Esophageal foreign bodies.

Abstract

1. Eugene D. McGahren, MD* 1. 2. *Associate Professor of Pediatric Surgery and of Pediatrics, University of Virginia Health System, Charlottesville, VA. After completing this article, readers should be able to: 1. Describe the most frequent presenting symptoms of esophageal foreign bodies. 2. List the three areas where esophageal foreign bodies commonly lodge. 3. List the investigative study that should be obtained in all cases of a suspected lodged foreign body. 4. List the four basic strategies to remove esophageal foreign bodies. 5. Delineate the percentage of foreign bodies that can be removed safely from the esophagus. The natural curiosity of children leads them to ingest many types of objects other than food. Inevitably, some of these objects become lodged in the esophagus, and the pediatrician then is faced with the challenge of determining how to remove such a foreign body. Thousands of children in the United States present with foreign bodies lodged in the esophagus each year. Most of these children are 4 years of age and younger, and boys comprise a slight majority. Children who have a lodged esophageal foreign body usually present for care between the hours of noon and midnight and usually within 6 hours of the foreign body ingestion. By far, coins are the foreign bodies detected most commonly. Other reported objects include but are not limited to those listed in Table 1.⇓ View this table: Table 1. Commonly Found Esophageal Foreign Bodies in Children The most frequent presenting symptoms are dysphagia, drooling, retching, and vomiting. However, infants and children also may experience coughing, choking, and significant airway compromise from foreign bodies lodged in the upper half of the esophagus (Table 2⇓). In most cases, a history of foreign body ingestion can be obtained from a parent, a caretaker, or the child. It is important to try to determine how long the foreign body has been present because those lodged for longer than 24 hours create a greater risk for erosion or other damage …