Ingested foreign Body

Background

• Usually children under 5 yrs or adults with intellectual impairment or DSH
• Impact in oesophagus at:
  • cricopharyngeus (C6)
  • aortic arch (T4) and
  • OG sphincter (T11)
• Pylorus of stomach
• Duodenum
• Ileocaecal valve (rarely at colonic flexures)

In general

• If an FB passes cricopharyngeus (C6) [narrowest part of GI tract], excellent chance it will pass the rest of the tract
• Fish bones usually scratch the mucosa, occasionally lodge in the tonsil
• Larger FB more likely to impact in oesophagus and cause erosion / perforation or lower GI obstruction
• Dentures are not all radio-opaque

Management

Depends on location / type of FB and symptoms

Priority AIRWAY, B and C

• If a FB in the throat, directly visualise. Check tonsils and valleculae
• If in oesophagus, need AP & lat. x-rays to determine level
• Proximal FB is more of an airway threat
• Some dentures are not radio-opaque
• Oesophageal FBs need to be removed endoscopically (urgently if button batteries or sharp)
• Once past duodenum: obstruction = removal, asymptomatic = wait and see

Button batteries

• Dangerous if left in the oesophagus (corrosive, burn & release toxic metals)
• They are benign once past the stomach