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GASTROINTESTINAL DISORDERS*
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*The authors acknowledge the special contributions of Kanwal S. Chaudhry, MD, to prior edition.
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ESOPHAGEAL FOREIGN BODIES
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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.
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Emergency Department Treatment and Disposition
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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 be useful. ...