Patterns and Complications of Ingested Foreign Bodies in Omani Children

Objectives: We sought to describe the frequency of encounters and complications of foreign body (FB) ingestion in children seen at Royal Hospital, Oman. Methods: Medical records of all children (≤ 13 years) who presented to Royal Hospital between 1 January 2011 and 31 December 2014 diagnosed with FB ingestion were reviewed. Children with FBs in their mouth or airway, with esophageal food impaction, and caustic ingestion were excluded from the analysis. Parameters including age, sex, type of FB, anatomical location of the FB on X-ray, endoscopic findings, and all complications were reviewed. Results: Of the 585 children diagnosed with FB ingestion, 385 were included in the study; 58.4% were males and 41.6% were females giving a male to female ratio of 1.4:1.0. Half (50.9%) of the children were less than three years old. Coins were the most frequently ingested objects (41.3%) followed by disc batteries (12.2%). Sixty-three patients (16.3%) required urgent esophagogastroduodenoscopy (EGD). EGD was performed mainly for coins (44.4%) followed by disc batteries (14.3%) in the esophagus or stomach. The complication rate was 5.2% in total, and 3.6% for clinically significant complications. We had no mortality cases. Conclusions: FB ingestion is common in toddlers in Oman. Coins and disc batteries are most commonly ingested calling for strict family vigilance. Endoscopy is done in a small number of children and clinically significant complications, in general, are low. However, these findings should not lead to a false sense of security, and ingested FBs should always be taken seriously

Celiac Disease in Oman: A Tertiary Centre Experience

Objective: To describe the frequency of encounter of celiac disease in Royal Hospital, Muscat, Oman.Methods: Retrospective study of records of all adult and pediatric patients in Royal Hospital from the period of 1/4/2006 to 31/3/2012. Data regarding symptoms, anthropometry of the patients, haemoglobuin levels, liver and thyroid functions were retrieved. Diagnosis of celiac disease was established based on combination of serological detection of anti tissues transglutaminase (tTG) or anti endomysial antibodies (EMA) with duodenal biopsy.Results: Only 9 children were identified in the hospital during the period of study. Two children were identified by screening protocol for Insulin Dependent Diabetes Melitus (IDDM) and one child from short stature workup. Six children presented with abdominal pain and diarrhea. Four children were severely wasted and stunted. No adult patients were identified with celiac disease. Anaemia was noted in 3 children and none had deranged thyroid functions.Conclusion: Celiac disease is infrequently encountered in Royal Hospital and might be under diagnosed. The low rate of celiac disease in children with IDDM might indicate a different genetic composition. Awareness about celiac disease and family screening should be implemented in Oman

Sengstaken-Blakemore Tube: an extra mile

Upper gastrointestinal bleeding (UGIB) in children has multiple etiologies but fortunately is not encountered commonly by pediatricians. Aorto-esophageal fistula (AEF) in children is a rare cause of UGIB and it is mainly secondary to accidental ingestion of foreign bodies, particularly disc batteries, or after cardiothoracic surgery. In this study, we report a case of a 3-year-old child who developed de novo AEF with no prior injury to the esophagus. The child presented with massive UGIB leading to hypovolemic shock, acute kidney injury, and cardiac arrest. The torrential bleed was controlled using a Sengstaken–Blakemore Tube (SBT), which allowed urgent chest CT angiography as well as subsequent thoracotomy and repair of the fistula Unfortunately, the child succumbed to repeated cardiac arrests secondary to the renal injury and severe acidosis. This case highlights the need for the early recognition of massive UGIB in children and the requirement to make appropriately sized SBTs available in all pediatric gastroenterology units

Early disseminated Mycobacterium Abscessus Complex Infection in an Infant with Coexisting Cystic Fibrosis and Progressive Familial Intrahepatic Cholestasis: A case report and literature review

Mycobacterium abscessus complex (MABSC) is a rapidly growing mycobacterium and may rarely cause disseminated infections in immunocompromised patients. In patients with Cystic Fibrosis (CF), it peaks between the ages of 11 and 15 years. We present a 5 months old infant with coexisting CF and Progressive Familial Intrahepatic Cholestasis (PFIC) who had pulmonary and cutaneous dissemination of MABSC infection. The management of this disseminated infection in an infant with two coexisting chronic diseases was challenging which resulted in a rapid deterioration of lung disease and the progression of PFIC to liver cirrhosis with a fatal outcome. Keywords: Cystic Fibrosis; Atypical Mycobacterium; Mycobacterium abscessus complex; Progressive Familial Intrahepatic Cholestasi