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Ingested foreign bodies in childhood
Injury April 1972
INJURY: THE BRITISH JOURNAL OF ACCIDENT SURGERY
264
first aid box and is not complete until the individual is returned to his normal working environment or is permanently placed in some other suitable work. Family doctors complain of the increasing load of certification which comes their way. Hospitals protest about the large amount of trivial injury and indisposition which block their departments. Industry is expressing more and more concern at rising sickness absence. The suggestion already made by the Office of Health Economics, for the greater involvement of industry in the management of illness and injury amongst its employees merits serious considerations. In any discussion of the treatment of occupational injury at work, two ethical problems are invariably raised : the problem of certification and Requests
for
reprinls
should be addressed
to:-.I.
REFERENCES ANNUAL REPORT OF H.M. CHIEF INSPECTOR OF FACTORIES(1970), p. 72. London: H.M.S.O. EIGHTH ANNUAL REPORT (1970/71), West Bromwich:
The West Midland Occupational (1971), p. 19. London: Economics.
OFF SICK
PLEWES, L.
London:
W.
(1966),
Accident
Health Service. Office of Health Services,
REDGRAVE’S FACTORIESACTS (1966),
London:
p. 460.
Pitman. 21st ed., p. 172.
Butterworths.
D. Cameron,Esq., M.B., F.R.C.S. (Edin.), Medical Centre, Pilkington BrothersLtd., St. Helens, LancashireWA10 3TT.
ABSTRACTS THORACIC IN JURIES
the problem of concurrent patient care. These are not insurmountable obstacles and with understanding and good will can readily be overcome. They should not be allowed to interfere with the management of industrial injury when this is not only of benefit to industry and the national economy, but also in the very best interests of the patient.
AND ABDOMINAL
Ingested Foreign Bodies in Childhood This study is based on 660 persons under the age of 16 who were admitted to two children’s hospitals because they had swallowed foreign bodies. Sixty-two per cent were kept under observation until the foreign body had emerged or until they had no symptoms. The foreign bodies that were removed were mostly in the upper two-thirds of the gullet or were long objects in the stomach or duodenum of a child 2 years old or less. None was removed from the rest of the intestine. Foreign bodies in the lowest third of the gullet may be observed for up to 12 hours if they have no sharp edges or corners. If a foreign body is to be removed from the stomach it should be prevented from passing into the duodenum by a prepyloric clamp. No operation should be undertaken without a very recent X-ray film that shows that operation is still needed. Sharp objects took about 7 days and blunt objects about 5 days to pass through the digestive tract. SPITZ, L. (1971), ‘ Management of Ingested Foreign Bodies in Childhood ‘, Br. med. J., 4, 469. Injury to the Duodenum
The management of duodenal injury is discussed with reference to a series of 23 cases. Injury without rupture required evacuation of intramural haematom?, with or without gastro-enterotomy. Rupture required repair, with or without gastro-enterotomy. Full mobilization of the duodenum is necessary to avoid overlooking lesions. Rupture with pancreatic damage proved the most serious problem. Pan-
creatico-duodenectomy though drastic may be lifesaving, especially when the main duct is damaged. It is preferable to finishing up with a fistula. Mortalityrates are greatly affected by delay in diagnosis. In diagnosis, radiography and paracentesis do not seem to be very helpful. ROMAN, E., SILVA, Y. J., and LUCAS, C. (1971), ‘ Management of Blunt Duodenal Injury ‘, Surgery Gynec. Obstet.,
132, 7.
Closing Colostomies
A colostomy, which is often a life-saving procedure in penetrating abdominal wounds, particularly war wounds, has to be closed before completion of the case. The preoperative preparation and details of the operative technique are described in this paper which is based on 60 cases. Extraordinary complications are sometimes encountered and considerable demands are made on the surgeon’s resourcefulness. SULLIVAN, W. G., MILLER, R. E., and EISEMAN, B. ‘ Closure of Colonic Stomas in Patients (1970), Injured in Combat ‘, Surgery Gynec. Obstet., 131, 1045. Rupture of the Thoracic
Aorta
An analysis of 14 cases. In some, death was immediate but in others there was time for diagnosis and treatment. In this latter group survival was good. Suspicioy, in a patient who has received a violent deceleration injury, is the best starting point. There may be no external evidence of injury. Signs are widening of the mediastinum, abnormal or obliterated aortic anatomy, depression of left main stem bronchus or deviation of the trachea to the right. None of these is definitive but an aortogram is. KIRSCH, M. M., CRANE, J. D., KAHN, P. R., GAZO, O., MOORES, W. Y., REDMAN, H., BROOKSTEIN,J. J., and SLOAN,H. (1970), ‘ Roentgenographic Evaluation
of Traumatic Obstet.,
Rupture
131, 900.
of Aorta ‘, Surgery Gynec.
INJURY: THE BRITISH JOURNAL OF ACCIDENT SURGERY
264
first aid box and is not complete until the individual is returned to his normal working environment or is permanently placed in some other suitable work. Family doctors complain of the increasing load of certification which comes their way. Hospitals protest about the large amount of trivial injury and indisposition which block their departments. Industry is expressing more and more concern at rising sickness absence. The suggestion already made by the Office of Health Economics, for the greater involvement of industry in the management of illness and injury amongst its employees merits serious considerations. In any discussion of the treatment of occupational injury at work, two ethical problems are invariably raised : the problem of certification and Requests
for
reprinls
should be addressed
to:-.I.
REFERENCES ANNUAL REPORT OF H.M. CHIEF INSPECTOR OF FACTORIES(1970), p. 72. London: H.M.S.O. EIGHTH ANNUAL REPORT (1970/71), West Bromwich:
The West Midland Occupational (1971), p. 19. London: Economics.
OFF SICK
PLEWES, L.
London:
W.
(1966),
Accident
Health Service. Office of Health Services,
REDGRAVE’S FACTORIESACTS (1966),
London:
p. 460.
Pitman. 21st ed., p. 172.
Butterworths.
D. Cameron,Esq., M.B., F.R.C.S. (Edin.), Medical Centre, Pilkington BrothersLtd., St. Helens, LancashireWA10 3TT.
ABSTRACTS THORACIC IN JURIES
the problem of concurrent patient care. These are not insurmountable obstacles and with understanding and good will can readily be overcome. They should not be allowed to interfere with the management of industrial injury when this is not only of benefit to industry and the national economy, but also in the very best interests of the patient.
AND ABDOMINAL
Ingested Foreign Bodies in Childhood This study is based on 660 persons under the age of 16 who were admitted to two children’s hospitals because they had swallowed foreign bodies. Sixty-two per cent were kept under observation until the foreign body had emerged or until they had no symptoms. The foreign bodies that were removed were mostly in the upper two-thirds of the gullet or were long objects in the stomach or duodenum of a child 2 years old or less. None was removed from the rest of the intestine. Foreign bodies in the lowest third of the gullet may be observed for up to 12 hours if they have no sharp edges or corners. If a foreign body is to be removed from the stomach it should be prevented from passing into the duodenum by a prepyloric clamp. No operation should be undertaken without a very recent X-ray film that shows that operation is still needed. Sharp objects took about 7 days and blunt objects about 5 days to pass through the digestive tract. SPITZ, L. (1971), ‘ Management of Ingested Foreign Bodies in Childhood ‘, Br. med. J., 4, 469. Injury to the Duodenum
The management of duodenal injury is discussed with reference to a series of 23 cases. Injury without rupture required evacuation of intramural haematom?, with or without gastro-enterotomy. Rupture required repair, with or without gastro-enterotomy. Full mobilization of the duodenum is necessary to avoid overlooking lesions. Rupture with pancreatic damage proved the most serious problem. Pan-
creatico-duodenectomy though drastic may be lifesaving, especially when the main duct is damaged. It is preferable to finishing up with a fistula. Mortalityrates are greatly affected by delay in diagnosis. In diagnosis, radiography and paracentesis do not seem to be very helpful. ROMAN, E., SILVA, Y. J., and LUCAS, C. (1971), ‘ Management of Blunt Duodenal Injury ‘, Surgery Gynec. Obstet.,
132, 7.
Closing Colostomies
A colostomy, which is often a life-saving procedure in penetrating abdominal wounds, particularly war wounds, has to be closed before completion of the case. The preoperative preparation and details of the operative technique are described in this paper which is based on 60 cases. Extraordinary complications are sometimes encountered and considerable demands are made on the surgeon’s resourcefulness. SULLIVAN, W. G., MILLER, R. E., and EISEMAN, B. ‘ Closure of Colonic Stomas in Patients (1970), Injured in Combat ‘, Surgery Gynec. Obstet., 131, 1045. Rupture of the Thoracic
Aorta
An analysis of 14 cases. In some, death was immediate but in others there was time for diagnosis and treatment. In this latter group survival was good. Suspicioy, in a patient who has received a violent deceleration injury, is the best starting point. There may be no external evidence of injury. Signs are widening of the mediastinum, abnormal or obliterated aortic anatomy, depression of left main stem bronchus or deviation of the trachea to the right. None of these is definitive but an aortogram is. KIRSCH, M. M., CRANE, J. D., KAHN, P. R., GAZO, O., MOORES, W. Y., REDMAN, H., BROOKSTEIN,J. J., and SLOAN,H. (1970), ‘ Roentgenographic Evaluation
of Traumatic Obstet.,
Rupture
131, 900.
of Aorta ‘, Surgery Gynec.