Foreign body ingestion is a potentially serious clinical problem in children. We report a case of an 8-month-old infant who developed complete bowel obstruction requiring laparotomy due to ingestion of a superabsorbent polymer ball with advertised growth up to 400 times its original size. Most ingested foreign bodies that pass through the pylorus will make it safely through the gastrointestinal tract. This is not true for water-absorbing balls that progressively increase in size and cause intestinal obstruction. Other household products and toys on the market use a similar polymer-based water-absorbing technology, thus increasing the risk for accidental ingestion by young children. These rapidly expanding objects can cause significant morbidity, and timely diagnosis and treatment are prudent to improve patient outcomes.
"Incidents of ingesting non-edible items occur in children, elderly, mentally impaired and intoxicated patients  . These non-edible items may be as bizarre as plastics, metal, plants, soil, hair, insects and highly absorbable items . Bowel obstruction from food items usually happen in people with poor gastrointestinal motility, Guillian-barre syndrome, hypothyroidism and fast eaters   . "
[Show abstract][Hide abstract] ABSTRACT: Aim:
To determine the utility of X-ray in identifying non-metallic foreign body (FB) and assess inter-radiologist agreement in identifying non-metal FB.
Focus groups of nurses, fellows, and attending physicians were conducted to determine commonly ingested objects suitable for inclusion. Twelve potentially ingested objects (clay, plastic bead, crayon, plastic ring, plastic army figure, glass bead, paperclip, drywall anchor, eraser, Lego™, plastic triangle toy, and barrette) were embedded in a gelatin slab placed on top of a water-equivalent phantom to simulate density of a child's abdomen. The items were selected due to wide availability and appropriate size for accidental pediatric ingestion. Plain radiography of the embedded FBs was obtained. Five experienced radiologists blinded to number and types of objects were asked to identify the FBs. The radiologist was first asked to count the number of items that were visible then to identify the shape of each item and describe it to a study investigator who recorded all responses. Overall inter-rater reliability was analyzed using percent agreement and κ coefficient. We calculated P value to assess the probability of error involved in accepting the κ value.
Fourteen objects were radiographed including 12 original objects and 2 duplicates. The model's validity was supported by clear identification of a radiolucent paperclip as a positive control, and lack of identification of plastic beads (negative control) despite repeated inclusion. Each radiologist identified 7-9 of the 14 objects (mean 8, 67%). Six unique objects (50%) were identified by all radiologists and four unique objects (33%) were not identified by any radiologist (plastic bead, Lego™, plastic triangle toy, and barrette). Identification of objects that were not present, false-positives, occurred 1-2 times per radiologist (mean 1.4). An additional 17% of unique objects were identified by less than half of the radiologists. Agreement between radiologists was considered almost perfect (kappa 0.86 ± 0.08, P < 0.0001).
We demonstrate potential non-identification of commonly ingested non-metal FBs in children. A registry for radiographic visibility of ingested objects should be created to improve clinical decision-making.
[Show abstract][Hide abstract] ABSTRACT: Foreign body ingestion is a common clinical scenario among patients of all ages. The immediate risk to the patient ranges from negligible to life threatening. Initial and follow-up management strategies depend on multiple patient and ingested object-related factors. Available literature on this topic tends to focus on the small child or adult, leaving the clinician caring for adolescents to extrapolate this information to guide decision making for individual patients. This article reviews foreign body ingestion literature with important implications to the adolescent patient and raises awareness of some highly dangerous objects such as large button batteries, high-powered magnets, long sharps, narcotic packages, and super absorbent objects. An additional focus includes the management of esophageal food impaction. We highlight the unique aspects to the care of the adolescent with intentional ingestion and co-morbid psychiatric illness. The article concludes by discussing the challenges to prevention of ingestion in the at-risk patient.
Journal of Adolescent Health 08/2014; 55(2). DOI:10.1016/j.jadohealth.2014.01.022 · 3.61 Impact Factor
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