Singh Vir, Lakshmanan Vishalakshi, Setlik Jennifer, Meckmongkol Teerin
Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA.
Emergency Medicine, Ocala Regional Medical Center, Ocala, USA.
Cureus. 2020 Nov 17;12(11):e11536. doi: 10.7759/cureus.11536.
The swallowed or aspirated foreign body is a common pediatric emergency medicine complaint for which emergency providers must be familiar with the intricacies of management. Most swallowed foreign bodies will harmlessly pass through the GI tract, but children with GI tract abnormalities may have an increased risk of object impaction. There are few reported cases of foreign object ingestion in children with GI tract abnormalities, specifically ostomies. The Foley catheter is a versatile tool that is easily accessible in the ED setting. We present a novel case of foreign body ingestion in an infant with a colostomy secondary to Hirschsprung's disease managed with Foley catheter retrieval through an ileostomy stoma. A 17-month-old infant presented to the ED with a chief complaint of an episode of bloody vomiting. He had a two-day history of increased irritability and intolerance of feeds with emesis after every feed. The child's medical history is pertinent for Hirschsprung's disease, for which the patient had a pull-through procedure shortly after birth and a revision of the pull-through. On physical examination, the patient's ostomy was found to contain brown-green liquid stool. A small ovular mass was visualized at the stoma during crying episodes. Supine posteroanterior radiograph of the abdomen showed an oval-shaped radiolucency consistent with a metallic ingested foreign body at the site of the stoma. The foreign object was removed using a Foley catheter and forceps and was found to be a penny. The patient was observed and discharged without complications later that day. Treatment of a symptomatic ingested foreign object requires careful consideration of the type of object present and its location in the body. In this case report, we discussed the removal of an ingested coin in a symptomatic 17-month-old infant with a history of ileostomy secondary to Hirschsprung's disease using a Foley catheter. In children with ostomies, prompt imaging and non-surgical removal may be an option to manage retrieval of these objects if the patient is stable and symptoms are not severe.
吞咽或误吸异物是儿科急诊医学中常见的病症，急诊医护人员必须熟悉其复杂的处理方法。大多数吞咽的异物会无害地通过胃肠道，但患有胃肠道异常的儿童发生异物嵌塞的风险可能会增加。关于患有胃肠道异常（尤其是造口术）的儿童异物摄入的报道病例很少。 Foley导管是一种用途广泛的工具，在急诊科很容易获得。我们报告了一例患有先天性巨结肠继发结肠造口术的婴儿异物摄入的新病例，通过回肠造口术造口用Foley导管取出异物。一名17个月大的婴儿因一次血性呕吐发作为主诉就诊于急诊科。他有两天易怒史，每次喂食后出现不耐受和呕吐。患儿的病史与先天性巨结肠有关，患儿出生后不久接受了拖出术，并对拖出术进行了修正。体格检查发现患者的造口内有棕绿色液体粪便。哭闹时在造口处可见一个小的椭圆形肿块。腹部仰卧前后位X线片显示在造口部位有一个椭圆形透光区，与摄入的金属异物一致。使用Foley导管和镊子取出异物，发现是一枚硬币。当天晚些时候对患者进行了观察，无并发症出院。对有症状的摄入异物的治疗需要仔细考虑异物的类型及其在体内的位置。在本病例报告中，我们讨论了使用Foley导管为一名患有先天性巨结肠继发回肠造口术病史的17个月大症状性婴儿取出摄入的硬币。对于有造口术的儿童，如果患者病情稳定且症状不严重，及时成像和非手术取出可能是处理这些异物取出的一种选择。
