Manejo del paciente con cuerpo extraño en vías aérea y digestiva <span class="so-article-trans-title" dir="auto"> Translated title: Management of patients with foreign bodies into the airway and digestive tracts </span>

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Abstract

Introducción: la penetración de un cuerpo extraño en las vías aéreo-digestivas trae consigo problemas serios, llegando incluso hasta la muerte. Objetivo: determinar el manejo del paciente con cuerpo extraño en vías aéreas y digestivas. Material y método: se realizó una investigación descriptiva, transversal y de intervención en pacientes vistos en el cuerpo de guardia del Hospital General Docente "Abel Santamaría Cuadrado" de pinar del Río en el período 2010-2011. El universo y la muestra estuvieron conformados por los 773 pacientes con sospecha o diagnóstico de cuerpos extraños en vías aéreo-digestivas. Se aplicaron métodos bio-estadísticos descriptivos, así como la prueba de X² al 95 % de certeza. Resultados: el 72,6 % de los casos fueron considerados urgencias, y el 75,5 % fueron confirmados con cuerpos extraños, predominando el grupo de 0-15 años (28,8 %), el sexo masculino (48,5%), localizados en hipofaringe (39 %), y los pertenecientes al Policlínico Universitario "Hermanos Cruz". (26 %). De las 154 esofagoscopias realizadas, solo 110 fueron positivas. Se diseñó una estrategia de intervención educativa dirigida a profesionales de la atención primaria de salud. Conclusiones: el manejo de cuerpos extraños en las vías aéreo-digestivas por los profesionales de la salud es un hecho común actualmente, sobre todo en menores de edad, lo que constituye un importante problema de salud, por lo que se diseñó una estrategia educativa para su manejo y así disminuir la morbimortalidad en estos pacientes.

Translated abstract

Introduction: the penetration of foreign bodies into airway and digestive tracts results in serious problems, leading even to death. Objective: to determine the management of patients with foreign bodies into the airway and digestive tracts. Method: a descriptive, cross-sectional and intervention research in patients attending to the emergency room at “Abel Santamaria Cuadrado” University Hospital was carried out from 2010 to 2011. The target group and the sample were comprised of 773 patients with suspect or diagnosis of foreign bodies into the airway-digestive tracts. Biostatistics and descriptive methods along with X2 test to 95% of confidence were the methods applied. Results: 72,6% of the cases were considered of emergencies, 75,5% confirmed as having foreign bodies, ages from 0-15 prevailed (28,8%), male sex (48,5%), most of the foreign bodies were located into the hypo-pharynx (39%), where most of patients (26%) belonged to “Hermanos Cruz” University outpatient clinic. Out of the 154 esophagoscopies performed only 110 were positive. An educational strategy was designed to the Primary Health Care Professionals. Conclusions: the management of foreign bodies into the airway and digestive tracts by primary health care professionals is at present a common fact, mainly in little children, which constitutes an important health problem; in consequence an educational strategy was designed to its management in order to diminish the morbidity or mortality rates of these patients.

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Battery ingestion in children.

Tal Marom, Abraham Goldfarb, Eyal Russo … (2010)

Ingestion of batteries by children became more frequent in recent years, due to the increasing accessibility of electronic toys and devices to children. Due to their electrochemical composition, impacted batteries in the esophagus may cause an extensive damage. Following the removal of a battery, the post-esophagoscopy management is still controversial. An otherwise healthy 8 year-old boy presented to the pediatric emergency room 3h after the unintentional swallowing of a lithium battery. On examination, the patient was diaphoretic and tachypneic. Plain PA chest film revealed a 2.5 cm diameter radiopaque round object in the upper esophagus. The patient was scheduled for an urgent rigid esophagoscopy which was performed 2h after admission. Esophagoscopy findings included an impacted lithium battery in an advanced emptying process at a level of 17 cm from the incisor teeth, with a 3rd degree ulcerative esophagitis. It was not possible to visualize either the distal esophagus or the stomach. A nasogastric tube was not inserted because of a significant risk for esophageal perforation if bluntly passed. Post-operative medical therapy included fasting, administration of intravenous antibiotic therapy, antacids, and steroids. Flexible esophagoscopy superior to the level of the mucosal injury performed one day later, revealed erosive esophagitis, without evidence of perforation. Upper digestive tract gastrografin swallow test performed 2 days after esophagoscopy did not demonstrate a leak from the esophagus, and oral feeding was carefully re-initiated. Treatment was discontinued the following day. Follow up on days 10 and 14 revealed a healthy child with normal swallowing. Battery ingestion-related injury results from direct pressure necrosis, local electrical currents and alkali leakage. Signs and symptoms of ingested battery are related to impaction duration, size of battery, battery content and peristaltic waves of the esophagus. Appropriate imaging studies should be performed to maximize identification of the foreign body before esophagoscopy. Esophageal stenting and adjuvant medical therapy (steroid therapy, antibiotic therapy and anti-reflux therapy) have a low evidence level of clinical benefit following caustic injuries from impacted batteries and spillage of their content to the esophagus. A judicious management should be tailored in each patient. Increased public and health personnel awareness is necessary to diminish the incidence of battery ingestion. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.