W Cheng, PKH Tam

Introduction: Foreign body ingestion is a common problem in paediatric surgical practice. This study attempts to elucidate the clinical presentation and the management.

Method: 33 years (from Jan. 1964 to May 1997) of records of the children admitted into the Division of Paediatric Surgery, Queen Mary Hospital with suspected ingestion of foreign body were reviewed. Symptoms of foreign body sensation, pain on swallowing, rest pain and drooling were assessed. Relative risk assessment was applied to these symptoms.

Results: Foreign bodies were detected in 43% (551, M:F = 310:241) of the 1264 (M:F = 722:542) children admitted. The age of the children ranged from 2 month to 16 years (mean = 5.2 years). The most common objects were coins (49%), fish bones (29%), metalic objects (13%) and chicken, pork or duck bones (3%). The age of bone ingestion group is older and more evenly spread (5.4 +/- 3.5 years) than non-food group (3.8 +/- 2.4 years) (t-test, p = 0.00). Whilst X-ray could detect all the coins, 86% of glass objects, the sensitivity in detecting fish-bone is only 30% even though the specificity is high (100%). Comparing the endoscoped children with and without fish bone, only painful sensation on swallowing was significant symptom (1.77, 95% confidence 1.006 - 3.106).

Conclusions: Preventative education should be focused on the parents of toddlers, especially boys. X-ray while useful in detecting metalic objects, can only detect one third of fish bone ingested verified by endoscopy. Pain on swallowing is an indication for endoscopy.