Abdulrahman Al Maawi, Ramakrishnaprasad Davuluri, Mohammed Al Sayed Daboos, Omar Al Samahy, John F Hakiem, Mahmoud Ali Tolba.
The fate of unusual intra-abdominal (sub-diaphragmatic) foreign bodies in children.
Pak J Surg Jan ;36(1):41-445.

Background: Foreign body (FB) ingestion in children is very common. Children can ingest a wide variety of FBs. Most of the ingested FBs pass spontaneously through the gastrointestinal tract. Other FBs, especially un-commonly ingested objects, can present with complications and need intervention so that foreign body could be extracted. The aim of this study was to highlight the importance of closed observation and timely intervention of the intra abdominal foreign bodies. Material and Methods: This was a retrospective study between November 2017 and May 2019 included all patients who presented to our department with variously ingested FBs were reviewed to detect those who needed intervention (surgical or endoscopic) to extract these FBs. The study was approved by our ethical committee and parent of each individuals gave informed consent to participate in the study. Results: During the specified time period, 80-patients with FB ingestion presented to our department. Out of these children, 4-patients ingested un-common FBs, presented with symptoms of complications and needed intervention to extract these FBs. 2-patients swallowed tooth pick. 1-patient ingested needle which were penetrated the duodenum. 1-patient ingested a sticky rubber toys and wires which were impacted in the colon. Conclusion: Children who ingest un-common FBs are more likely to present with complications of impaction or perforation. Negative plain abdominal and chest x-rays are not sufficient to conclude conservative treatment as radiolucent FB might have been ingested. CT or endoscopy should be done to rule out retained foreign bodies prospective identification of the site of perforation has become the essential part of pre-operative evaluation, Contrast-Enhanced Computed Tomography (CECT) can determine the site of perforation in the accuracy of 86% medical decision making, requires integration of clinical data, closed observation and timely intervention. Foreign body impaction lead to serious complications, despite being a rare situation, prevention remains the key to this health problem.

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