International Journal of Contemporary Pediatrics

Latha GS et al. Int J Contemp Pediatr. 2016 May;3(2):681-683

http://www.ijpediatrics.com

pISSN 2349-3283 | eISSN 2349-3291

Case Report

DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20161066

A rare case of ingestion of unusual foreign body in an adolescent girl

Latha GS*, Mallikarjun GP, Veeresh Babu, Kishan Ashok Bhagwath

Department of Paediatrics, SSIMS & RC, Davangere, India

Received: 29 February 2016

Revised: 12 April 2016

Accepted: 13 April 2016

*Correspondence:

Dr. Mallikarjun GP,

E-mail: drmallikarjungp@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Foreign body ingestion is a frequently encountered problem in the paediatric age group as an emergency. It is known that 80-90% ingested foreign body pass through gastrointestinal tract spontaneously without any complications. Only 0-2% may need endoscopic intervention and hardly less than 1% may end in need of surgery. A case of 16 year old adolescent girl presents with history of intentional ingestion of multiple bangle pieces. This case report highlights the rarest consumption of foreign body ingestion with suicidal intention, from rural area. The case shows close monitoring and conservative management in unharmful small objects (usually <2 cm) gives good outcome without surgical or invasive procedures.

Keywords: Foreign body ingestion, Paediatric

INTRODUCTION

Foreign body ingestion is a frequently encountered problem in the paediatric age group as an emergency. Majority of accidental ingestion is commonly seen in the children aged less than 3 years of age, whereas intentional ingestion is primarily seen in adolescents or in adult population with suicidal intention. It is known that 80-90% ingested foreign body pass through gastrointestinal tract spontaneously without any complications. Only 0-2% may need endoscopic intervention and hardly less than 1% may end in need of surgery.1,2 Intentional ingestion is most commonly seen with adolescent patients with intellectual or mental disabilities, substance abuse or psychotic disorders.3

CASE REPORT

Here we report a case of 16 year old adolescent girl presents with history of intentional ingestion of multiple bangle pieces. Three days after ingestion this was revealed to mother by herself, she had taken with suicidal intention as she had broken newly bought show piece unknowingly. Three days after ingestion, she started having abdominal pain and with the fear of ingestion of bangle pieces, she was scared to death. She revealed this to her mother and she was brought to the hospital.

Clinically, the patient was stable with generalised vague tenderness over the abdomen, plain radiography of erect abdomen revealed multiple small linear radio-opaque shadows interspersed with faecal residual gas shadow along the large intestine from cecum, ascending colon, transverse colon, descending colon, sigmoid colon identified by the haustral pattern on radiography. No signs of intestinal obstruction or small bowel dilatation. No free air under diaphragm noted. Follow up plain radiography after three days revealed absence of the foreign body opacities correlating with expulsion in the faecal matter.

DISCUSSION

Foreign body ingestion is a common problem in the paediatric population.4 As majority of the foreign body pass through the gastrointestinal tract uneventfully, morbidity and mortality is rare in childhood but that may cause serious anxiety in parents.

Figure 1: Erect abdomen radiography shows the linear radio opaque foreign bodies distributed along the haustral pattern confirming the large intestinal location, which correlates with three days history of consumption of ground glass pieces of bangles.
Figure 1: Erect abdomen radiography shows the linear radio opaque foreign bodies distributed along the haustral pattern confirming the large intestinal location, which correlates with three days history of consumption of ground glass pieces of bangles.
Figure 2: Follow up plain radiography after three days revealed absence of the foreign body opacities along the large intestine.
Figure 2: Follow up plain radiography after three days revealed absence of the foreign body opacities along the large intestine.
Figure 3: Removed bangle pieces in the faecal matter.
Figure 3: Removed bangle pieces in the faecal matter.

It also depends upon the type, size, shape of objects that the child has consumed.5,6 Commonly ingested foreign bodies encountered in the paediatric age group is coins, batteries, magnets, steel balls, food or meat bolus, chicken fish bones, screws, needles, sharp objects. Miscellaneous like marbles, rings, and toys.7,8

In our case she was an adolescent girl coming from a low socioeconomic status with a busy family dynamics. She was psychologically normal girl with normal mental status studying in 10th standard. Psychiatric opinion was taken to evaluate the psychosocial and mental status of the child. Apart from being overanxious she was normal. She was treated with antipsychotics and counselling was done. She was treated with conservative measures and supportive management and monitored for complications which might occur and watch for bangle pieces to pass in faecal matter, finally she came out without any complications, and bangle pieces were collected which she used to pass daily in faecal matter.

CONCLUSIONS

Foreign body ingestion is a common entity in infants and toddlers. Children tend to ingest common things which are present at home. This case report highlights the rarest consumption of foreign body ingestion with suicidal intention, from rural area. It’s practice in the rural area in certain parts of India, where they crush bangles pieces and being used for female foeticide. This might be one of the reasons for the girl to consume bangle pieces. Here, we need to know the possibility of ingesting rarest things in children and adolescents. Sometimes we do need to keep the possibility of rarest things like bangle glass pieces as in our case. The case shows close monitoring and conservative management in unharmful small objects (usually <2 cm) gives good outcome without surgical or invasive procedures.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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