Ingested foreign body - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T23:11:57Z

Prepared the page for translation

Rossdonaldson1 at 21:07, 1 November 2023

2023-11-01T21:07:05Z

← Revisión anterior		Revisión del 21:07 1 nov 2023
Línea 1:		Línea 1:
	==Background==		==Background==
			[[File:Gray1032.png\|thumb\|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]
			[[File:Layers of the GI Tract english.svg\|thumb\|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]
			[[File:Illu esophagus.jpg\|thumb\|Esophagus anatomy and nomenclature based on two systems.]]
	*Esophageal impaction can result in airway obstruction, stricture, or perforation. Perforation can be due to multiple mechanisms but is generally either mechanical (e.g. ingested bones) or via chemical corrosion (e.g. button battery)<ref>Arugula R, Dorofaeff T. Oesophageal button battery injuries: think again. Emerg Med Australas. 2011 Apr;23(2):220-3.</ref>		*Esophageal impaction can result in airway obstruction, stricture, or perforation. Perforation can be due to multiple mechanisms but is generally either mechanical (e.g. ingested bones) or via chemical corrosion (e.g. button battery)<ref>Arugula R, Dorofaeff T. Oesophageal button battery injuries: think again. Emerg Med Australas. 2011 Apr;23(2):220-3.</ref>
	*Esophageal irritation can be perceived as foreign body (globus sensation)		*Esophageal irritation can be perceived as foreign body (globus sensation)

Rossdonaldson1: /* Evaluation */

2022-04-23T13:46:26Z

Evaluation

← Revisión anterior		Revisión del 13:46 23 abr 2022
Línea 55:		Línea 55:
	**Cannot use with metallic objects (if metallic, should be radiopaque on plain films)		**Cannot use with metallic objects (if metallic, should be radiopaque on plain films)
	**Higher cost than CT, some EDs may not be equipped to perform at certain times, may require sedating the patient due to long image capture times		**Higher cost than CT, some EDs may not be equipped to perform at certain times, may require sedating the patient due to long image capture times
	*Endoscopy
	**Direct visualization of the object and any surrounding damage to the esophagus
	*Barium Swallow is '''not recommended''' due to risk of aspiration, mediastinitis, and barrium coating mucosa (makes endoscopy more difficult)		*Barium Swallow is '''not recommended''' due to risk of aspiration, mediastinitis, and barrium coating mucosa (makes endoscopy more difficult)

Rossdonaldson1: /* Evaluation */

2022-04-23T13:45:21Z

Evaluation

← Revisión anterior		Revisión del 13:45 23 abr 2022
Línea 38:		Línea 38:
	[[File:Battery in stomach.png\|thumb\|Button battery in stomach on [[KUB]].]]		[[File:Battery in stomach.png\|thumb\|Button battery in stomach on [[KUB]].]]
	[[File: Esophageal_fb.JPG \|thumb\|Penny in the esophagus of a 12 mo male]]		[[File: Esophageal_fb.JPG \|thumb\|Penny in the esophagus of a 12 mo male]]
			[[File:PMC3725977 BMRI2013-846091.002.png\|thumb\|Plain X-ray: an esophageal button battery foreign body. (a) Anteroposterior view (double contour), (b) Lateral view.]]
	===Imaging===		===Imaging===
	*May not be needed in settings such as a known food bolus		*May not be needed in settings such as a known food bolus

Rossdonaldson1: /* Evaluation */

2022-04-23T13:43:59Z

Evaluation

← Revisión anterior		Revisión del 13:43 23 abr 2022
Línea 35:		Línea 35:

	==Evaluation==		==Evaluation==
	[[File:Abdominal foreign body.png\|thumb\|Body-packing with multiple foreign bodies ("balls" of hashish) on [[KUB]]]]		[[File:Abdominal foreign body.png\|thumb\|[[Body packing]] with multiple foreign bodies ("balls" of hashish) on [[KUB]]]]
	[[File:Battery in stomach.png\|thumb\|Button battery in stomach on [[KUB]].]]		[[File:Battery in stomach.png\|thumb\|Button battery in stomach on [[KUB]].]]
	[[File: Esophageal_fb.JPG \|thumb\|Penny in the esophagus of a 12 mo male]]		[[File: Esophageal_fb.JPG \|thumb\|Penny in the esophagus of a 12 mo male]]

Rossdonaldson1: /* Background */

2022-04-23T12:00:35Z

Background

← Revisión anterior		Revisión del 12:00 23 abr 2022
Línea 11:		Línea 11:
	**Aortic cross over the esophagus<ref name="systematic review"></ref>		**Aortic cross over the esophagus<ref name="systematic review"></ref>
	**Lower Esophageal Sphincter<ref name="systematic review"></ref>		**Lower Esophageal Sphincter<ref name="systematic review"></ref>

			{{FB types}}

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Differential Diagnosis */

2022-03-29T23:49:55Z

Differential Diagnosis

← Revisión anterior		Revisión del 23:49 29 mar 2022
Línea 30:		Línea 30:
	''Consider [[Foreign body aspiration\|tracheal/lung aspiration ]] of foreign body''		''Consider [[Foreign body aspiration\|tracheal/lung aspiration ]] of foreign body''
	{{Dysphagia DDX}}		{{Dysphagia DDX}}
			{{Upper GI bleeding peds DDX}}

	==Evaluation==		==Evaluation==

Spbarrettmd: /* Button Battery */

2022-01-27T13:17:48Z

Button Battery

← Revisión anterior		Revisión del 13:17 27 ene 2022
Línea 93:		Línea 93:
	===Button Battery===		===Button Battery===
	*Administer 10mL of honey every 10min if child is > 12 months old and ingestion < 12 hours old <ref>https://www.poison.org/battery/guideline</ref>		*Administer 10mL of honey every 10min if child is > 12 months old and ingestion < 12 hours old <ref>https://www.poison.org/battery/guideline</ref>
	*Call the National Button Battery Ingestion Hotline: ~~202~~-~~625~~-~~3333~~ (24/7) <ref>http://www.poison.org/battery</ref>		*Call the National Button Battery Ingestion Hotline: 800-498-8666 (24/7) <ref>http://www.poison.org/battery</ref>
	*True emergency if located in esophagus		*True emergency if located in esophagus
	**Perforation can occur within 6hr of ingestion		**Perforation can occur within 6hr of ingestion

Egerdtsmd: /* Background */

2021-11-09T21:20:08Z

Background

← Revisión anterior		Revisión del 21:20 9 nov 2021
Línea 5:		Línea 5:
	**Exceptions: Irregular or sharp edges, particularly wide (>2.5cm) or long (>6cm) objects		**Exceptions: Irregular or sharp edges, particularly wide (>2.5cm) or long (>6cm) objects
	*Common foreign bodies:		*Common foreign bodies:
	**Most common in children: coins		**Most common in children: coins (in the US), animal bones (outside the US)
	**Most common in adults: food bolus		**Most common in adults: food bolus
	*Site of obstruction:		*Site of obstruction:
Línea 37:		Línea 37:
	===Imaging===		===Imaging===
	*May not be needed in settings such as a known food bolus		*May not be needed in settings such as a known food bolus
	*~~[[CXR]]~~ PA and lateral		*PA and lateral films necessary, should include neck, chest, and abdomen
			*Consider obtaining lateral neck films
	**Coins in esophagus present their face on AP view		**Coins in esophagus present their face on AP view
	**Coins in trachea present their face on lateral view		**Coins in trachea present their face on lateral view
	**Bones can only be visualized <50% of time		**Bones can only be visualized <50% of time
	**Button batteries may present with "double-ring sign"		**Button batteries may present with "double-ring sign"
			**~60% of foreign bodies are radiopaque
	*CT chest		*CT chest
	**Very high-yield for both radiopaque and non-radiopaque objects		**Very high-yield for both radiopaque and non-radiopaque objects
	**Sensitivity >99% and specificity 70-92%<ref>Loh WS, Eu DK, Loh SR, Chao SS. Efficacy of computed tomography scans in the evaluation of patients with esophageal foeign bodies. Ann Otol Rhino Laryngol. Oct 2012; 121 (10) 678- 681</ref> <ref> Liu YC, Zhou SH, Ling L. Value of helial computed tomography in the early diagnosis of esophageal foreign bodies in adults. Am J Emerg Med. Sep 2013;31(9),1328-32</ref>		**Sensitivity >99% and specificity 70-92%<ref>Loh WS, Eu DK, Loh SR, Chao SS. Efficacy of computed tomography scans in the evaluation of patients with esophageal foeign bodies. Ann Otol Rhino Laryngol. Oct 2012; 121 (10) 678- 681</ref> <ref> Liu YC, Zhou SH, Ling L. Value of helial computed tomography in the early diagnosis of esophageal foreign bodies in adults. Am J Emerg Med. Sep 2013;31(9),1328-32</ref>
			*MRI
			**Consider for radiolucent objects to avoid radiation load of CT
			**Cannot use with metallic objects (if metallic, should be radiopaque on plain films)
			**Higher cost than CT, some EDs may not be equipped to perform at certain times, may require sedating the patient due to long image capture times
	*Endoscopy		*Endoscopy
			**Direct visualization of the object and any surrounding damage to the esophagus
	*Barium Swallow is '''not recommended''' due to risk of aspiration, mediastinitis, and barrium coating mucosa (makes endoscopy more difficult)		*Barium Swallow is '''not recommended''' due to risk of aspiration, mediastinitis, and barrium coating mucosa (makes endoscopy more difficult)

Línea 71:		Línea 78:

	===Coin Ingestion===		===Coin Ingestion===
	*~~Can attempt~~ removal with a foley catheter ~~under fluoroscopy~~, ~~though~~ not ~~recommended~~ as ~~risk~~ for ~~aspiration~~ or ~~perforation~~		*If attempting to avoid endoscopy, there are non-endoscopic management options
			**Foley Catheter removal
			***Traditionally was done with fluoroscopy, but has been demonstrated to be safe without it. First described by Bigler et. al. in 1966 <ref>Bigler FC. The use of a Foley catheter for removal of blunt foreign bodies from the esophagus. J Thorac Cardiovasc Surg. 1966;51:759–760.</ref>
			***Does not require subspecialist
			***Cheap, can save 300-800% on the total Emergency Department bill by avoiding endoscopy <ref>Choe JY, Choe BH. Foreign Body Removal in Children Using Foley Catheter or Magnet Tube from Gastrointestinal Tract. Pediatr Gastroenterol Hepatol Nutr. 2019;22(2):132-141. doi:10.5223/pghn.2019.22.2.132</ref> <ref>Dokler ML, Bradshaw J, Mollitt DL, Tepas JJ., 3rd Selective management of pediatric esophageal foreign bodies. Am Surg. 1995;61:132–134.</ref> <ref>Little DC, Shah SR, St Peter SD, Calkins CM, Morrow SE, Murphy JP, et al. Esophageal foreign bodies in the pediatric population: our first 500 cases. J Pediatr Surg. 2006;41:914–918.</ref>
			***The diameter of the foley balloon should be decided based on the diameter measured on radiograph or with twin object brought in by a family member. This procedure can be done with or without sedation depending on the patient age and clinical comfortability but has been demonstrated to be equally effective without sedation. The catheter is then inserted into the esophagus passed the foreign body, inflated with either air or normal saline, and slowly retracted <ref>Choe JY, Choe BH. Foreign Body Removal in Children Using Foley Catheter or Magnet Tube from Gastrointestinal Tract. Pediatr Gastroenterol Hepatol Nutr. 2019;22(2):132-141. doi:10.5223/pghn.2019.22.2.132</ref> <ref>Kang JH, Jung HJ, Suh JK, Park JS, Park HJ, Chu MA, et al. Feasibility of foley catheter prior to endoscopy for the removal of esophageal coin in children. Korean J Pediatr Gastroenterol Nutr. 2011;14:251–257.</ref>
			***Gold standard is still endoscopy, but consider if endoscopy not available or after shared decision-making conversation with patient and family

			**Bougienage
			***The basis of this technique involves purposefully passing the object into the stomach to help facilitate spontaneous passage thereafter and ensure no esophageal impaction
			***Has also been described as safe (<1% complication rate), effective (>95% effective), and cheap (similar cost benefit as detailed above) <ref>Burgos A, Rábago L, Triana P. Western view of the management of gastroesophageal foreign bodies. World J Gastrointest Endosc. 2016;8(9):378-384. doi:10.4253/wjge.v8.i9.378</ref> <ref>Allie EH, Blackshaw AM, Losek JD, Tuuri RE. Clinical effectiveness of bougienage for esophageal coins in a pediatric ED. Am J Emerg Med. 2014;32:1263–1269.</ref> <ref>Arms JL, Mackenberg-Mohn MD, Bowen MV, Chamberlain MC, Skrypek TM, Madhok M, Jimenez-Vega JM, Bonadio WA. Safety and efficacy of a protocol using bougienage or endoscopy for the management of coins acutely lodged in the esophagus: a large case series. Ann Emerg Med. 2008;51:367–372.</ref>
			***This involves using a thin, flexible esophageal dilator and passing it from the oral cavity into the esophagus. One can measure the needed depth by measuring a Hurst dilator from the tip of the nose to the epigastrium, then a quick insertion with the child restrained can yield forced passage of the object passed the lower esophageal sphincter.<ref>Tenenbein, M. Chapter 11: Foreign Bodies. In: Schafermeyer, R ed. Strange and Schafermeyer's Pediatric Emergency Medicine. 4th Edition. McGraw Hill; 2014.</ref>

	===Button Battery===		===Button Battery===
Línea 99:		Línea 117:

	==Disposition==		==Disposition==
	*~~Will~~ need GI follow up as ~~majority of the time there is a structural abnormality that may lead to recurrence (esophageal web~~, ~~stricture, tumor, etc)~~		*80-90% of ingested foreign bodies will pass spontaneously and do not require observation or hospitalization
			*If endoscopy performed, generally patients can still be discharged afterward and do not require hospitalization unless direct mucosal injury or other complication is identified
			*If any necrosis is present (button battery, caustic ingestion), will likely need GI follow up as strictures, fistulas can occur

	==Complications==		==Complications==

Dieseldoc: /* Food Impaction */

2021-11-01T13:18:15Z

Food Impaction

← Revisión anterior		Revisión del 13:18 1 nov 2021
Línea 65:		Línea 65:
	*Glucagon 1-2mg IV/IM (adults) to relax LES - may cause severe nausea/vomiting		*Glucagon 1-2mg IV/IM (adults) to relax LES - may cause severe nausea/vomiting
	**Only one RCT of glucagon with 24 patients compared glucagon to diazepam and found no difference in the need for endoscopy<ref>Tibbling L et al. Effect of spasmolytic drugs on esophageal foreign bodies. Dysphagia 1995; 10(2): 126-7. PMID: 7600855</ref>		**Only one RCT of glucagon with 24 patients compared glucagon to diazepam and found no difference in the need for endoscopy<ref>Tibbling L et al. Effect of spasmolytic drugs on esophageal foreign bodies. Dysphagia 1995; 10(2): 126-7. PMID: 7600855</ref>
	**The major side effect of glucagon is vomiting and can increase the risk for esophageal perforation or aspiration		**The major side effect of glucagon is vomiting and can increase the risk for esophageal perforation or aspiration. Consider pretreatment with an antiemetic
	**Rate of success increases with soft foods and lack of anatomic pathology, though in majority of presentations this information, particularly anatomic defects, is unknown		**Rate of success increases with soft foods and lack of anatomic pathology, though in majority of presentations this information, particularly anatomic defects, is unknown
	*Carbonated beverage (effervescents) may be effective for small impactions (carbonation dilates esophagus)<ref name="systematic review"></ref>		*Carbonated beverage (effervescents) may be effective for small impactions (carbonation dilates esophagus)<ref name="systematic review"></ref>