Effect of Whole Bowel Irrigation for Ingested Lead-Containing Foreign Bodies: A Pediatric Case Series

Background: Foreign body (FB) ingestions cause lead toxicity in pediatric patients. These ingestions result in continued lead absorption until passage or removal from the gastrointestinal (GI) tract. Whole-bowel irrigation (WBI) is frequently recommended to aid in the removal of FBs, however effectiveness of this practice is not clear. Methods: We performed a retrospective chart review of pediatric patients (<18 years old) admitted for treatment of lead toxicity at an academic pediatric medical center from 1 January 2017 through 31 October 2023. We abstracted patient age, identity of ingested FB, lead concentrations, duration of WBI, maximum flow rate of WBI, success or failure of FB passage, performance and results of endoscopy, and duration of hospital stay. Results: Nine cases with radiopaque FB suspected to be lead were treated with WBI. Three cases resulted in the complete expulsion of the ingested FB. Four patients underwent endoscopic removal after WBI median duration of 47.5 h (range 27–80.5 h). One patient failed to clear despite 168.5 h of WBI. Conclusion: WBI did not lead to the clearance of all FBs in this series. Practitioners should consider early endoscopic removal if WBI does not result in passage of the FB within the first 48 h.