Alrazzak Baraa Alabd, Al-Subu Awni, Elitsur Yoram
Department of Pediatrics, Section of Gastroenterology, Marshall University, Joan C. Edwards School of Medicine, Huntington, West Virginia, USA.
Avicenna J Med. 2013 Apr;3(2):33-6. doi: 10.4103/2231-0770.114113.
Esophageal impaction in children is a medical emergency that needs an immediate medical attention. In the last years multiple objects have been detected and were removed endoscopically. In the last decade, Eosinophilic Esophagitis (EoE) has been associated with esophageal stenosis, leading to esophageal impaction with various objects including toys, food, coins and other.
To determine the various objects and symptoms associated with impactions and to develop algorithm that guides Emergency Department Physicians and Primary care Providers when facing such problem in pediatric patient.
A retrospective chart review of all children referred to the pediatric gastroenterology service at Marshall University for FB impaction between 2000 and 2010 was performed. Foreign bodies treated by other specialties were excluded from this review. Clinical and demographic data were retrieved.
A total of 291 charts with the diagnosis of foreign body reviewed of which only 126 met the inclusion criteria and considered for final calculation. Male/Female ratio and mean age were 1.17:1.0, and 3.65 ± 0.75 years, respectively. Time of impaction before ER evaluation was: < 24hrs in 75 patients, >24hrs in 17 and in 34 the time of ingestion was not known. Radiology was performed in 118 patients, of whom 1 had pneumo-mediastinum and 1 had pneumothorax. Endoscopic localization of the objects showed: 81- proximal, 23- middle esophagus, and 22- in the distal esophagus. The esophageal mucosa showed non-specific changes in 37 patients, 5 with EoE features, 1 patient with hiatal hernia, 1 patient with candidiasis, and in 5 pts had no mucosal description.
Children with foreign body in the esophagus are commonly seen in our Hospital ER. Those children may harbor undiagnosed medical conditions that will need future therapy. Careful endoscopic assessment with mucosal biopsies is needed to diagnose those conditions earlier. Referral to a GI specialist may be warranted.
儿童食管异物梗阻是一种需要立即就医的医疗急症。近年来，已检测到多种异物并通过内镜取出。在过去十年中，嗜酸性粒细胞性食管炎（EoE）与食管狭窄相关，导致包括玩具、食物、硬币等各种物体引起的食管异物梗阻。
确定与异物梗阻相关的各种物体和症状，并制定一种算法，以指导急诊科医生和初级保健提供者在面对儿科患者的此类问题时做出决策。
对2000年至2010年间转诊至马歇尔大学儿科胃肠病科治疗食管异物梗阻的所有儿童病历进行回顾性分析。其他专科治疗的异物病例被排除在本研究之外。收集临床和人口统计学数据。
共查阅了291份诊断为异物的病历，其中只有126份符合纳入标准并纳入最终计算。男/女比例为1.17:1.0，平均年龄为3.65±0.75岁。急诊评估前异物梗阻的时间为：75例患者<24小时，17例患者>24小时，34例患者摄入时间不详。118例患者进行了放射学检查，其中1例有纵隔积气，1例有气胸。异物的内镜定位显示：81例位于食管近端，23例位于食管中段，22例位于食管远端。37例患者食管黏膜有非特异性改变，5例有EoE特征，1例有食管裂孔疝，1例有念珠菌病，5例未描述黏膜情况。
我院急诊科常见食管异物患儿。这些儿童可能存在未被诊断的疾病，需要进一步治疗。需要通过仔细的内镜评估和黏膜活检来更早地诊断这些疾病。可能需要转诊至胃肠病专科医生处。
