What is the role of GI tract in the pathophysiology of pediatric foreign body ingestion?

Updated: Oct 04, 2018
  • Author: Gregory P Conners, MD, MPH, MBA, FAAP, FACEP; Chief Editor: Dale W Steele, MD, MS  more...
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Answer

Once a swallowed foreign body reaches the stomach of a child with a normal GI tract, it is much less likely to lead to complications. Foreign bodies occasionally become lodged at the ileocecal valve. [3] Coins made largely from zinc, most notable United States cents, have been reported to interact with stomach acid leading to stomach ulceration. [4] Foreign-body — induced appendicitis has been reported. [5] Other exceptions include pointed or toxic foreign bodies or objects too long (ie, >6 cm) or too wide (ie, >2 cm) to pass through the pyloric sphincter.

Another important exception is the child who has swallowed more than one magnet; reports exist of swallowed toy magnets attracting and adhering tightly to each other through the GI tract, leading to small bowel obstruction or necrosis of intervening tissues, sometimes with severe sequelae. [6, 7, 8] Magnets may also attract other ferrous swallowed foreign bodies, causing similar problems. [9]

Children with known GI tract abnormalities are more likely to encounter complications. Previous surgery may cause abnormalities of peristalsis, increasing the likelihood of foreign body impaction. For example, children who have had surgery to correct pyloric stenosis are more likely to retain a foreign body in the stomach.

Previously unsuspected lower GI tract abnormalities may present as a complication of foreign body ingestion. For example, a small foreign body may become lodged in a Meckel diverticulum.

Impacted foreign bodies

A foreign body lodged in the GI tract may have little or no effect; cause local inflammation leading to pain, bleeding, scarring, and obstruction; or erode through the GI tract. Migration from the esophagus most often leads to mediastinitis but may involve the lower respiratory tract or aorta and create an aortoenteric fistula. Migration through the lower GI tract may cause peritonitis.


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