Ingested foreign body: Difference between revisions
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==Background== | ==Background== | ||
*Esophageal impaction can result in airway obstruction, stricture, or perforation | |||
**Perforation due to mechanical (ingested bones) or chemical corrosion (button battery) | |||
*Esophageal irritation (e.g. from swallowed bone) can be perceived as foreign body | |||
*Most common site for obstruction is upper 1/3 of esophagus | |||
*Once object has traversed pylorus usually passes without issue | |||
**Exceptions: | |||
***Irregular or sharp edges | |||
***Particularly wide (>2.5cm) or long (>6cm) | |||
==Diagnosis== | ==Diagnosis== | ||
===History==== | |||
====Adults==== | |||
*Retrosternal pain | |||
== | *Dysphagia | ||
*Vomiting | |||
*Choking | |||
*Coughing/aspiration (if secretions pool proximal to the obstruction) | |||
====Children==== | |||
*Refusal or inability to eat | |||
*Vomiting | |||
*Gagging and choking | |||
*Stridor | |||
*Neck or throat pain | |||
*Drooling | |||
===Imaging=== | |||
*CXR PA and lateral | |||
**Coins in esophagus present their face on AP view | |||
**Coins in trachea present their face on lateral view | |||
**Bones can be visualized <50% of time | |||
*CT chest | |||
**Very high-yield for both radiopaque and nonradiopaque objects | |||
*Endoscopy | |||
==DDx== | ==DDx== | ||
Tracheal/lung aspiration | |||
==Treatment== | ==Treatment== | ||
===Urgent Endscopy=== | |||
# | #Complete obstruction of esophagus (pooling, risk of aspiration) | ||
# | #Ingestion of sharp or elongated objects (toothpicks, soda can tabs) | ||
# | #Ingestion of multiple foreign bodies | ||
#Ingestion of button batteries | |||
== | #Evidence of perforation | ||
# | #Coin at the level of the cricopharyngeus muscle in a child | ||
# | #Airway compromise | ||
#Presence of foreign body for >24hr | |||
== | ===Food Impaction=== | ||
#Uncomplicated food impaction (no bones, incomplete obstruction) manage expectantly | |||
##Do not allow food bolus to remain impacted for >12-24hr | |||
##Options | |||
###Glucagon 1-2mg IV (adults) | |||
###Coca-Cola | |||
##Obtain esophagogram after treatment to ensure passage | |||
===Coin Ingestion=== | |||
#Can attempt removal with a foley catheter under fluoroscopy | |||
===Button Battery=== | |||
*Call the National Button Battery Ingestion Hotline: 202-325-3333 (24/7) | |||
*True emergency if located in esophagus | |||
**Perforation can occur within 6hr of ingestion | |||
**Obtain urgent endoscopic removal | |||
***If endoscopy unavailable AND <2hr since ingestion Foley balloon technique can be tried | |||
*Batteries that have passed esophagus can be managed expectantly w/ 24hr f/u | |||
===Sharp Objects=== | |||
*Intestinal perforation from objects distal to stomach is common (up to 35%) | |||
*Require immediate removal (even if located in stomach or duodenum) | |||
**If object is distal to duodenum and pt is asymptomatic document passage w/ daily films | |||
**If object is distal to duodenum and pt symptomatic obtain immediate surgery consult | |||
===Narcotics Ingestion=== | |||
*Consider whole-bowel irrigation | |||
*Endoscopy contraindicated | |||
==Source== | ==Source== | ||
Tintinalli | |||
[[Category:GI]] | [[Category:GI]] | ||
Revision as of 01:20, 1 August 2011
Background
- Esophageal impaction can result in airway obstruction, stricture, or perforation
- Perforation due to mechanical (ingested bones) or chemical corrosion (button battery)
- Esophageal irritation (e.g. from swallowed bone) can be perceived as foreign body
- Most common site for obstruction is upper 1/3 of esophagus
- Once object has traversed pylorus usually passes without issue
- Exceptions:
- Irregular or sharp edges
- Particularly wide (>2.5cm) or long (>6cm)
- Exceptions:
Diagnosis
History=
Adults
- Retrosternal pain
- Dysphagia
- Vomiting
- Choking
- Coughing/aspiration (if secretions pool proximal to the obstruction)
Children
- Refusal or inability to eat
- Vomiting
- Gagging and choking
- Stridor
- Neck or throat pain
- Drooling
Imaging
- CXR PA and lateral
- Coins in esophagus present their face on AP view
- Coins in trachea present their face on lateral view
- Bones can be visualized <50% of time
- CT chest
- Very high-yield for both radiopaque and nonradiopaque objects
- Endoscopy
DDx
Tracheal/lung aspiration
Treatment
Urgent Endscopy
- Complete obstruction of esophagus (pooling, risk of aspiration)
- Ingestion of sharp or elongated objects (toothpicks, soda can tabs)
- Ingestion of multiple foreign bodies
- Ingestion of button batteries
- Evidence of perforation
- Coin at the level of the cricopharyngeus muscle in a child
- Airway compromise
- Presence of foreign body for >24hr
Food Impaction
- Uncomplicated food impaction (no bones, incomplete obstruction) manage expectantly
- Do not allow food bolus to remain impacted for >12-24hr
- Options
- Glucagon 1-2mg IV (adults)
- Coca-Cola
- Obtain esophagogram after treatment to ensure passage
Coin Ingestion
- Can attempt removal with a foley catheter under fluoroscopy
Button Battery
- Call the National Button Battery Ingestion Hotline: 202-325-3333 (24/7)
- True emergency if located in esophagus
- Perforation can occur within 6hr of ingestion
- Obtain urgent endoscopic removal
- If endoscopy unavailable AND <2hr since ingestion Foley balloon technique can be tried
- Batteries that have passed esophagus can be managed expectantly w/ 24hr f/u
Sharp Objects
- Intestinal perforation from objects distal to stomach is common (up to 35%)
- Require immediate removal (even if located in stomach or duodenum)
- If object is distal to duodenum and pt is asymptomatic document passage w/ daily films
- If object is distal to duodenum and pt symptomatic obtain immediate surgery consult
Narcotics Ingestion
- Consider whole-bowel irrigation
- Endoscopy contraindicated
Source
Tintinalli