Foreign Body Ingestion

Infants and young children experiment with unfamiliar objects by placing them in their mouths. Most swallowed foreign objects pass uneventfully. The age range of children who swallow foreign bodies is from 6 months-3 years. A higher incidence of obstructed ingested foreign bodies occurs with esophageal pathology, especially after repaired esophageal atresia and among children with psychiatric disease and retardation. Foreign bodies are most likely to be caught at the normal anatomic sites of esophageal narrowing. Foreign bodies at other levels are indicative of a stricture or vascular ring (Fig. 2.22). Foreign bodies lodge at the level of the thoracic inlet (53%) in the thoracic esophagus (32%), and the least common site is the cervical esophagus (15%) (Hamed et al. 1997). Presentation is usually with dysphagia and chest pain. Salivation and drooling occur with esophageal obstruction. Swallowed objects may be unchewed or partially chewed food, or other foreign objects, 66% of which are coins in children (Fig. 2.23) (Webb 1995).

More than one coin may occasionally be ingested (Fig. 2.24). The older the children, the larger the coins ingested (Cheng and Tam 1999). Acute coin ingestion is rarely symptomatic unless the coin is above the thoracic inlet (Sharieff et al. 2003). The majority of coins will not pass spontaneously. However, some coins will pass spontaneously and can be followed for 24 h, thereby decreasing the need for operative removal (Sharieff et al. 2003). The coin should be removed if repeat radiography reveals non-passage. Flexible endoscopy is safer than blind removal, and provides immediate information about the esophagus at the site of impaction.

Button battery ingestion is rare, but the incidence is increasing (Yardeni et al. 2004). Most are less than 15 mm in diameter, and pass uneventfully. Button batteries contain alkali and cause injury by direct corrosion, voltage burns and pressure necro-

Fig. 2.22a,b. Impacted coin above an unsuspected vascular ring. a Frontal chest radiograph shows the coin lodged in the proximal esophagus above the aortic arch. b Barium esophagram reveals an aberrant retroesophageal right subclavian artery

Fig. 2.22a,b. Impacted coin above an unsuspected vascular ring. a Frontal chest radiograph shows the coin lodged in the proximal esophagus above the aortic arch. b Barium esophagram reveals an aberrant retroesophageal right subclavian artery a b a

Fig. 2.23a,b. Radiolucent foreign body. AP (a) chest radiograph and magnified view (b) reveal an impacted piece of unchewed chicken in the cervical esophagus outlined by esophageal air

Fig. 2.23a,b. Radiolucent foreign body. AP (a) chest radiograph and magnified view (b) reveal an impacted piece of unchewed chicken in the cervical esophagus outlined by esophageal air

Fig. 2.24a,b. Two impacted coins. a The AP view of the airway is confusing. The metallic density resembles part of the tracheostomy tube. b The lateral radiograph reveals two coins in the esophagus

Fig. 2.24a,b. Two impacted coins. a The AP view of the airway is confusing. The metallic density resembles part of the tracheostomy tube. b The lateral radiograph reveals two coins in the esophagus

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