Determine Whether Foreign Body Should Be Removed

1. Esophageal foreign body. Foreign bodies located in the upper third of the esophagus should be removed within 12 hours. For objects located in the middle third of the esophagus, an x-ray should be repeated within 12-24 hours. A sharp object in the esophagus raises the risk of perforation and becomes a medical emergency.

a. Techniques for removal. These techniques vary, depending on the nature of the foreign body. Coins may be removed by rigid endoscopy, Foley removal, or bougienage.

i. Rigid endoscopy. Long the method of choice; usually occurs in the operating room under general anesthesia and is performed most often by an ENT surgeon or a gastroenterologist. It allows direct inspection of the esophagus to identify esophageal injury or unsuspected additional foreign bodies.

ii. Foley catheter method. Usually performed under fluoroscopic guidance by a radiologist. The uninflated balloon end of the Foley catheter is inserted until it is located beyond the coin. The balloon is then inflated with contrast material and the coin is pulled upward into patient's mouth. This technique works best for round, smooth objects. It does not permit inspection of the esophagus and should be reserved for use in healthy children who have had uncomplicated coin ingestion. A concern about the balloon-tipped catheter technique is the lack of airway control.

iii. Bougienage. The least commonly used procedure for coin removal. A lubricated esophageal dilator is passed into the esophagus, dislodging the coin and causing it to pass into the stomach. This technique should be reserved for use in healthy children who were seen ingesting a single foreign body.

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