Paediatrics: Ingested foreign bodies

Ingested foreign bodies

Swallowed foreign bodies are fairly common in young children. The incident may have been witnessed. Alternatively, the child may present with:

•   dribbling;

•   regurgitation;

•   occasionally cough and stridor.

Diagnosis

Chest X-ray: the majority of ingested foreign bodies are radio-opaque (coins).

Management

•   Oesophageal: if the foreign body is in the oesophagus it should be removed within 24hr, usually by oesophagoscopy. Button batteries in the oesophagus must be retrieved or pushed down into the stomach within a few hours of ingestion. Electrolytic ulceration of the oesophagus occurs rapidly and this may lead to perforation or fistulation into the tracheal or aorta.

•   Below the diaphragm: if the foreign body is below the diaphragm it will invariably pass spontaneously per rectum and all that is required is reassurance. Serial radiographs are unnecessary. The only proviso is a child who has had previous abdominal surgery in which case adhesions may impede passage of the object:

•   Parents should be asked to examine the child’s stools for the foreign body.

•   Colicky abdominal pain and vomiting (i.e. possible signs of intestinal obstruction) warrant review and a repeat X-ray. Provided the child remains asymptomatic, surgery to retrieve the object should be deferred for several months.

Button batteries below the diaphragm should be treated in exactly the same way as other ingested foreign bodies. The battery will pass spontaneously long before it disintegrates