Ingested Foreign Bodies and Toxic Materials: Who Needs to be Scoped and When?

Abstract

1. Yasemin Cagil, MD* 2. Jenna Diaz, MD† 3. Seth Iskowitz, MD‡ 4. Alisa J. Muniz Crim, MD§ 1. *Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA 2. †Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Washington University School of Medicine in St Louis, St Louis, MO 3. ‡Division of Pediatric Gastroenterology, Hepatology, and Nutrition, C.S. Mott Children’s Hospital Michigan Medicine, Ann Arbor, MI 4. §Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nicklaus Children’s Hospital, Miami, FL Providers should be able to identify the signs and symptoms of foreign body and toxic material ingestion in children, select the proper diagnostic tests needed to confirm the diagnosis, and describe adequate treatment modalities for the described ingestions. After completing this article, readers should be able to: 1. Understand the common types of foreign body and toxic material ingestions. 2. Recognize the presenting symptoms of the described ingestions. 3. Recognize which patients warrant emergency endoscopic intervention. 4. Recognize which patients warrant nonemergency endoscopic intervention. 5. Recognize which patients warrant noninvasive medical management. 6. Review the role of prevention. Foreign body and toxic substance ingestions are a common reason for families to seek emergency care. Often, the pediatric patient is unable to describe the nature of the ingestion and/or the timing of the event. This can pose significant barriers to both caregivers and the medical team. Coins, button batteries, magnets, pointed and/or large objects, food, absorptive substances, alcohol, acidic and alkaline substances, detergent pods, and hydrocarbons are all frequently reported ingestions. Each ingested object or substance requires an individualized approach to management. The most common site for foreign bodies to become entrapped is in the proximal esophagus at the site of the cricopharyngeus muscle. Other common locations include the midesophagus, at the site of compression from the aortic arch, and at the lower esophageal sphincter. Most foreign bodies that are ingested by children pass spontaneously without complications; however, endoscopic removal may be necessary in some situations. Parameters that must be considered regarding the need for endoscopic removal of ingested foreign bodies include the child’s age, weight, clinical presentation, time since ingestion, type and size of the foreign body, location in the gastrointestinal tract, and underlying intestinal abnormalities. This section describes the most commonly ingested foreign bodies and their management. (1) ### Coins Coins remain the most commonly ingested …