34 - Aerodigestive Foreign Bodies and Caustic Ingestions

Abstract

Foreign body ingestion and aspiration is a common cause of morbidity and mortality in the pediatric population. Aerodigestive foreign bodies usually occur in toddler age children and are often exploratory in nature. Coins are the most commonly ingested object, whereas food impaction is more prevalent in older children and adults. Coins and button batteries show subtle differences on radiographic imaging (single vs. double-halo). The distinction is important as button batteries require urgent removal. A detailed history and physical and a high index of suspicion despite negative imaging are required. Chronic pulmonary symptoms, such as cough or wheezing that persists despite maximal medical therapy, may be the only sign of a foreign body. Often, a diagnostic endoscopy may be required to definitively investigate the upper aerodigestive tract. Noncaustic esophageal foreign bodies can be observed for a short period of time to see if they are able to pass into the stomach. Caustic substances such as detergent, button batteries, and household cleaners require urgent endoscopy for removal or evaluation of soft tissue injury. Airway foreign bodies require immediate removal in the operating room. A team-based approach with cooperation between the anesthetist, surgeon, and operating room staff is required during these procedures. Early intervention can prevent acute and chronic complications, which can be devastating. Early complications include partial mucosal erosion, perforation, airway edema or obstruction, respiratory failure, infections, and even death. Late complications include tracheoesophageal or vasculature fistulas, strictures, mature airway stenosis, emphysema, and persistent pneumonias.