Nonesophageal foreign body

a. Stomach. Foreign bodies in the stomach should be removed immediately when they are causing symptoms of abdominal pain, obstruction, or vomiting. Sewing needles have a propensity to perforate, and removal is usually recommended. Long foreign bodies (> 5 cm) should also be removed from the stomach. Foreign bodies that remain in the stomach usually require no acute intervention. Parents can be reassured that 98% of stomach foreign bodies are expelled per rectum. If a sharp object is found in the stomach, vigilance may be all that is required if the child is asymptomatic.

b. Intestine. If at the time of evaluation, a long foreign body has passed into the small intestine, serial abdominal x-rays may be indicated. Smooth, round foreign bodies usually pass through the GI tract within 1 week. Asking parents to search child's stools for evidence of the foreign body is a controversial approach, as parents may discontinue the task before the foreign body is retrieved.

3. Disc batteries. Disc button batteries, such as those found in watches, calculators, toys, and hearing aids, are a relatively new cause of GI ingestion. Disc batteries can be distinguished from coins radiographically. In the AP projection, a battery appears as a double-density shadow and in the lateral projection, the edges are rounded and reveal a step-off at the junction of the anode and cathode. Several types of disc batteries may cause corrosive injury to the mucosa; however, most ingestions of disc batteries are benign. A disc battery located in the esophagus should be removed immediately. Once the battery reaches the stomach; however, it is likely to pass through the remainder of the GI tract without complication, thus requiring no intervention. C. Medications. Historically, it had been suggested that medications such as glucagon and diazepam could be used to enhance motility or to relax the lower esophageal sphincter. Guidelines about the use of these medications are lacking due to limited investigation.

VI. Problem Case Diagnosis. Plain chest x-ray confirmed the diagnosis of an esophageal foreign body, revealing a coin at the level of the thoracic outlet in this 2-year-old boy. Because of the symptoms produced and the location of the foreign body, the coin was removed.

VII. Teaching Pearl: Question. Do clinical features of stridor, wheezing, and dysphagia indicate a foreign body in an airway rather than in the GI tract?

VIII. Teaching Pearl: Answer. Upper esophageal foreign bodies can present with stridor, wheezing, and dysphagia.

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