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GASTROINTESTINAL DISORDERS*

*The authors acknowledge the special contributions of Kanwal S. Chaudhry, MD, to prior edition.

ESOPHAGEAL FOREIGN BODIES

Clinical Summary

One of the most common gastrointestinal (GI) emergencies are ingested foreign bodies (FBs). Fortunately, most FBs pass through the GI tract spontaneously and require minimal medical intervention. In young children, typical swallowed FBs include coins, beads, button batteries, and toys, typically anything within reach. Accidental FB ingestions in adolescents are typically a result of a partially digested food bolus that becomes lodged in the esophagus. Unfortunately, some FB ingestions are intentional for various psychiatric reasons, and these ingestions may include sharp and potentially harmful objects (eg, razors, glass). The pediatric patient with an FB ingestion may be asymptomatic; however, a patient with a lodged FB in the esophagus often presents with drooling, excessive salivation, voice changes, vomiting, or respiratory symptoms.

TABLE 15.1NONSPECIFIC SIGNS AND SYMPTOMS AND COMPLICATIONS OF RETAINED ESOPHAGEAL FOREIGN BODIES (FB)
FIGURE 15.1

Drooling as a Presenting Sign of an Esophageal Foreign Body (FB). An afebrile child presented with a sudden onset of drooling and inability to eat solid foods. There was no witnessed episode of choking, gagging, or any FB ingestion. An esophageal FB was suspected based on the history and subsequently confirmed (see Figure 15.2C). Drooling is a very common and consistent sign seen with a high-grade esophageal obstruction. (Photo contributor: Binita R. Shah, MD.)

Emergency Department Treatment and Disposition

After stabilizing the patient, the first treatment priority is identifying the location of the FB. The location of a metallic FB may be found through the use of a hand-held metal detector. However, the most common technique for detection of radiopaque FBs is radiography. Plain-film imaging of the entire GI tract is often used to avoid missed FBs. Obtain anteroposterior and lateral CXRs if the FB is above the diaphragm to determine if it is in the trachea or esophagus and whether there is >1 FB (eg, 2 or more coins stacked together). If the FB is suspected to be radiolucent and perforation is not a concern, contrast esophagram may ...

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