1. FOREIGN BODIES

2. FOREIGN BODY ASPIRATION
FOREIGN BODIES
FOREIGN BODY ASPIRATION

3. FOREIGN BODY ASPIRATION
Foreign body aspiration can be a life-threatening emergency requiring immediate intervention.
symptoms can go unnoticed for years with serious sequelae.
The removal of a foreign body in the respiratory tract generally leads to a rapid recovery

4. Age incidence
Children from the age of 9 to 30 months are susceptible to airway foreign bodies due to these children's mobility and their oral orientation
Older children and adults add to the problem by giving the toddler inappropriate foods, such as peanuts and popcorn, or small objects, which the child promptly puts into his or her mouth and which can be aspirated

5. Contributing factors include
Age : Infants and young children curiosity and their inclination for exploration
the male gender
immature coordination of swallowing,
lack of molars before age 4 years,
Neurologic impairment,
seizure disorders,
anatomic or functional esophageal disorders,
immature laryngeal sphincter control
an unsafe environment

6. Factors that Make Young Children Susceptible to Aspiration
Age younger than 3 years
Male gender
Children often cry, shout, run, and play with objects in their mouths
Absence of molars to chew certain foods adequately
Immature coordination of swallowing and airway protection
Oral exploration of the environment
Immature laryngeal sphincter control

7. Types of F.B Organic material Nonorganic Peanut Sunflower seed Almond
Popcorn
Apple Orange seeds  
  Nonorganic
Buttons
Toys parts
Pins and needles

8. Evaluation
The most important factor in evaluating a child who possibly aspirated an FB is an accurate history.
The common signs and symptoms will be present in 50% to 90% of cases
In a series of 100 FB aspiration cases, a choking crisis occurred in 95% and was the most sensitive clinical parameter.
FBs that lodge in the larynx and trachea can be completely obstructive, causing sudden death.
persistent cough, hemoptesis, fever, malaise, and respiratory compromise retractions

9. Inspiratory stridor and respiratory distress with indrawing of the supraclavicular, substernal or intercostal areas indicate that the object is in the larynx or subglottic area.
Foreign bodies in the trachea or bronchus cause a wheeze

10. Symptoms
Penetration syndrome " defined as a sudden onset of choking and intractable cough with or without vomiting”
Cough
Fever
Breathlessness
Wheezing
Cyanosis
No symptoms

11. Radiographic examination
consists of anteroposterior and lateral views of the extended neck and chest.
56% of patients will have a normal chest radiograph
CXR findings:
air trapping
atelectasis
mediastinal shift
Pneumonia
a radiopaque object

12. Radiographic Findings in Patients With Foreign Body Aspiration
Adult Group, No. of Radiographs With Diagnosis (% Relative Frequency)
Child Group, No. of Radiographs With Diagnosis (% Relative Frequency)
9 (50)
11 (14)
Atelectasis
3 (17)
49 (64)
Air trapping
10 (13)
Pneumonia
2 (11)
3 (4)
Visible foreign body
9 (12)
Normal radiograph

17. Progress of disease Symptomatic phase Asymptomatic phase Complications
Pneumonia
Lung abscess
Bronchiectasis
Hemoptasis
Erosion & perforation

18. signs
Respiratory distress
Localized wheezing
Poor air entry

19. The complications that develop as a result of aspiration
obstruction due to granulation tissue or strictures,
atelectasis,
bronchiectasis,
pneumonia,
empyema,
lung abscess,
perforation with pneumothorax,
systemic sepsis.

20. Special consideration
Great care needs to be taken with peanuts, which is why they should not be given to young children. Not only can they obstruct the bronchus, but the oil content can also produce a lipoid pneumonia which is known to develop rapidly.

21. treatment
Bronchoscopic removal of the foreign body

22. ESOPHAGEAL FOREIGN BODIES

23. Esophageal FB
The most common site (70%) of lodgement is at the level of the cricopharyngeus muscle (the area between the clavicles on the x-ray).
The other two sites of lodgement are
mid-oesophagus
the gastro-oesphageal junction.
Coins and smooth blunt objects are the most commonly ingested items

24. Level of Retention of Esophageal Foreign Bodies
Cricopharyngeus muscle 63%–84%
Aortic crossover mid-esophagus 10%–17%
Lower esophagus sphincter 5%–20%

25. Congenital and acquired esophageal anomalies that contribute to FB obstruction of the esophagus.
Esophageal atresia
Esophageal anastomosis
vascular ring,
cartilaginous rests,
middle mediastinal mass,
an esophageal stricture,
achalasia,
Duplication cyst

26. Clinical symptoms of a patient with an FB that obstructs the esophagus
sudden onset of acute and severe coughing,
pain in the pharyngeal or retrosternal region,
gagging,
poor feeding,
Drooling
respiratory symptoms
Periesophageal inflammation from an unsuspected esophageal FB can cause airway symptoms such as wheezing, stridor, and coughing.
Significant respiratory symptoms can be seen with an esophageal FB as the esophageal dilation can result in airway compression.

27. Radiologic evaluation include a lateral view and an anteroposterior view of both the neck and chest

28. treatment
Esophagoscopic removal

29. Batteries unique injuries
Related to:
Direct caustic injury, alkaline corrosive
pressure necrosis,
tissue necrosis from electrical discharge,
toxin release (mercury poisoning).
Disc batteries can cause corrosive injury to the esophagus within 4 hours

30. Complications caused by esophageal impaction of button batteries
Include:
tracheoesophageal fistula
esophageal burn with and without perforation,
Aortoesophageal fistula,
esophageal stricture,
death.

32. treatment
Emergency endoscopy must be performed for batteries retained in the esophagus because of the high propensity of early mucosal injury.

33. GASTROINTESTINAL FOREIGN BODIES

34. Late complications include
97% of ingested FBs that passed through the esophagus on radiographic study were spontaneously evacuated
Commonly ingested sharp FBs include bones, nails, safety pins, needles, sharp toys, and toothpicks.
Disc battery ingestion requires removal if lodged in the esophagus. Once the battery is in the stomach, it can be managed conservatively with spontaneous passage expected without complications
Ingestion of multiple magnets usually causes minimal initial physical findings.
Late complications include
bowel perforation,
volvulus,
ischemia,
enteroenteral fistulas.
Removal of magnets is recommended when there are more than one and while they are still in the stomach. Once they are distal to the stomach, observation is necessary to ensure that they all pass per the rectum.

35. types
Sharp objects
Blunt objects
Disc batteries
magnets

36. Sharp objects Majority pass without problems Need careful observation
Surgical intervention:
Peritonitis
Bleeding
Obstruction
Failure to progress

38. Blunt objects Coins; buttons; marbles Most of these objects pass
Observation at home
surgical intervention if complicated:
Peritonitis
Bleeding
Obstruction
Failure to progress within 4-6 weeks

39. Disc batteries Serious complications because of
Corrosive injury
Electric current
Should be removed if no progress within 6 to 12 hours

41. magnets
Ingestion of multiple magnets usually causes minimal initial physical findings.
Late complications include
bowel perforation,
volvulus,
ischemia,
enteroenteral fistulas.
Removal of magnets is recommended when there are more than one and while they are still in the stomach. Once they are distal to the stomach, observation is necessary to ensure that they all pass per the rectum.