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Key Features

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  • Dysphagia, odynophagia, drooling, regurgitation, and chest/abdominal pain are typical symptoms of esophageal foreign body.

  • Esophageal foreign bodies should be removed within 24 hours of ingestion.

  • Esophageal button batteries must be removed emergently because of their ability to cause lethal injury.

  • Most foreign bodies in the stomach will pass spontaneously.

  • most common foreign body ingested by children is the coin

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Clinical Findings

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  • Most common presenting symptoms

    • Dysphagia

    • Odynophagia

    • Drooling

    • Regurgitation

    • Chest

    • Abdominal pain

  • Respiratory symptoms, such as cough, become prominent when foreign bodies are retained in the esophagus for more than 1 week

  • Ingested foreign bodies tend to lodge in narrowed areas

    • Valleculae

    • Thoracic inlet

    • Gastroesophageal junction

    • Pylorus

    • Ligament of Treitz

    • Ileocecal junction

    • Site of congenital or acquired intestinal stenoses

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Diagnosis

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  • Radiography

    • Radio-opaque objects will be easily visualized

    • Non–radio-opaque objects, such as plastic toys, may not appear on standard radiograph

  • Contrast esophagram is useful if there is particular concern, based on patient symptoms, for a retained esophageal foreign body that is non–radio-opaque

  • Use of contrast, however, may delay or increase the risk of anesthesia due to aspiration concerns

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Treatment

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  • Removal

    • Esophageal foreign bodies should be removed within 24 hours to avoid ulceration

    • Disk-shaped button batteries lodged in the esophagus should be removed immediately

    • Large, open safety pins may not pass the pyloric sphincter and may cause perforation

    • Objects longer than 5 cm may be unable to pass the ligament of Treitz

    • Magnets require consideration for removal if

      • More than one was ingested

      • Single magnet was ingested along with a metallic object because of the risk of fistula or erosion of mucosal tissue trapped between two adherent foreign bodies

    • Rare earth metal magnets, or neodymium magnets

      • Very powerful small magnets that are sold in bulk

      • Have caused multiple cases of bowel perforation necessitating surgical intervention

    • Ingestion of multiple magnets

      • Should lead to immediate endoscopic removal if technically feasible

      • If not, their migration through the GI tract should be followed radiographically until they are passed

    • Straight pins, screws, and nails

      • Have a blunt end that is heavier than the sharp end

      • May pass without incident

      • Need for endoscopic removal must be considered on a case-by-case basis

    • Double-sided sharp objects, such as fishbones and wooden toothpicks

      • Are weighted equally on each end

      • Should be removed because they can migrate through the wall of the GI tract into the pericardium, liver, and inferior vena cava

  • Contraindications to removal

    • Precarious airway

    • History that foreign body has been present for several days

    • Previous esophageal surgery

  • Smooth foreign bodies in the stomach, such as buttons or coins, may be monitored without attempting removal for up to several months if the child is free of symptoms

  • Balanced electrolyte lavage solutions containing polyethylene glycol

    • May help the passage of small, smooth foreign bodies lodged in the intestine

    • Useful in hastening the passage of foreign bodies that may contain an absorbable ...

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