Esophageal Foreign Body (Peds)

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)

    -glucagon (caution causes vomiting)

    -fails --> endosopic removal

2) Coin (or similar round/smooth FB)

    a. Below diaphram

         i. asymptomatic

              -d/c home, check stool x 1 wk, repeak KUB if not passed as outpt

         ii. sx obstruction or perf

              -surgery

    b. Above diaphram

         i. asymptomatic

              -Obs + repeat XR x 6hrs

              -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

GI: Esophageal Foreign Body

Source

6/04 EM Reports- By Lampe