Foreign Bodies in the Alimentary Tract

Key Features

• 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

Clinical Findings

• 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

Diagnosis

• 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

Treatment

• 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 ...