec Times City International Hospital

The gastrointestinal foreign body is an endoscopic gastrointestinal emergency. This accident is common in children under 5 years old. There are many different causes of digestive problems in children. Digestive foreign bodies are usually caused by children not actively swallowing but accidentally swallowing objects that are too large or angular, falling into the digestive tract and not being digested. In rare cases, the child has a neurological or mental defect.
Commonly ingested items include coins, button batteries, toys, toy parts, magnets, screw pins, marbles, bones and food bolts.

Coins are the most common foreign body ingested by children.

The number of battery and button foreign bodies has increased with the use of button batteries in household and entertainment products. Serious sequelae (eg, esophageal burn, perforation, or fistula) occur in approximately 3% of all cases of button battery ingestion. In addition to direct necrosis, contact of the flat esophageal wall with both poles of the conductive battery leads to liquefaction necrosis and esophageal perforation. Retained batteries can also cause problems through leakage of caustic materials (in general, batteries contain a heavy metal such as mercury, silver, lithium, and strong hydroxides of sodium or potassium).

Objects that enter children's intestines include staples, needles, straight paper clips, and fish bones; accounts for 10-15% of swallowed foreign bodies. Sharp objects have a high risk of puncture (15-35%). When placed in the subnasopharynx, they can cause bronchial abscesses. Eat toothpicks and bones that have the ability to punch holes.

Meat or fish bones are the most common esophageal foreign bodies in adults but are relatively rare in children. Children with food foreign bodies often have underlying esophageal disease (eosinophilic esophagitis, stricture, or esophageal motility disorder).

With the increasing use of small magnets in toys and household items, ingesting magnets has become a serious health hazard in children. High power magnets consisting of neodymium (also known as rare earth magnets) are now common components of household appliances. These magnets are also commonly available as table toys and stress relievers (e.g. Buckyballs), consisting of 200 small, cube-shaped, or cylindrical magnetic balls. Although these are marketed to adults, they have been linked to many ingestion incidents in children. Many children who develop complications from ingesting multiple magnets have underlying conditions such as developmental delays or autism. In some cases, an older child has accidentally swallowed these magnets while using them to mimic a punctured tongue, so the risk isn't just limited to young children. In 2011, the Product Committee Consumer Safety Products USA has issued a warning describing the safety risks of these magnets, and legislation to restrict the sale of these products remains controversial.

These foreign bodies require special attention to ensure that the hazards involved are appropriately addressed. For example, "fidget spinner" toys with lights or motors that include button batteries, with risks associated with serious esophageal injury. They also contain radioactive and radiopaque components, which can rupture and progress. exclusively in the gastrointestinal tract.

Long, blunt foreign bodies, such as toothbrushes, batteries, and spoons, are commonly eaten by the oldest children, adolescents, or adults. The risks involved and the approach depend on the length and other characteristics of the foreign body.

Toys and household products made from superabsorbent polymers present a risk of intestinal obstruction if ingested. These objects can expand 30 to 60 times in volume when hydrated. Some of these toys was voluntarily removed from the market in the United States in 2012, but other products are still available.

High-lead objects include lead weights used for fishing (submersibles), curtain weights, rifle bullets, and some toys or medals. Acute lead toxicity can occur after ingestion of these items and death has been reported. Markedly elevated lead levels were measured within 90 min of ingestion of a lead-containing foreign object. The acidic environment of the stomach enhances the dissolution of metals. Acute lead toxicity presents with nonspecific symptoms including lethargy and vomiting. Providers should be alert to this possibility in a child with retained foreign body and should measure serum lead levels if lead toxicity is suspected. Foreign bodies suspected of having high lead content should be removed from the esophagus or stomach as quickly as possible. Administration of antacids (ie, antacids, histamine type 2 receptor blockers [H2RAs], proton pump inhibitors) may decrease lead solubility.
Bezoar - Gastric bezoar is uncommon, causes nonspecific symptoms, and is often found incidentally in patients undergoing upper gastrointestinal endoscopy or imaging. These may include plant substances (phytobezoars), hair (trichobezoars), drugs (pharmacopoeias), or other materials.
Bezoar formed from curd (lactobezoar) is also uncommon and is most likely to occur in preterm infants fed concentrated formula. Lactobezoars usually respond to conservative management, including bowel rest, with or without saline lavage. Case reports describe the dissolution of lactobezoar with acetylcysteine.