Esophageal Foreign Body (Peds): Difference between revisions

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==Background==
==Background==
*Most common site in upper 1/3 of esophagous
*Most common site in upper 1/3 of esophagous
*5% of FB are more than 1 FB
*5% of FB are more than 1 FB
*Disk batteries can cause esophageal burns 4hrs & perf in 6hrs
*Disk batteries can cause esophageal burns 4hrs & perf in 6hrs
== ==


==Diagnosis==
==Diagnosis==
Clinical
Clinical


Consider CXR and/or soft tissue lateral x-ray
*Consider CXR and/or soft tissue lateral x-ray
 
**(soft tissue lateral of neck, cxr, kub), if no FB on xr (radiolucent, ie plastic, button), but child w/ sx or strong hx of recent FB ingestion, then endoscopy is indicated.
(soft tissue lateral of neck, cxr, kub), if no FB on xr (radiolucent, ie plastic, button), but child w/ sx or strong hx of recent FB ingestion, then endoscopy is indicated.
**Coins in the esoph are in coronal plane & coins in trachea in the sagital plane
 
*Coins in the esoph are in coronal plane & coins in trachea in the sagital plane
 


==DDx==
==DDx==
Tracheal/lung aspiration
Tracheal/lung aspiration


==Treatment==
==Treatment==
 
===Stable===
 
# Food bolus (soft; ie. no bones)
STABLE
##glucagon (caution causes vomiting)
 
##fails --> endosopic removal
1) Food bolus (soft; ie. no bones)
# Coin (or similar round/smooth FB)
 
## Below diaphram
    -glucagon (caution causes vomiting)
### asymptomatic
 
####d/c home, check stool x 1 wk, repeak KUB if not passed as outpt
    -fails --> endosopic removal
### sx obstruction or perf
 
####surgery
2) Coin (or similar round/smooth FB)
## Above diaphram
 
### asymptomatic
    a. Below diaphram
####Obs + repeat XR x 6hrs
 
####Consider "Foley manuver" if fails Obs
          i. asymptomatic
# Disk or button battery
 
## Esophagus --> immediate removal (endoscopy)
              -d/c home, check stool x 1 wk, repeak KUB if not passed as outpt
## Below diaphram
 
### asymptomatic
          ii. sx obstruction or perf
####Outpt obs with close f/u
 
####needs to be removed if still in stomach after 24-48hr
              -surgery
### Sypmtomatic
 
#### immediate removal (endoscopy)
    b. Above diaphram
# Sharp (ie bone, pin, etc) or long (>3-6cm)
 
## Esophagous, stomach, and/or symptomatic
          i. asymptomatic
### Immediate removal (endoscopy)
 
### Below stomach and asymptomatic
              -Obs + repeat XR x 6hrs
####Outpt obs with close F/U
 
####perf rare (<1-2%)
              -Consider "Foley manuver" if fails Obs
 
3) Disk or button battery
 
    a. Esophagus --> immediate removal (endoscopy)
 
    b. Below diaphram
 
          i. asymptomatic
 
              -Outpt obs with close f/u
 
              -needs to be removed if still in stomach after 24-48hr
 
          ii. Sypmtomatic
 
              -immediate removal (endoscopy)
 
4) Sharp (ie bone, pin, etc) or long (>3-6cm)
 
    a. Esophagous, stomach, and/or symptomatic
 
          --> Immediate removal (endoscopy)
 
    b. Below stomach and asymptomatic
 
          -->Outpt obs with close F/U
 
              -perf rare (<1-2%)
 


==See Also==
==See Also==
GI: Esophageal Foreign Body
GI: Esophageal Foreign Body


==Source==
==Source==
6/04 EM Reports- By Lampe
6/04 EM Reports- By Lampe


[[Category:Peds]]
[[Category:Peds]]
[[Category:GI]]

Revision as of 06:44, 6 June 2011

Background

  • Most common site in upper 1/3 of esophagous
  • 5% of FB are more than 1 FB
  • Disk batteries can cause esophageal burns 4hrs & perf in 6hrs

Diagnosis

Clinical

  • Consider CXR and/or soft tissue lateral x-ray
    • (soft tissue lateral of neck, cxr, kub), if no FB on xr (radiolucent, ie plastic, button), but child w/ sx or strong hx of recent FB ingestion, then endoscopy is indicated.
    • Coins in the esoph are in coronal plane & coins in trachea in the sagital plane

DDx

Tracheal/lung aspiration

Treatment

Stable

  1. Food bolus (soft; ie. no bones)
    1. glucagon (caution causes vomiting)
    2. fails --> endosopic removal
  2. Coin (or similar round/smooth FB)
    1. Below diaphram
      1. asymptomatic
        1. d/c home, check stool x 1 wk, repeak KUB if not passed as outpt
      2. sx obstruction or perf
        1. surgery
    2. Above diaphram
      1. asymptomatic
        1. Obs + repeat XR x 6hrs
        2. Consider "Foley manuver" if fails Obs
  3. Disk or button battery
    1. Esophagus --> immediate removal (endoscopy)
    2. Below diaphram
      1. asymptomatic
        1. Outpt obs with close f/u
        2. needs to be removed if still in stomach after 24-48hr
      2. Sypmtomatic
        1. immediate removal (endoscopy)
  4. Sharp (ie bone, pin, etc) or long (>3-6cm)
    1. Esophagous, stomach, and/or symptomatic
      1. Immediate removal (endoscopy)
      2. Below stomach and asymptomatic
        1. Outpt obs with close F/U
        2. perf rare (<1-2%)

See Also

GI: Esophageal Foreign Body

Source

6/04 EM Reports- By Lampe

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