Yabancı Cisim Yutma Öyküsü veya Şüphesi Olan Çocukların Değerlendirilmesi: Tek Merkez Deneyim

Öz

Amaç: Yabancı cisim yutma olayları çocukluk döneminin önemli sorunlarından biridir. Bu çalışmada merkezimizin beş yıllık tecrübesi tartışıldı. Olguların yuttukları cisimler ve takip süreçleri, invaziv işlemler, gelişen komplikasyonlar ve kamuya olan maliyetleri geriye dönük olarak incelendi. Gereç ve Yöntemler: Nisan 2014-Ocak 2019 tarihleri arasında, çocuk acil, erişkin acil ve çocuk gastroenteroloji polikliniklerine yabancı cisim yutma şikayeti ile başvuran 0-18 yaş arası çocuklara ait hasta dosyaları ve hastane otomasyon sistemindeki verileri geriye dönük olarak incelendi. Bulgular: Yabancı cisim yutma şikayeti ile başvuran 590 olgunun ortalama yaşı 52,8 ay ve 274’ü (%46,4) kız idi. Olguların 219’unda (%37,1) klinik ve radyolojik olarak yabancı cisim saptanmadı. Hastaların 570’i (%96,6) asemptomatik olup en çok yutulan yabancı cisim madeni para 179 (%30,3) idi. Olguların 35’ine (%5,9) endoskopik girişim gerekli oldu. İki olguya (%0,3) cerrahi işlem yapıldı. Hasta başına ortalama 2,5 konvansiyonel radyografi çekildi. Olguların 47’sine (%8.0) ise bilgisayarlı tomografi çekildi. Hasta başına kamu maliyetleri ortalama 111,07 TL olarak hesaplandı. Sonuç: Yabancı cisim yutma olayları nadiren invaziv işlemlere, radyolojik tetkikler nedeni ile X-ışını maruziyetine ve hastane giderleri nedeni ile kamu harcamalarının oluşmasına neden olmaktadır. Olguların önemli bir bölümünde yabancı cisim saptanamamıştır. En sık yutulan cisimler günlük hayatta kullanılan ve kolay ulaşılabilen cisimler olduğundan ebeveynler tarafından evde alınacak koruyucu önlemlerle bu sorunun azalacağı öngörülebilir.

Anahtar Kelimeler

• Cerrahi
• Endoskopi
• Konvansiyonel radyografi
• Maliyet
• Yabancı cisim yutma

Evaluation of Children with a History of Foreign Body Ingestion or Suspection: A Single Center Experience

Öz

Objective: Foreign body ingestions is one of the important issues of childhood. In this study, the five-year experience of our center was discussed. The objects and follow-up processes that the patients ingested, invasive procedures, complications and costs to the public were analyzed retrospectively. Material and Methods: Data for children aged 0-18 years presenting to pediatric emergency, adult emergency and pediatric gastroenterology units due to foreign body ingestion between April 2014 and January 2019 were examined retrospectively from patient files and the hospital automation system. Results: The mean age of the 590 children presenting with foreign body ingestion was 52.8 months, and 274 (46.4%) were girls. In clinically and radiologically, no foreign body was detected in 219 (37.1%) of the cases. 570 (96.6%) of the patients were asymptomatic and the most commonly ingested objects were coins 179 (30.3%). Endoscopic procedures were required in 35 (5.9%) of cases. Surgical intervention was performed in two (%0.3) cases. A mean of 2.5 conventional radiographs were taken per patient. Computed tomography was performed in 47 (8.0%) of the cases. The mean costs per patient were calculated as 111.07 Turkish Liras. Conclusion: Foreign body ingestion rarely cause to invasive procedures, x-ray exposure due to radiological imaging, and public costs. Since the most frequently ingested objects are that used in daily life and are easily accessible, it can be predicted that this issue will be reduced by preventive measures to be taken by parents at home.

Anahtar Kelimeler

• Conventional radiography
• Cost
• Endoscopy
• Foreign body ingestion
• Surgery

Kaynakça

1. Dereci S, Koca T, Serdaroğlu F, Akçam M. Foreign body ingestion in children. Turk Pediatri Ars 2015;50:234–40.
2. Wright CC, Closson FT. Updates in pediatric gastrointestinal foreign bodies. Pediatr Clin North Am 2013;60:1221–39.
3. Bolton SM, Saker M, Bass LM. Button battery and magnet ingestions in the pediatric patient. Curr Opin Pediatr 2018;30:653–59.
4. Kay M, Wyllie R. Pediatric foreign bodies and their management. Curr Gastroenterol Rep 2005;7:212- 8.
5. Waltzman ML, Baskin M, Wypij D, Mooney D, Jones D, Fleisher G. A randomized clinical trial of the management of esophageal coins in children. Pediatrics 2005;116:614-9
6. Erginel B, Karlı G, Gün Soysal F,Keskin E, Özbey H, Çelik A, Salman T. Çocukluk çağında yabancı cısım yutma. İst Tıp Fak Derg 2016;79:27-31.
7. Wahbeh G, Wyllie R, Kay M. Foreign body ingestion in infants and children: location, location, location. Clin Pediatr (Phila) 2002;41:633 40.
8. Kramer RE, Lerner DG, Lin T, Manfredi M, Shah M, Stephen TC, Gibbons TE, Pall H, Sahn B, McOmber M, Zacur G, Friedlander J, Quiros AJ, Fishman DS, Mamula P. Management of Ingested Foreign Bodies in Children: A Clinical Report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr 2015;60:562–74.

9. Özaydın S, Erol M, Çelebi S, Başdaş CB, Güvenç Ü, Sander S. Yutulan Yabancı Cisimlerin Oluşturduğu Gastrointestinal Cerrahi Sorunlar. İKSST Derg 2016;8:106-10.
10. Tiryaki HT, Akbıyık F, Şenel E, Mambet E, Livanelioğlu Z, Atayurt HF. Çocukluk çağında yabancı cisim yutulması. Türkiye Çocuk Hast. Derg 2010;4:94-9.
11. Gummin DD, Mowry JB, Spyker DA, Brooks DE, Fraser MO, Banner W. 2016 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th Annual Report. Clin Toxicol (Phila) 2017; 55(10): 1072–252.
12. Wright CC, Closson FT. Updates in Pediatric Gastrointestinal Foreign Bodies. Pediatr Clin N Am 2013;60:1221–39.
13. Manfredi M. Caustic Ingestion and Foreign Bodies. In Wyllie R, Hyams JS, Kay M, eds. Pediatric gastrointestinal and liver disease. Fifth edition. Chapter 18. Philadelphi, Elsevier, 2016:206-21.
14. Arana A, Hauser B, Hachimi-Idrissi S, Vandenplas Y. Management of Ingested Foreign Bodies in Childhood and Review of the Literature. Eur J Pediatr 2001;160:468-72.
15. Ibrahim AH, Andijani A, Abdulshakour M, Algain S , Thamrah AA , Ali MM , Marwah H , Aldaher A, Bashir S , Alsaleem B, Asery A, Al-Hussaini A . What Do Saudi Children Ingest? A 10-Year Retrospective Analysis of Ingested Foreign Bodies From a Tertiary Care Center. Pediatr Emerg Care 2019;24:1-7.
16. Uyemura MC. Foreign body ingestion in children. Am Fam Physician 2005;72:287-91.
17. Louie JP, Alpern ER, Windreich RM. Witnessed and unwitnessed esophageal foreign bodies in children. Pediatric Emergency Care 2005;21:582–85.
18. Heim SW, Maughan KL. Foreign bodies in the ear, nose, and throat. Am Fam Physician 2007;76:1185–9.
19. Gün F, Salman T, Abbasoglu L, Celik R, Celik A. Safetypin ingestion in children: a cultural fact. Pediatric Surgery International 2003;19:482-84.
20. Grimes JC, Spier BJ, Swize LR, Lindstrom MJ, Pfau PR. Predictors of Recurrent Ingestion of Gastrointestinal Foreign Bodies. Can J Gastroenterol 2013; 27: e1–e4.
21. Low Kapalu CM, Ibrahimi N, Mentrikoski JM, Attard T. Pediatric Recurrent Intentional Foreign Body Ingestion: Case Series and Review of the Literature J Pediatr Gastroenterol Nutr 2020; doi: 10.1097/MPG.0000000000002757.