xam

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 within 2 hours of ingestion. This is a time critical situation
  • 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 . Last review Dr Rory O'Brien Dr ÍOS 16/06/21.