Ingested foreign Body



Background

  • Usually children under 5 yrs or adults with intellectual impairment
  • 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 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.

Management

Depends of location / type of the 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 and lateral x-rays to determine level. Proximal FB is more of an airway threat.
  • Oesophageal FBs need to be removed endoscopically (urgently if button batteries or sharp objects).
  • Once past duodenum, clinical obstruction warrants removal, asymptomatic requires wait and see.

Button batteries

  • Are dangerous if left in the oespphagus (corrosive, can burn and release toxic metals) . They are benign onve past the stomach.

Specific Paediatric Cases

Please see paediatric FB ingestion


Content by Dr Íomhar O' Sullivan 29/01/2009. Next review 29/01/2010