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Approximately 80% of all foreign body ingestions occur
in children, with the peak incidence between 6 and 36 months of
age.1,2,3 Coins are the most frequently ingested
object in young children. Food impactions are less common and, when
seen, are more likely to be associated with an underlying esophageal
disorder, such as eosinophilic esophagitis. Of those foreign body
ingestions that come to medical attention, 80% to 90% will
pass spontaneously through the gastrointestinal tract, another 10% to
20% will require endoscopic removal, and fewer then 1% ultimately
require surgery.4 Any history of possible foreign body
ingestion requires immediate attention, as outlined in Figure
395-1. Foreign body aspiration is disussed in Chapter 118.
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Esophageal Foreign
Bodies
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The esophagus is the site of foreign body impaction in 20% of
cases.1 Areas of physiologic narrowing, including
the upper esophageal sphincter at the cricopharyngeus muscle, the
mid-esophagus at the impression made by the aortic arch and left
main stem bronchus, and immediately above the lower esophageal sphincter
are sites where foreign bodies typically lodge. Children with underlying esophageal
motility disorders, or those who have undergone prior esophageal
surgery, are at increased risk of impaction, perforation, or obstruction.5
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A child with a foreign body in the esophagus may present with
a choking episode, coughing, drooling, vomiting, or food refusal
(Table 395-1). Older children may complain of
dysphagia or chest pain. Respiratory symptoms may be present due
to compression of the trachea or larynx and occasionally are the
single presenting symptom of an esophageal foreign body. A high
index of suspicion must be maintained, as approximately 40% of
foreign body ingestions are not witnessed, and the child is asymptomatic
in about half of all cases.1,2,5,6
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Diagnosis is based on history and is supported by the radiographic finding
of a foreign body. On an anteroposterior radiograph, a coin in the
esophagus will be positioned with the flat surface of the coin in
the coronal plane. This compares to seeing the ...