- Handheld metal detectors may allow rapid localization of metallic foreign bodies without further imaging.
- A coin that has passed the thoracic inlet of the esophagus can be observed and will usually pass through the gastrointestinal (GI) tract without problems.
- Sharp objects that pass the pylorus should be treated conservatively, but carefully observed for signs of obstruction.
- Lead containing objects must get past the acid medium of the stomach to avoid leaching of lead and absorption.
- Multiple ingested magnets must be retrieved.
- Watchful waiting is acceptable in most cases of foreign body ingestion.
Foreign bodies are a common cause of pediatric emergency department (ED) visits. Objects lodged in the upper esophagus can be a threat to airway patency and require prompt removal under controlled conditions, whenever possible. Many, if not most, objects do not cause symptoms and pass uneventfully through the GI tract. Some foreign bodies become impacted, typically in anatomical sites that are narrow or tortuous. Some of these impaction sites are amenable to procedural removal, while others may require surgical intervention.
Exploration of the environment is the hallmark of early childhood development. Learning about the environment involves cataloging objects by their sight, smell, sound, touch, and taste. From nearly the moment that infants begin to grasp objects, they are at risk of ingesting a foreign body. Small colorful objects can be particularly problematic, so we are alerted to the choking hazards of toys and products that have small parts. Developmentally inappropriate foods can also cause problems. A hot dog or nuts offered to a child who does not have molars to grind and process the food can cause choking and aspiration. Older children develop more complex behaviors and will hide objects within close reach. Foreign bodies that are squirreled away in the mouth can be swallowed nonintentionally when a child is distracted or startled. Toddlers may insert an object into other body orifices during the process of body exploration.
According to the American Association of Poison Control Centers Toxic Exposure Surveillance System, in excess of 92 000 pediatric foreign body ingestions occurred in 2003.1 A number of ingestions will go unnoticed and many will not be reported to poison control, so it is difficult to translate this statistic into a number of ED visits. Nevertheless, it is clear that the health care burden for managing ingested foreign bodies is high. Fortunately, morbidity and mortality are the exception, especially when objects threatening the airway are excluded. Most objects will travel through the GI tract without incident. Those that cause symptoms are likely to do so because of the location in which they are impacted.
Anatomic Sites for Obstruction
Three frequent sites of impaction are in the esophagus. The first major site is at the thoracic inlet, which is the first narrowing of the GI tract. In general, symptoms may include a vague discomfort of the throat and chest, drooling, and ...