一种新颖的、非侵入性的方法：使用口服橄榄油取出儿童食管硬币：病例报告

文献信息

中文摘要

引言： 异物吞入是儿科急诊就诊的常见原因，其中硬币是经常遇到的吞入物体。临床表现从完全无症状到流涎、吞咽困难、咳嗽和胸部不适等症状不等。未能及时识别和恰当处理食管异物可能导致严重并发症，这凸显了及时诊断和管理的必要性。
病例介绍： 我们报告一例6岁男孩，在意外吞下一枚硬币约4小时后出现流涎和胸骨后疼痛。平片显示一枚圆形不透X线异物嵌顿于食管远端。在与父母进行知情讨论后，未立即进行内镜取出，而是采取了保守试验，包括口服橄榄油（1 mL/kg）随后不限量饮水。一小时后复查影像学评估显示硬币完全通过食管进入回盲部区域，患儿症状完全缓解。他从急诊科出院回家，情况稳定。硬币在24小时内随粪便自行排出，无任何并发症。
结论： 本病例提出了一个产生假设的概念，即口服橄榄油作为一种简单、廉价、微创的辅助手段，可能对特定的一组食管下段嵌顿硬币的儿童有益。这种方法可能减少内镜干预的需要，尽量减少麻醉暴露，缩短急诊科停留时间，降低因内镜而住院的比例，并减少医疗资源利用。然而，患者选择应谨慎进行，并严格遵循既定的异物吞入管理原则。

英文摘要

INTRODUCTION: Foreign body ingestion is a common reason for pediatric emergency department presentation, with coins representing a frequently encountered ingested object. Clinical presentation ranges from being entirely asymptomatic to symptoms such as drooling, dysphagia, cough and chest discomfort. Failure to promptly recognize and appropriately manage an esophageal foreign body may result in serious complications, underscoring the need for a timely diagnosis and management.
CASE PRESENTATION: We report the case of a 6-year-old boy who presented with drooling and retrosternal pain, approximately 4 h after accidentally swallowing a coin. Plain radiographs demonstrated a round radio-opaque foreign body lodged within the distal esophagus. Following an informed discussion with the parents, instead of immediate endoscopic retrieval, a conservative trial consisting of oral olive oil (1 mL/kg) followed by unrestricted water intake was undertaken. Repeat radiographic evaluation one hour later demonstrated complete passage of the coin beyond the esophagus to the ileocecal region, with complete resolution of the child's symptoms. He was discharged home from the emergency department in a stable condition. The coin was passed spontaneously in the stool within 24 h, without any complications.
CONCLUSION: This case serves as a hypothesis generating concept of the potential role of oral olive oil as a simple, inexpensive, minimally invasive adjunct for selected cohort of children with coins lodged in the lower esophagus. Such an approach may reduce the need for endoscopic intervention, minimize exposure to anesthesia, shorten emergency department length of stay, reduce rates of admission for endoscopy, and decrease healthcare resource utilization. Nevertheless, patient selection should be done cautiously, with strict adherence to established foreign body ingestion management.