Abstract
As technology advances there are chances of new hazards to health also increases. In the current era of the digitalized world using a smart electronic device may cause harm to the children. We reported a case of foreign body ingestion which is new in the field of ENT practice. A 1-year-old male child patient presents with an ingested foreign body memory card guard slot cover. To date, this is a newer one in all types of an old foreign body reported in ENT practice.
Keywords: Foreign body, Mobile gadgets, Accessories, Memory card guards
Introduction
Foreign body ingestion is the common problem of children all over the world, whether it’s a developed country or developing country. The peak incidence of foreign body ingestion is between 6 months to 3 years [1]. In children the incidence is equal in males and females [2]. Although coins are the most common ingested foreign body, fishbone impaction is common in countries where fish is the main diet [3]. Children can swallow different types of objects. Commonly ingested foreign bodies in children are coins, toys, batteries, needles, straight pins, safety pins, screws, earrings, pencils, erasers, glass fragments, keys, marble, fish, and chicken bones. Depending on symptoms of presentation in a patient, we have to take an emergency decision on it. At least 80% of ingested foreign bodies pass through the gastrointestinal system spontaneously, whereas 20% will require endoscopic intervention. On the other hand, <1% of foreign body ingestion cases will require surgical intervention to retrieve them or to deal with complications [4].
Case Reports
One-year-old male child accidentally ingested a foreign body memory card guard of mobile while playing at home. After a few hrs. of ingestion of a foreign body child shows symptoms of vomiting and difficulty in swallowing so parents rushed to our ENT OPD at a tertiary care center. We examined the patient and asked the history of the patients to the parents, but the parents were unaware of the incident. So after taking the vitals parameters of the patient we advised an X-ray neck, AP, lateral view, and X-ray chest PA view for confirmation of any suspected foreign body ingestion. On the X-ray neck, AP view we find out one foreign body in the upper esophagus just below the cricopharynx as shown in Fig. 1.
Fig. 1.
X-ray neck AP view showing foreign body
After confirmation over X-ray, we decided to take a patient in the operation theater for emergency removal of a foreign body under general anesthesia after getting all routine blood investigations like CBC, HB, KFT, and blood group. All routine blood investigations were within normal limits. The blood group was RhB positive. After taking written, informed consent from a parent, the patient shifted to the operation theater for foreign body removal under general anesthesia. Foreign body removal is done with a pediatric rigid esophagoscope as shown in images 2. After the removal of the foreign body, it is confirmed that its mobile memory card guard it’s an astonishing foreign body to ENT surgeons as before such type of foreign body was not seen in our ENT practice. It’s a new type of foreign body matching perfectly with the current digital era because it’s a totally handy object for children nowadays (Fig. 2).
Fig. 2.
Showing foreign body mobile sim card guard after removal
After removal of this foreign body check oesophagoscopy done to look for any other foreign body particulate material of this foreign body remains in situ or any other foreign body. Sometimes one or two foreign bodies present so we have to do check scopy. After the check scopy, the patient extubated and kept NBM for 12 h. and the next day discharged on the antibiotic, antacid, and antiinflammatory for 5 days and advised 5 days complete liquid diets and inform urgently if any symptoms develop.
Discussion
All over the world, many times children present with foreign body ingestion. So all the otorhinolaryngologists, gastroenterologists, surgeons, and physicians must have adequate knowledge to deal systematically with each type of foreign body according to the symptoms and location of the foreign body. Most commonly the swallowed foreign body gets lodged in the upper part of the esophagus. In the esophagus there are three most common sites for lodgment one is cricopharynx second is mid esophagus where the aorta crosses over the esophagus and a third is a lower esophageal sphincter. Out of these three sites in the esophagus, cricopharynx is the most common site. At least 75% of the coins are stuck on this site [5].
As we know the most common foreign body in the esophagus is the coin. If these types of foreign bodies encounter, then we have to be very careful with the symptoms of the patient. In this case, it is an inert type of foreign body with sharp edges so we have to remove it without delay. Corrosive objects like digital battery cells and sharp edge foreign bodies needed immediate attention and removal. Observation for 24 h awaiting passage of the coin to the stomach can be justified unless the patient is symptomatic. In a series of 86 patients reported by Chaikhouni et al. [6] the main risk factor for esophageal perforation was the presence of the coin in the esophagus for more than 24 h.
Many small electronic gadgets are now in use such as hearing aid batteries, watches, toys with small batteries, and smartphones with accessories. These types of objects are very handy nowadays, which is rapidly increasing in the last 10 years in all parts of developing countries with the affordability of gadgets in all strata of society. When such foreign bodies ingested causes caustic injury to the esophagus. Litovitz reported a series of 119 cases of battery ingestion. Batteries smaller than 20 mm in diameter, usually pass through the gastrointestinal system while larger ones may lodge in the esophagus and stomach [7].
Radiolucent foreign bodies such as glass, wooden, plastic beads, plastic covers these types of foreign bodies will not be detected by X-ray. For these types of foreign bodies, we have to do check scopy with a flexible oesophagoscopy.
Sharp and elongated foreign bodies are very much risky to the patient as they cause perforation injury to the esophagus by their sharp pointed edges, these foreign bodies cause significant morbidity and mortality as they are responsible for 15% to 35% of perforations following foreign body ingestion [8–10].
Conclusion
Foreign body ingestion is a very dynamic and natural phenomenon of children in all countries. Problems of the foreign body mostly faced by a general physician, an ENT specialist, and an endoscopic gastroenterologist. Few foreign bodies are inert which are not dangerous, but some are corrosive which causes damage to underlying tissue and causes complications to the patient. In this case, the foreign body was inert but was sharp-edged which may be harmful while removing. So all concerned specialists have to be very competent to deal with the most simple as well as a complicated foreign body without any risk to the patient’s life. Nowadays we are living in a modern digitalized era, so our small accessory objects change with time, so parents and caregivers should be cautioned not to leave small objects around children’s. Gadgets Company should mention instruction on its main wrapper that small parts of mobile gadgets are dangerous to life if ingested and keep away from children. Mention some instructions on their inner pamphlets in the bold letter.
Acknowledgments
The study is conducted at the ENT department of our institute thanks to all my seniors and entire colleague for their kind support.
Funding
No funding sources.
Compliance with Ethical Standard
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
This study approved by the institutional ethical committee.
Footnotes
Publisher's Note
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