Conservative management of sharp metallic foreign body ingestion in a toddler in a low-resource setting: a case report

Abstract

Introduction

Foreign body ingestion is common in children. Swallowing sharp metallic objects such as screws poses a high risk of intestinal perforation. Standard management requires urgent endoscopic removal, which may not be readily available everywhere.

Case presentation

A 1-year-old male presented 2 h after ingesting a metallic screw, experiencing vomiting but hemodynamically stable. Initial abdominal radiograph located the screw in the proximal small bowel. Due to the unavailability of pediatric endoscopy, the child was admitted for conservative management. He was given intravenous fluids and clear liquids by mouth. Additionally, he received oral lactulose. He underwent frequent serial abdominal exams and serial abdominal radiographs. The foreign body progressed daily, and two days after the admission it was seen in the ileocecal region by x-ray. On the third hospital day, the screw passed spontaneously in the stool without complications. He remained asymptomatic and tolerated his enteral feedings throughout the admission.

Conclusion

A trial of conservative management under strict clinical monitoring can be attempted in children who swallowed sharp foreign bodies and are asymptomatic, particularly in resource-limited settings where standard interventional options are inaccessible.