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