P SHARP METALLIC FB

Foreign body ingestion is a common problem in children. We share our experience of managing sharp metallic foreign body ingestion in four children. A 7-month-old girl was brought to us with complaints of episodic excessive cry and blood tinged vomitus since two days. X-ray abdomen showed a hair pin in the small bowel loops (Fig. 1A). The baby was clinically stable without any symptoms. After 3 hours of hospitalization (36 hours after ingestion); baby passed the foreign body in stools (Fig. 1B). A 6-year-old boy presented to us with accidental ingestion of a nail; there was no history of vomiting or pain abdomen. X-ray revealed sharp metallic foreign body in the stomach lying transversely (Fig. 1 C). Under close observation, child passed the nail in the stools after 30 hours of its ingestion (Fig. 1 D). A 9-month-old girl was brought to us with history of accidental ingestion of an open safety pin. Serial X-rays showed the uneventful transit of foreign body through gastrointestinal tract (Fig. 1 E). Baby passed the foreign body spontaneously in the stools after 36 hours of its ingestion (Fig. 1 F). A 13-year-old girl was brought to us with history of accidental ingestion of a table pin. X-ray revealed a sharp metallic foreign body in the small bowel (Fig. 1 G). Her psychiatric evaluation was normal. She was closely observed with daily X-rays with watchful waiting, and she passed the foreign body in the stool after 10 days (Fig. 1 H). Majority of foreign bodies reaching the stomach will pass spontaneously in stools uneventfully [1]. However, the sharp metallic foreign body may rarely migrate to almost any intra-abdominal organ causing serious complications such as bowel perforation, bleeding, and obstruction [1,2]. As per Jackson’s statement “advancing points perforate and trailing points do not”; i.e., sharp metallic foreign body travels with its blunt end first [2,3]

Endoscopic retrieval of sharp metallic foreign bodies, even if they have reached the stomach uneventfully, is advocated by some experts, while many centers manage them with watchful waiting [3,4]. Those not amenable to endoscopic retrieval need to be followed-up with daily radiographs; surgical removal should be contemplated if it fails to progress over three days [2,3].