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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.

Figure 395-1.

Algorithm for management of a suspected foreign body ingestion.

*Consider Foley or bougienage technique if there is no underlying esophageal disease or previous esophageal surgery, otherwise flexible or rigid endoscopy should be performed by an experienced individual. The best management approach for sharp foreign bodies in the stomach and small intestine depends upon the specific foreign body and local expertise.

Esophageal Foreign Bodies

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

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

Table 395-1. Symptoms and Signs of Complications from Foreign Body Ingestion

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 ...

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