Ingestion of FB is a frequent cause of consultation or
admission to the pediatric emergency room [9,10]. The mean age found in the
literature varies between 3 and 5 years [11,12]. In our series, the mean age
was 4.9 years. Frequency increases from the age of 6 months as soon as manual
prehension is possible [13]. In more than 70% of cases, these ingestions occur
in children under 4 years of age [14]. Indeed, children in the oral phase with
oropharyngeal immaturity have a high risk of involuntary ingestion of foreign
bodies. Moreover, the curiosity of the child's entourage to explore could
explain this situation [15]. Male predominance is obvious in most of the series
in litterature [16]. The same finding is noted in our study. Physical
examination is most often normal and should be performed upon admission of the
patient [17]. More than 80% of FBs are asymptomatic [18]. Symptomatology
depends on several parameters: age, medical and surgical history, size and
location of the FB or occurrence of a complication secondary to the ingestion
[19]. Sometimes, it is delayed for several minutes to several hours, or even
does not appear until the complications occur [20]. In children, the
symptomatology is much more misleading, and attention must be paid to the
observations of the entourage: hypersialorrhea, dysphagia, vomiting and
odynophagia are signs frequently reported in the literature [21]. However, in
our series these digestive manifestations are not frequent. This could be
related to the frequency of intestinal localization in our series, thus
explaining the absence of clinical symptoms in the majority of our patients.
Respiratory signs are less frequent and are related to the blockage of the
esophagus by compression of the respiratory tract, particularly in small children
[22]. In our series, these signs represent only a tiny part (3.8%) and are
found in the esophageal location of the FB. Diagnosis of a radiopaque foreign
body is in general easy on standard X-ray images: this assessment is positive
in 84% of cases in children. The positive predictive value of standard
radiography is excellent, especially in children [23, 24]. We found a similar
rate to the literature. Hodge and Schunk each showed in their study that 17%
and 38% respectively of asymptomatic children may have a coin trapped in the
esophagus [25,26]. The nature of the ingested foreign bodies varies from one
study to another, but especially varies with patient age [27,28]. Any object
that can be grasped by a child may then readily be brought to the mouth and
ingested [29]. Soft objects are by far the most common and coins are the most
frequent EC in children [30]. This was the case in our series. The main site of
blockage of FBs is located in the esophagus [31]. This could be explained by
the three physiological constrictions of the esophagus, one superior at the
level of the esophageal orifice, the other at the middle third related to the
aortic arch at the level of T3-T4, the last inferior at the cardia; 78% of FBs
remain blocked at the esophageal orifice, compared to 13% at the middle third
and 18% at the cardia. FB may also become blocked in the stomach or at the
pylorus, and more rarely at the ileocecal valve or appendix [32,33]. The rate
of spontaneous expulsion of FBs is higher in case of gastric or intestinal
localization [34,35]. Our results confirm these data. In case of esophageal
location, the lower third is more favorable for spontaneous passage of FBs
[36]. The rate of immediate extraction or within 24 hours of FBs by endoscopy
is situated between 52% and 99.4% [36]. In our series and the one of Delport
and al, abstention and surveillance are the first line of treatment [37].
Unlike several authors, we believe that endoscopic extraction should not be
performed systematically but rather reserved for specific situations. In regard
to our results, and outside of any emergency, monitoring and education of the
parents on the possible complications to watch out for remains, in our opinion,
the most appropriate way of management. In fact, this avoids the patient having
to be hospitalized, the risks incurred during an endoscopy and thus enables an
outpatient follow-up with regular X-rays in order to evaluate the progression
of the FB until its spontaneous evacuation.
