(sorry for the long reply)
Let me clarify:
What I said is that 95% of FB pass uneventfully and 5% are RETAINED.(Morris
and Wood: Oxford Textbook of Surgery).
I never quoted any RATE of complication: the true rate of complication of a
retained FB is difficult to calculate, because in most studies the retained
FB are removed early.
Also, you might not see these cases in the ED because the symptoms could happen
after several months if not years and the patient could be referred directly
to the surgeons by the GP.
Anyhow, the way I see it is:
1. do nothing = high risk
2. XRay chest + neck + abdomen = Patient exposed to unnecessary radiations (abdo
x-ray)as FB could be passed uneventfully in a few days.
3. Xray chest and neck only and do nothing if not found on Xray = risk of complications
from retained body.
4. Xray chest and neck and if not found ask parents to look for FB in the stools.
If not found review (GP could do it) and XRay the abdomen. If FB found and pt
asymptomatic repeat abdo xray to see if there is progression. If no progression
consider removal = Lower risk of radiation if passed. Lower risk of complication
if retained.
Is this unreasonable?
(My great concern are non-radiopaque FBs).
M. Della Corte
Staff Grade ED
Oxford
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