Humans ; Child ; Caustics/toxicity* ; Burns, Chemical/therapy* ; Consensus ; Upper Gastrointestinal Tract/injuries*

OBJECTIVETo study the clinical features and prognosis of gastrointestinal injury caused by foreign bodies in the upper gastrointestinal tract in children.

METHODSA retrospective analysis was performed for the clinical data of 217 children who were diagnosed with foreign bodies in the upper gastrointestinal tract complicated by gastrointestinal injury by gastroscopy from January 2011 to December 2016, including clinical features, gastroscopic findings, complications, and prognosis.

RESULTSAmong the 217 children, 114 (52.5%) were aged 1-3 years. The most common foreign body was coin (99/217, 45.6%), followed by hard/sharp-edged food (45/217, 20.7%) and metal (35/217, 16.1%). The most common gastrointestinal mucosal injury was ulceration (43.8%), followed by erosion (33.2%). Compared with other foreign bodies, button cells were significantly more likely to cause esophageal perforation (P<0.01). The esophagus was the most commonly injured organ (207/217, 95.4%). Of all the 217 children, 24 (11.1%) experienced infection. The children with perforation caused by foreign bodies had a significantly higher incidence rate of infection than those with ulceration caused by foreign bodies (P=0.003). Of all the 217 children, 204 (94.0%) underwent successful endoscopic removal of foreign bodies. Among these children, 98 were hospitalized due to severe mucosal injury and were given anti-infective therapy, antacids, and supportive care including enteral nutrition through a nasogastric tube and/or parenteral nutrition. Of all the children, 10 left the hospital and were lost to follow-up, and all the other children were improved and discharged.

CONCLUSIONSMost cases of foreign bodies in the upper gastrointestinal tract occur at 1-3 years of age. Coin, hard/sharp-edged food, and metal are the most common foreign bodies. Button cells are more likely to cause esophageal perforation. The incidence rate of secondary infection increases with the increasing severity of gastrointestinal mucosal injury. Children undergoing endoscopic removal of foreign bodies and enteral nutrition through a nasogastric tube tend to have a good prognosis.

Female ; Food ; adverse effects ; Foreign Bodies ; diagnosis ; etiology ; therapy ; Humans ; Infant ; Male ; Metals ; adverse effects ; Prognosis ; Retrospective Studies ; Upper Gastrointestinal Tract ; injuries

Strong corrosive acid is accidentally ingested by children or by psychiatric patients for the purpose of suicidal attempt. Late complications include chemical burn to pharyunx, perforation and stricture of upper gastrointestinal tract, respiratory insufficiencyand renal failure caused by hemoglobinuria following hemolysis. Acetic acid is difficult to ingestion large volume in a time because it is a strong irritant, provocating painful pharynx, and its autopsy case is rare. We report an autopsy case of acetic acid intoxication with acute disseminated intravascular coagulation (DIC) in several hours. We present pathogenesis of acetic acid intoxication and the associated forensic problems. A comatous 39-year-old female was admitted to emergency room 6 hours after she swallowed 90 gm of acetic acid. She was treated with gastric lavage but she was expired 9 hours after swallowing acetic acid. She was consulted to Department of Forensic Medicine of Kyungpook National University School of Medicine. She was grossly icteric and livor mortis was generally dark red. External wounds were 10 hemorrhagic lesions with 5 x 3.7cm and 3 x 2.8cm on the left arm and hand dorsum and facial abrasions. Internal gross examination revealed several purpural lesions in the gastric serosal surface and greater omentum. Microscopically, the stomach showed diffuse mucosal coagulation necrosis and intravascular hyalinized or fibrinoid thrombi in submucosal blood vessels. Liver showed necrosis of periportal area (zone I) and intracellular cholestasis around the central vein. Sections from renal tissue frequently show hemoglobin casts in the tubules and RBCs in the Bowman's capsules. Acetic acid of a remnant bottle, sampled blood and bloody necrotic tissues in the stomach were toxicologically examined in National Science Laboratory. The purity of ingested acetic acid is 98%, the concentration of acetic acid ion in blood is 734ppm and the content in gastric juice is 0.09%. In patients after acetic acid ingestion, DIC is most probably caused by procoagulants, produced by extensive acid-induced necrosis of the upper gastrointestinal tract. In this case, several purpural lesions were revealed on the arm, around facial abrasion and intravenous injection sites of the wrists. These are important to differentiate with contusion because she was battered before acetic acid ingestion. Purpurae in DIC are poorly demarcated, dark purple elevations with spreading margin but subcutaneous hemorrhage in contusion is grayish black or dark red with well demarcation (Table 2). But careful examination should be considered because traumatic hemorrhage is also exaggerated and mixed in DIC. (The Korean Journal of Legal Medicine)
Acetic Acid* ; Adult ; Arm ; Autopsy ; Blood Vessels ; Burns, Chemical ; Capsules ; Child ; Cholestasis ; Constriction, Pathologic ; Contusions ; Dacarbazine ; Deglutition ; Disseminated Intravascular Coagulation ; Eating ; Emergency Service, Hospital ; Female ; Forensic Medicine ; Gastric Juice ; Gastric Lavage ; Gyeongsangbuk-do ; Hand ; Hemoglobinuria ; Hemolysis ; Hemorrhage ; Humans ; Hyalin ; Injections, Intravenous ; Liver ; Necrosis ; Omentum ; Pharynx ; Postmortem Changes ; Purpura ; Renal Insufficiency ; Stomach ; Upper Gastrointestinal Tract ; Veins ; Wounds and Injuries ; Wrist