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Case 6-1: Swallowed flashing toy ambulance

Patient Presentation

A 23-month-old presented to the emergency department (ED) after his mother noted a red light flashing in his stomach 45 minutes prior. The mother thought the child had swallowed a very small ambulance toy car with a small battery-powered flashing red light. The child was in no distress.

Figure 6-1.

RA = a flashing red light from a swallowed toy ambulance

Figure 6-2.

Abdominal x-ray. WA = toy ambulance in the stomach

Figure 6-3.

Abdominal x-ray. WA = toy ambulance has passed into distal colon

Clinical Features

With the examination room lights turned off, a red light flashing at a rate of 1 per second could clearly be seen. Every flash elicited a giggle from the toddler. Abdominal examination was completely benign.

Differential Dx

  • The diagnosis of an ingested toy with a battery powered red light was obvious.

  • The clinical location of the foreign body was past the esophagus and in either the stomach or the small bowel.

Emergency Care

A supine abdominal radiograph revealed the toy to be in the stomach, correlating with physical examination findings. The foreign body did not appear radiographically to have any sharp edges that might impede transit through the gastrointestinal system. The regional poison center was contacted for concern regarding dangers associated with battery ingestions. Since the battery was past the esophagus, and thought to be fully encased without direct exposure to the gastrointestinal wall lining, the decision was made to allow an opportunity for the foreign body to pass through the patient’s gastrointestinal tract.

Outcome

The toddler was discharged home and followed up 24 hours later for a repeat radiograph, which demonstrated significant passage of the toy into the distal colon. The toddler never returned to the ED, with presumptive passage of the foreign body without complication.

Key Learning Points

  • Button battery and cylindrical battery ingestion can cause serious gastrointestinal injury. Diagnostic and therapeutic management decisions are complex and depend on patient age, location of the battery in the gastrointestinal tract, size and type of battery ingested, the presence of a co-ingested magnet, and the length of time since ingestion. The National Battery Ingestion Hotline is a good resource for management decisions.

Further Reading

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Kramer  RE, Lerner  DG, Lin  T,  et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr. 2015;60(4):562.  [PubMed: 25611037]

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