Research

An audit of ingested and aspirated foreign bodies in children at a university hospital in South Africa: The Pietermaritzburg experience

N F Majola, V Y Kong, H Mangray, V Govindasamy, G L Laing, D L Clarke

Abstract


Background. The ingestion or aspiration of foreign bodies (FBs) by children is a common problem around the world. Our centre in Pietermaritzburg, South Africa, has a dedicated paediatric surgical service, and all patients with an ingested or aspirated FB are managed under the direct care of a paediatric surgeon.

Objectives. To review our centre’s experience with this problem by means of a retrospective audit and use the data to develop and refine appropriate local management guidelines.

Methods. Grey’s Hospital has a hybrid electronic medical registry (HEMR) that captures patient data on admission, after a procedure and on discharge. The HEMR was reviewed and all patients with an appropriate International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) code indicating an ingested or aspirated FB were identified and retrieved for review.

Results. A total of 105 cases of FB ingestion or aspiration in children <12 years of age from January 2012 to December 2014 were identified from the HEMR. The patients’ ages ranged from 4 months to 10 years (mean 3 years and 6 months), and 59.0% (n=62) were male and 41.0% (n=43) female. A total of 107 FBs were removed (two patients each had two coins removed). The commonest FBs were coins (n=77, 71.9%), followed by batteries (n=6, 5.6%), plastic toys (n=5, 4.7%), buttons (n=5, 4.7%), screws/washers (n=3, 2.8%), seeds (n=2, 1.9%), needles (n=2, 1.9%), bones (n=2, 1.9%), a marble (n=1, 0.9%), a rubber eraser (n=1, 0.9%), a curtain hook (n=1, 0.9%), a nail (n=1, 0.9%) and a wood speck (n=1, 0.9%). Of the FBs, 67 (62.6%) were in the oesophagus, 17 (15.9%) in the respiratory system, 14 (13%) in the intestine and 9 (8.4%) in the oral cavity. The average time from ingestion/aspiration to presentation was <48 hours. Of the FBs, 67 (62.6%) were removed via rigid oesophagoscopy and 13 (12.1%) via rigid bronchoscopy, 13 (12.1%) were passed rectally, and 9 (8.4%) were removed via grasping forceps in the oral cavity, 4 (3.7%) via thoracotomy and 1 (0.9%) via emergency laparotomy. A total of 15 complications included mucosal ulceration/slough (n=6, 40.0%), oesophageal perforation (n=3, 20.0%), aspiration pneumonia (n=3, 20.0%), and tracheal perforation, lung collapse and contact bleed (n=1 each, 6.7%). No patient presented in respiratory distress or needed emergency airway management, and there were no deaths.

Conclusions. The development of a dedicated paediatric surgery service and the implementation of management protocols have resulted in excellent outcomes for this problem.

 


Authors' affiliations

N F Majola, Department of Paediatric Surgery, Grey’s Hospital, Pietermaritzburg, South Africa

V Y Kong, Department of Paediatric Surgery, Grey’s Hospital, Pietermaritzburg, South Africa

H Mangray, Department of Paediatric Surgery, Grey’s Hospital, Pietermaritzburg, South Africa

V Govindasamy, Department of Paediatric Surgery, Grey’s Hospital, Pietermaritzburg, South Africa

G L Laing, Department of Paediatric Surgery, Grey’s Hospital, Pietermaritzburg, South Africa

D L Clarke, Department of Paediatric Surgery, Grey’s Hospital, Pietermaritzburg, South Africa; Department of Surgery, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

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Keywords

Trauma; Paediatrics; Ingestion and aspiration; Foreign bodies; South Africa

Cite this article

South African Medical Journal 2018;108(3):205-209. DOI:10.7196/SAMJ.2018.v108i3.12590

Article History

Date submitted: 2018-02-27
Date published: 2018-02-27

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