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)
   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