Critical Care Medicine
Gastrointestinal Emergencies: Esophageal Foreign Body and Ingestion (button battery, lye, etc.)
Esophageal Foreign Body and Ingestions
1. Description of the problem
Foreign body ingestion often occurs in young children between the ages of 6 months and 3 years. Many foreign bodies will pass without complication, but if foreign bodies get lodged in the esophagus they should be removed. Button batteries, sharp objects, and magnets should be removed endoscopically if located within the reach of an endoscope. Long objects (>5 cm) generally should be removed if in the stomach as passage is unlikely and many can cause an ileal obstruction if they pass the stomach. Lead-containing objects (fishing sinkers, toys, etc.) should be removed immediately if possible.
Caustic substance ingestion often occurs in young children. If asymptomatic and the child is able to eat without difficulty, monitoring is appropriate. If symptomatic and/or the ingestion is with an extremely caustic substance, endoscopy is recommended within the first 24 to 48 hours.
2. Emergency Management
Stabilize patient with careful attention to respiratory status if respiratory symptoms are present, as foreign bodies can obstruct the trachea.
Obtain a detailed history from parents as to the exact nature of the foreign body (coin, button battery, toy, magnet, etc.).
Obtain AP and lateral plain films.
If esophageal foreign body, sharp object, long object, multiple magnet, or button "disk" battery, endoscopic removal is suggested.
If foreign body is post-pyloric, endoscopic removal is not possible and repeat radiographs may be necessary if not identified in the stool.
Stabilize patient with careful attention to the airway as the airway can be compromised in a caustic ingestion.
Obtain a detailed history from parents of the caustic ingestion and call the local Poison Control Center.
Perform a careful physical exam of oropharynx for lesions related to ingestion.
If signs of esophageal injury (ie, drooling, difficulty swallowing) or extensive oropharyngeal lesions), consider endoscopy for evaluation of potential esophageal injury.
Depending on esophageal injury, may need early dilation, corticosteroids, follow-up contrast study of the esophagus or simply clinical follow-up.
Foreign body - AP and lateral plain films
Caustic ingestion - Careful physical exam of the oropharynx
Foreign body - the prognosis of a foreign body is excellent after removal or natural passage and rarely causes long-term issues unless associated injury is present (esophageal perforation, etc.).
Caustic Ingestion - the prognosis or a caustic ingestion is directly related to the degree of esophageal injury present. Severe esophageal injury may cause significant morbidity and stricturing requiring serial endoscopic dilations and ultimately may require surgery. Mild esophageal injuries often heal without complications.
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
Clinical Pain Advisor Articles
- Risks Associated With Co-Administration of Aspirin and Other NSAIDs
- Stages of Low Back Pain Have Specific Sets of Clinical Indicators
- FDA Approves Aimovig for Migraine Prevention
- First Non-Opioid Drug Approved for Managing Opioid Withdrawal Symptoms
- Pain Interference Associated With Depression, Pain Self-Efficacy in Chronic Musculoskeletal Pain
- Effect of Prescription Drug Monitoring Programs on Fatal, Nonfatal Drug Overdoses
- Standardized SCS Workflow May Effectively Alleviate Failed Back Surgery Syndrome-Related Pain
- Marijuana Legalization and Opioid Prescribing Rates
- Medical Marijuana Users More Likely to Use Prescription Drugs for Medical, Nonmedical Purposes
- Interbrain Coupling During Handholding Associated With Analgesia, Empathy
- Opioid-Related Adverse Drug Events Associated With Worse Patient, Cost Outcomes
- Education Plus Exercise, Single Corticosteroid Injection Effective in Long Term for Gluteal Tendinopathy
- Detox vs Medication-Assisted Treatment for Opioid Use Disorder in Pregnancy: Expert Roundtable
- Naloxone Training Beneficial for PA Students
- Supervised Injection Sites Hailed as the Latest Strategy to Fight the Opioid Crisis