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Foreign bodies of the esophagus and gastrointestinal tract in children

INTRODUCTION

Infants put almost everything into their mouths, and toddlers eat just about anything. Of more than 100,000 cases of foreign body ingestion reported each year in the United States, 80 percent occur in children [1-4]. The majority of foreign body ingestions occur in children between the ages of six months and three years [1,5,6]. Fortunately, most foreign bodies that reach the gastrointestinal tract pass spontaneously. Only 10 to 20 percent will require endoscopic removal, and less than 1 percent require surgical intervention [1,5,7]. Although mortality from foreign body ingestion is extremely low, deaths have been reported [5,8,9].

In the United States, coins are the most common foreign bodies ingested by children. Other objects, including toys, toy parts, magnets, batteries, safety pins, screws, marbles, bones, and food boluses have been reported [3,7,10-12]. Ingestion of multiple foreign objects and repeated episodes are uncommon occurrences and usually occur in children with developmental delay [10,13]. The capsules used for capsule endoscopy are occasionally retained in the gastrointestinal tract. This complication is more common in patients with an underlying pathology [14-16] and may require endoscopic or surgical removal [17,18].

The diagnosis and management of foreign bodies in the esophagus are discussed here. Concerns specific to ingestion of button batteries (disk batteries) are discussed in greater detail separately. Management of gastric bezoars is discussed elsewhere. (See "Button and cylindrical battery ingestion" and "Gastric bezoars".)

CLINICAL MANIFESTATIONS

Most children with esophageal foreign bodies are brought to medical attention by their parents because the ingestion was witnessed or reported to them [1,5,19,20]. In these settings, they often are asymptomatic. As an example, in a case series of 325 pediatric patients, only half of the children with an esophageal foreign body displayed symptoms at the time of the ingestion, such as retrosternal pain, cyanosis, or dysphagia, and in many of these cases the symptoms were transient [21].

When symptoms do occur, they are often related to the location of the foreign body. Older children may localize the sensation of something "stuck" to the neck or lower chest, suggesting irritation in the upper or lower esophagus, respectively. Children with complaints of substernal chest pain are more likely to have mucosal ulceration of the esophagus when evaluated by endoscopy, especially if the foreign body has been present for more than 72 hours, or was found unexpectedly on chest imaging [22]. Patients of any age may present with refusal of feeds or dysphagia, drooling, or respiratory symptoms including wheezing, stridor, or choking. (See "Assessment of stridor in children" and "Approach to wheezing in children".)

                      

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Literature review current through: Nov 2014. | This topic last updated: Aug 11, 2014.
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