Pediatric gastrointestinal foreign body ingestions.

One hundred twenty-five consecutive emergency department cases of pediatric gastrointestinal foreign body ingestions were analyzed retrospectively to tabulate data, identify high risk ingestions, and draw conclusions regarding the standard of care. Eleven patients (9%) were admitted for endoscopy or observation of high risk situations. Twenty patients (16%) were managed invasively, 19 with esophageal foreign bodies; 17 of 20 attempts at invasive management were successful. There was a 2% incidence of minor complications; no major complications (perforation, obstruction, bleeding, or mediastinal infection) or complications of invasive procedures were observed. High risk factors identified included the following: 1) the ingestion of rounded objects (esophageal impaction); 2) the presence of social, developmental, or psychiatric risk factors (29.6% incidence); and 3) esophageal disease (significantly associated with recurrent foreign bodies and frequent endoscopy or other surgical procedures). We conclude that, while asymptomatic gastric and intestinal foreign bodies can be managed with outpatient observation, hospitalization is indicated for endoscopic management and for symptom complexes suggestive of complication. Immediate endoscopy is recommended for removal of esophageal foreign bodies and for direct evaluation of the esophagus.