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Background: In the pediatric emergency department, children often present with vomiting and mild dehydration, commonly presumed to indicate viral gastroenteritis. However, it is crucial to consider less common diagnoses like foreign body ingestion. This condition, mostly affecting toddlers, can be easily overlooked, particularly if not witnessed. Yet, missing such a diagnosis can lead to serious consequences. In this report, we present a rare case where sonographic imaging facilitated a challenging diagnosis despite insufficient anamnestic details of a foreign body ingestion. Case Description: A 2-year-old male with an unremarkable medical history displayed symptoms of anorexia, vomiting, and malaise in the emergency department that began 5 days earlier. During this period, he also developed increasing fatigue, pallor, and food refusal. Despite normal bowel movements, hydration, and urinary output, his condition raised concern for dehydration, prompting referral to the hospital. Initial physical examination revealed signs of mild dehydration, but no acute signs of meningeal irritation or peritonitis. His vital signs were within normal ranges, and laboratory results showed moderate hyponatremia (127 mmol/L). Due to insufficient improvement after empiric treatment with fluids, and a visual documentation of biliary vomiting, further investigation led to the diagnosis of foreign body ingestion. Sonographic imaging revealed distended bowel loops and visualization of a chain of magnetic beads in the right lower abdominal quadrant. Abdominal X-ray corroborated these findings with signs of retroperitoneal air. Prompt surgical intervention revealed 18 small bowel perforations, which were repaired successfully. Postoperatively, the child received broad-spectrum antibiotics, total parenteral nutrition, and was monitored in the intensive care unit before being discharged home after 7 days with no long-term complications. Conclusions: This case emphasizes the significance of considering the possibility of foreign body ingestion in pediatric patients, even in the absence of relevant background details. It also highlights the potential role of ultrasound imaging in diagnosing foreign body ingestion and preventing severe complications. Early recognition and timely intervention can lead to a favorable outcome, underscoring the value of a thorough diagnostic approach in pediatric emergency settings.
Frenkel et al. (Fri,) studied this question.