Pediatric emergency medicine trisk 0677 0677
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Known or suspected foreign body ingestion
Plain radiograph
(include neck, chest, abdomen)
Foreign body
in esophagus
Foreign body in stomach or
lower Gl tract
No foreign body
on radiograph
t
Observe (<24 hrs)
• Round, non- sharp
objects
Remove
• Symptomatic
• Button battery
• Sharp objects
• Multiple magnets
• Long objects
(>6 cm)
• Large objects
(>2.5 cm)
Observe
• Asymptomatic
• Single button battery if either
0 battery <20 mm OR
0 Patient >5 years old
• Single magnet
Consider endoscopy if
patient is symptomatic to
evaluate for nonradiopaque
foreign body
Remove3
• Symptomatic
• Single button battery
0 Patient <5 years old AND
battery >20 mm
• Multiple button batteries/magnets
• Magnet co- ingestion with battery
• Sharp objects
• Long objects (>6 cm)
• Large objects (>2.5 cm)
FIGURE 32.4 Management of ingested foreign body. GI, gastrointestinal. a Remove with
endoscopy, consult general surgery if object is not within reach and patient is symptomatic.
Esophageal Foreign Body: Removal
In general, once an esophageal foreign body is detected, it should be removed
promptly. Emergent removal (in <2 hours, regardless of NPO status) of a foreign
body in the esophagus may be necessary if the patient is symptomatic or if the
ingested foreign body is a button battery. A button battery should be removed
emergently as it may cause esophageal injury within a few hours of ingestion,
leading to permanent sequelae. Other types of foreign bodies that may require
urgent removal (in <24 hours) include sharp objects (e.g., nails, straight pins,
open safety pins), multiple magnets, long objects (>6 cm in length), and large
objects (>2.5 cm in diameter). Location of the foreign body within the esophagus
influences the likelihood of spontaneous passage. Asymptomatic esophageal
coins in the distal third of the esophagus are most likely to pass into the stomach
spontaneously with a 47% rate of passage. Those in the proximal or middle third
of the esophagus have a 26% and 10% rate of spontaneous passage. Up to onefourth of esophageal coins pass spontaneously within 8 to 16 hours. Therefore,
when evaluating an acute esophageal foreign body (within a few hours of
