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6.03 Swallowed Foreign Body


Presentation

Parents bring in a young child shortly after he has swallowed a coin, safety pin, toy, etc. The child may be asymptomatic or have recurrent or transient symptoms of vomiting, drooling, dysphagia, pain or a foreign body sensation. Disturbed adults may be brought from mental health facilities to the hospital on repeated occasions, at times accumulating a sizeable load of ingested material.

What to do:

What not to do:

Discussion

The narrowest and least distensible strait in the gastrointestinal tract is usually the cricopharyngeus muscle at the level of the thyroid cartilage. Next narrowest is usually the pylorus, followed by the lower esophageal sphincter and the ileocecal valve. Thus, anything which passes the throat will probably pass through the anus as well. In general, foreign bodies below the diaphragm should be left alone. A swallowed foreign body can irritate or perforate the GI tract anywhere, but does not require treatment until complications occur.

A significant portion of children with esophageal foreign bodies are asymptomatic and therefore any child suspected of ingesting a foreign body requires an x ray to document whether or not it is present and if so where it is located. Children with distal esophageal coins may be safely observed up to 24 hours before an invasive removal procedure, since most will spontaneously pass the coins. Even safety pins and razor blades usually pass without incident.

Large button batteries (the size of quarters) have become stuck in the esophagus, eroded through the esophageal wall, and produced a fatal exsanguination; but the smaller variety, and batteries which passed into the gut, have not been such a danger.

References:


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
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