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

Foreign body

  1. Stabilize patient with careful attention to respiratory status if respiratory symptoms are present, as foreign bodies can obstruct the trachea.

  2. Obtain a detailed history from parents as to the exact nature of the foreign body (coin, button battery, toy, magnet, etc.).

  3. Obtain AP and lateral plain films.

  4. If esophageal foreign body, sharp object, long object, multiple magnet, or button "disk" battery, endoscopic removal is suggested.

  5. If foreign body is post-pyloric, endoscopic removal is not possible and repeat radiographs may be necessary if not identified in the stool.

Caustic ingestion

  1. Stabilize patient with careful attention to the airway as the airway can be compromised in a caustic ingestion.

  2. Obtain a detailed history from parents of the caustic ingestion and call the local Poison Control Center.

  3. Perform a careful physical exam of oropharynx for lesions related to ingestion.

  4. If signs of esophageal injury (ie, drooling, difficulty swallowing) or extensive oropharyngeal lesions), consider endoscopy for evaluation of potential esophageal injury.

  5. Depending on esophageal injury, may need early dilation, corticosteroids, follow-up contrast study of the esophagus or simply clinical follow-up.

3. Diagnosis

Foreign body - AP and lateral plain films

Caustic ingestion - Careful physical exam of the oropharynx

Prognosis

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.

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