Pediatric emergency medicine trisk 0675 0675
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Gastrointestinal Foreign Body
Esophageal Foreign Body: Diagnosis
Children with esophageal foreign bodies often have a history of swallowing the
object (either witnessed by parents or reported by the child). Symptoms
associated with esophageal impaction include dysphagia, refusal to eat, foreignbody sensation, localizing pain, drooling, gagging and vomiting. In the absence of
an ingestion history, the diagnosis may be challenging because these same
symptoms occur with common childhood ailments such as acute gastroenteritis,
pharyngitis, or gingivostomatitis. Any patient with swallowing difficulty requires
a thorough examination of the mouth, oropharynx, neck, chest, and abdomen.
Radiographic evaluation may be needed in some cases (see Chapter 56 Pain:
Dysphagia ). The approach to a child with an ingested foreign body is outlined in
Figure 32.4 .
FIGURE 32.2 Two-view chest radiograph demonstrating aspirated radiopaque foreign body (an
earring) located in the left bronchus.
Children with an esophageal foreign body may be asymptomatic (40% of
children with coins in the esophagus). Radiographic evaluation is therefore
recommended for most children with a history of an ingested foreign body. In the
asymptomatic patient, this evaluation is generally urgent but not emergent;
however, button battery ingestions and multiple magnet ingestions are exceptions,
as discussed below. If the patient’s symptoms suggest esophageal impaction,
endoscopy is recommended for visualization and removal of the object. In most
cases, oral contrast studies should be avoided due to the risk of aspiration and
