FB ingestion



Background

Clinical

  • Typically 1-5 years old (or adults with intellectual impairment).
  • Most are low risk and do not need imaging or intervention.
  • FB lodged in the oesophagus will present with drooling or dysphagia.
  • Intestinal obstruction will present with abdominal pain, vomiting, dysphagia or anorexia.
  • Beware any inhalation symptoms rather than ingestion.
  • Fish bones in oropharynx - may need ENT.
  • Please note any prior medical or surgical history that may hinder transit of the FB.

Anatomy

Impact

  • Oesophagus:
    • Cricopharyngeus (C6) [narrowest part of GIT]
    • Aortic arch (T4) and
    • OG sphincter (T11)
  • Pylorus of stomach
  • Duodenum
  • Ileocaecal valve (rarely flexures)

High risk

  • Button batteries in the oesophagus must be removed. Once they reach the stomach then are benign.
  • FB size >6cm long, >2.5cm wide
  • Magnet ± metal ingestion are potentially very dangerous and (like button batteries in the oesophagus) require imaging / removal.

Management

  • Avoid x-rays in well children who have ingested a "non-high-risk" object and are eating normally now.
  • High risk objects (right) or any signs of obstruction sould have an AP and lateral neck/chest and abdominal films (single film in younger children).
  • Sharp objects beyond the oesophagus are generally benign.
  • If the child has ingested a low risk FB <6cm long or 2.5cm wide, is clinically well and is eating normally, they can be discharged without imaging or formal follow up.
  • Ensure those discharged are "safety netted" with appropriate advice (please return if breathing problems, abdominal pain, not eating, vomiting or fever).


Content By Dr Íomhar O' Sullivan date. Last review Dr ÍOS<9/11/18.