Esophagus: Foreign Body

Foreign Body Ingestion

Foreign Body Ingestion

  • Most Common in Young Children (6 Months – 3 Years)
  • Most Common Site of Impaction: Esophagus
    • Occurs at Sites of Physiologic Narrowing:
      • Upper Esophageal Sphincter (UES)
      • Crossover of the Aortic Arch
      • Diaphragmatic Hiatus/Lower Esophageal Sphincter (LES)
    • Most Common Site Overall: Thoracic Inlet (Below Cricopharyngeus)
  • Risk of Perforation Increases with Length of Time

Common Objects

  • Food Impaction – Most Common Esophageal Foreign Body in Adults
  • Coins – Most Common Foreign Body in Peds
  • Magnets – Bowel Trapped Between Magnets Can Cause Pressure Necrosis & Perforation
  • Button (Disc) Batteries
  • Sharp Objects – Can Perforate
  • Superabsorbent Polymer – Can Expand in Size When Hydrated Up to 30-60 Times
  • Long Object > 5-6 cm – Generally Cannot Pass

Urgency of Endoscopic Management

Emergent Indications

  • Esophagus:
    • Sharps
    • Button Batteries
    • Complete Obstruction (Drooling/Cannot Handle Secretions)
    • Causing Airway Compromise
  • Stomach/Duodenum:
    • None

Urgent Indications

  • Esophagus:
    • Blunt Objects
    • Food Impaction
  • Stomach/Duodenum:
    • Sharps
  • Either:
    • Magnets – Some Recommend Observation if Only a Single Magnet
    • Long Object > 5-6 cm
    • Superabsorbent Polymer
    • Lead-Containing Products

Non-Urgent Indications

  • Esophagus:
    • Coins (Can Observe 12-24 Hours)
  • Stomach/Duodenum:
    • Button Batteries (Can Observe for 48 Hours – Remove if Not Passed)
    • Blunt Objects with Diameter > 2.5 cm

Battery Ingestion

Button Battery Ingestion

  • Can Cause Necrosis & Ulceration/Perforation from Electrical Current When in Esophagus or Retained in Stomach
  • Initial Management:
    • Indications for Radiographic Localization:
      • Age ≤ 12 Years
      • Battery Size ≥ 12 mm or Unknown
    • Single Small Battery: Observe at Home without Imaging
  • Treatment:
    • Esophageal Impaction: Emergency Endoscopic Removal
    • Stomach Location:
      • Symptomatic: Endoscopic Removal
      • Asymptomatic:
        • *Asymptomatic Indications Debated
          • Age < 5 Years & Battery Size ≥ 20 mm
          • Remains in Stomach After 4 Days & Age < 6 Years or Battery Size ≥ 15 mm
    • Intestinal Location:
      • Asymptomatic: Observe
      • Symptomatic: Surgical Removal

Cylindrical Battery Ingestion

  • Initial Management: Radiographic Localization for All
  • Treatment: Generally Observe
    • Stomach Location:
      • Some Recommend Removal Depending on Type of Battery & Age
      • Endoscopic Removal if Remains in Stomach After 48 Hours
    • Intestinal Location:
      • Surgical Removal if Concerned for Perforation/Peritonitis

Button Battery 1

Button Battery Impaction in Esophagus 1

References

  1. Wikimedia Commons. Public Domain
  2. Szaflarska-Popławska A, Popławski C, Romańczuk B, Parzęcka M. Endoscopic removal of a battery that was lodged in the oesophagus of a two-year-old boy for an extremely long time. Prz Gastroenterol. 2015;10(2):122-6. (License: CC BY-NC-ND-3.0)