Surgically managed small-intestinal foreign bodies in children: clinical-radiologic characteristics and factors associated with perforation.

OBJECTIVE: To investigate the clinical and radiologic features of surgically managed small-intestinal foreign bodies (FBs) in children and to identify factors associated with intestinal perforation. METHODS: We retrospectively reviewed the records of 45 children who underwent surgery for small-intestinal FBs at Shanghai Children's Hospital between February 2019 and June 2026. Clinical, imaging, operative, and postoperative data were collected. Continuous variables were presented as medians and interquartile ranges and compared using the Mann-Whitney U test. Categorical variables were compared using Fisher's exact test, and perforation rates across FB categories were evaluated using the Fisher-Freeman-Halton exact test. RESULTS: Intestinal perforation occurred in 34 of 45 patients (75.6%). Compared with patients without perforation, those with perforation more frequently presented with abdominal tenderness (73.5% vs. 27.3%, P = 0.011) and had metallic FBs detected on radiography (55.9% vs. 0%, P = 0.001). Computed tomography provided additional visualization and localization of poorly radiopaque or radiolucent FBs, including jujube pits, trichobezoars, and superabsorbent polymer beads. Patients with perforation had a longer median hospital stay than those without perforation (12.0 [8.0-20.0] vs. 8.0 [7.0-10.5] days, P = 0.018). FB type was significantly associated with perforation (overall P < 0.001); all patients with magnetic objects or jujube pits developed perforation. CONCLUSION: Intestinal perforation was common among children undergoing surgery for small-intestinal FBs and was associated with abdominal tenderness and FB type. CT was valuable for detecting radiolucent FBs. Early surgical assessment should be considered when perforation or worsening intestinal obstruction is suspected.