Foreign Body Ingestion
Nadine Najjar
Young children are instinctively curious about their environment, and their exploration can result in ingestion of a variety of foreign bodies.
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.
Most cases occur by accident in children, and they are often asymptomatic. However, complications can carry significant morbidity and mortality.
RELEVANT ANATOMY
Ingested foreign bodies tend to lodge in areas of physiologic narrowing:
Upper esophagus at the level of the cricopharyngeus muscle
Midesophagus at the level of the aortic arch
Lower esophagus at the level of the gastroesophageal junction
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
More than 100 000 cases are reported each year, and 80% of these cases are in children.1
Foreign body ingestion is common in children, particularly aged 6 months to 4 years.2
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
Symptoms depend on the size of the object in relation to the patient, location, and duration.
More often than not, patients are asymptomatic.
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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