Foreign Body Ingestion
Nadine Najjar
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Young children are instinctively curious about their environment, and their exploration can result in ingestion of a variety of foreign bodies.
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Anything can be ingested—commonly ingested foreign bodies include toys, fish bones from food, button batteries (Figure 33.1), coins, safety pins, magnets, food boluses, and much more.
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Most cases occur by accident in children, and they are often asymptomatic. However, complications can carry significant morbidity and mortality.
RELEVANT ANATOMY
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Ingested foreign bodies tend to lodge in areas of physiologic narrowing:
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Upper esophagus at the level of the cricopharyngeus muscle
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Midesophagus at the level of the aortic arch
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Lower esophagus at the level of the gastroesophageal junction
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If the foreign body has passed the cricopharyngeus muscle, there is a much greater chance that it will pass into the stomach without consequence because this is the area of greatest narrowing.
EPIDEMIOLOGY
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More than 100 000 cases are reported each year, and 80% of these cases are in children.1
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Foreign body ingestion is common in children, particularly aged 6 months to 4 years.2
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A vast majority of ingested foreign bodies pass uneventfully through the gastrointestinal tract. However, the most common areas of impaction are the upper esophagus at the level of the cricopharyngeus muscle (˜70% of all cases), midesophagus at the level of the aortic arch (10%-15%), and gastroesophageal junction (5%-10%).3
Figure 33.1 A 3-year-old boy with ingested button battery complicated by tracheoesophageal fistula (TEF). Frontal radiograph shows a foreign body projecting over the upper chest with a circle within a circle appearance (arrow), consistent with an ingested button battery. (Reprinted with permission from Lee EY. Pediatric Radiology: Practical Imaging Evaluation of Infants and Children. Philadelphia, PA: Wolters Kluwer; 2018.) |
CLINICAL PRESENTATION
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Symptoms depend on the size of the object in relation to the patient, location, and duration.
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More often than not, patients are asymptomatic.
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However, if the object lodges in the esophagus (Figure 33.2), children can present with sudden onset of coughing, chest pain, poor feeding, and drooling.
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