Pediatric emergency medicine trisk 0672 0672
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similarly sized inorganic object. While the ingestion of a single blunt magnet may
cause few problems, the ingestion of more than one can lead to magnetic
attraction across bowel walls, resulting in bowel necrosis, perforation, or
obstruction.
DIFFERENTIAL DIAGNOSIS
Gastrointestinal Foreign Body
Esophagus
The esophagus is the most common site of lodgment for an ingested foreign body.
Most childhood esophageal foreign bodies are round or spherical objects, with
coins accounting for 50% to 75% of these ( Fig. 32.1 ). This contrasts with adults,
whose impacted esophageal foreign bodies tend to be food (meat) and bones (e.g.,
fish or chicken), and are often associated with underlying conditions of the
esophagus, such as strictures, dysmotility, or extrinsic compression. Most
children with an esophageal foreign body have a structurally and functionally
normal esophagus. Children with acquired esophageal strictures (e.g., secondary
to caustic ingestions) or repaired congenital conditions (e.g., esophageal atresia,
tracheoesophageal fistula) are at increased risk for recurrent esophageal
impaction with food.
Foreign bodies of the esophagus tend to lodge at three sites. The thoracic inlet (
Fig. 32.1 ) is the most common location, accounting for 60% to 80% of
esophageal foreign bodies. The next most common sites are the gastroesophageal
junction (10% to 20%) and the level of the aortic arch (5% to 20%). The level of
lodgment in children with underlying esophageal abnormalities varies based on
the location of the constricting lesion. Foreign bodies that remain lodged in the
esophagus may lead to potentially serious complications, including respiratory
distress, upper airway compromise, esophageal perforation, mediastinitis, and
aortic or tracheal fistula formation.
Stomach and Lower Gastrointestinal Tract
Objects that pass safely into the stomach usually traverse the remainder of the GI
tract without complications. Various foreign objects, including sharp objects such
as screws, tacks, and staples, have been documented to pass safely. In the younger
child, long objects (greater than 5 cm) may be unable to negotiate the turns of the
small intestine and become impacted in the duodenum or ileocecal region.
However, no definitive age or length guidelines exist. In addition, some very
