eMedicine Specialties > Pediatrics: General Medicine > Gastroenterology

Gastrointestinal Foreign Bodies: Workup

Author: John A Sandoval, MD, Fellow, Pediatric Surgery, University of Colorado School of Medicine
Coauthor(s): Frederick Merrill Karrer, MD, The David R and Kiku Akers Chair in Pediatric Surgery, The Children's Hospital; Head, Division of Pediatric Surgery, Professor of Surgery and Pediatrics, University of Colorado School of Medicine; Casey M Calkins, MD, Assistant Professor of Surgery, Division of Pediatric Surgery, Department of Pediatric Surgery, Medical College of Wisconsin; Consulting Staff, Children's Hospital of Wisconsin
Contributor Information and Disclosures

Updated: Mar 3, 2009

Workup

Laboratory Studies

  • No laboratory studies are usually necessary for diagnostic or treatment purposes; however, blood and urine mercury levels are reasonable adjuncts to the workup in the case of a fragmented rectal thermometer.

Imaging Studies

  • Plain radiography
    • Radiography is mandated for children with suspected GI foreign body ingestion.
    • This assists in locating radiopaque foreign bodies in the hypopharynx and esophagus. In small children, a mouth-to-anus film (babygram) can be obtained. In older children, anteroposterior (AP) and lateral chest radiographs that include the neck help to locate radiopaque foreign bodies in the hypopharynx and esophagus.
    • Coins are usually observed in a coronal alignment on AP films.

      Impacted esophageal coin in the thoracic inlet in...

      Impacted esophageal coin in the thoracic inlet in a 2-year-old child. Note the coronal alignment on this posteroanterior (PA) radiograph that is suggestive of an esophageal location.

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      Impacted esophageal coin in the thoracic inlet in...

      Impacted esophageal coin in the thoracic inlet in a 2-year-old child. Note the coronal alignment on this posteroanterior (PA) radiograph that is suggestive of an esophageal location.

    • If the foreign body is in the trachea, they typically lie in a sagittal orientation. Disk batteries appear as a circular double density on radiography, representing the cell's cathode and anode.
  • Flat plate radiography of the abdomen/pelvis
    • This may be helpful to assess whether the object has slipped into the stomach in an older child or teenager.
    • A flat plate of the pelvis may be helpful when a rectal foreign body is suspected.
  • Barium swallow or upper GI contrast study
    • Contrast studies are helpful if the foreign body in question is radiolucent.
    • Barium is contraindicated in cases in which esophageal perforation is suspected.
    • Gastrografin may be used as the contrast agent if a study is necessary.
  • CT scanning: CT scanning of the neck, chest, abdomen, and pelvis is highly reliable in localizing foreign bodies yet is necessary only in difficult or complicated cases.9

Other Tests

  • Although the use of metal detectors for location of ingested metallic objects has proven efficacious, this technique is not commonly used in clinical practice.

Diagnostic Procedures

  • No diagnostic procedures outside of the radiology suite are required.

More on Gastrointestinal Foreign Bodies

Overview: Gastrointestinal Foreign Bodies
Workup: Gastrointestinal Foreign Bodies
Treatment: Gastrointestinal Foreign Bodies
Follow-up: Gastrointestinal Foreign Bodies
Multimedia: Gastrointestinal Foreign Bodies
References
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References

  1. Kirsner JB. The 1994 G. Brohee Lecture (Los Angeles). The scientification of gastroenterology during the 20th century. Acta Gastroenterol Belg. Jan-Feb 1995;58(1):1-20. [Medline].

  2. Morgenthal CB, Richards WO, Dunkin BJ, Forde KA, Vitale G, Lin E. The role of the surgeon in the evolution of flexible endoscopy. Surg Endosc. Jun 2007;21(6):838-53. [Medline].

  3. Chen MK, Beierle EA. Gastrointestinal foreign bodies. Pediatr Ann. Dec 2001;30(12):736-42. [Medline].

  4. Smith MT, Wong RK. Foreign bodies. Gastrointest Endosc Clin N Am. Apr 2007;17(2):361-82, vii. [Medline].

  5. Ayantunde AA, Oke T. A review of gastrointestinal foreign bodies. Int J Clin Pract. Jun 2006;60(6):735-9. [Medline].

  6. Velitchkov NG, Grigorov GI, Losanoff JE. Ingested foreign bodies of the gastrointestinal tract: retrospective analysis of 542 cases. World J Surg. Oct 1996;20(8):1001-5. [Medline].

  7. Cheng W, Tam PK. Foreign-body ingestion in children: experience with 1,265 cases. J Pediatr Surg. Oct 1999;34(10):1472-6. [Medline].

  8. Tokar B, Cevik AA, Ilhan H. Ingested gastrointestinal foreign bodies: predisposing factors for complications in children having surgical or endoscopic removal. Pediatr Surg Int. Feb 2007;23(2):135-9. [Medline].

  9. Kay M, Wyllie R. Pediatric foreign bodies and their management. Curr Gastroenterol Rep. Jun 2005;7(3):212-8. [Medline].

  10. Robinson AJ, Bingham J, Thompson RL. Magnet induced perforated appendicitis and ileo-caecal fistula formation. Ulster Med J. Jan 2009;78(1):4-6. [Medline].

  11. Butterworth J, Feltis B. Toy magnet ingestion in children: revising the algorithm. J Pediatr Surg. 2007;42:e3-5. [Medline].

  12. Kaye RD, Towbin RB. Interventional procedures in the gastrointestinal tract in children. Radiol Clin North Am. Jul 1996;34(4):903-17. [Medline].

  13. Duncan M, Wong RK. Esophageal emergencies: things that will wake you from a sound sleep. Gastroenterol Clin North Am. Dec 2003;32(4):1035-52. [Medline].

  14. Bigler FC. The use of a Foley catheter for removal of blunt foreign bodies from the esophagus. J Thorac Cardiovasc Surg. May 1966;51(5):759-60. [Medline].

  15. Weissberg D, Refaely Y. Foreign bodies in the esophagus. Ann Thorac Surg. Dec 2007;84(6):1854-7. [Medline].

  16. Morrow SE, Bickler SW, Kennedy AP. Balloon extraction of esophageal foreign bodies in children. J Pediatr Surg. Feb 1998;33(2):266-70. [Medline].

  17. Malhotra A, Jones L, Drugas G. Simultaneous gastric and small intestinal trichobezoars. Pediatr Emerg Care. Nov 2008;24(11):774-6. [Medline].

  18. Dahshan AH, Kevin Donovan G. Bougienage versus endoscopy for esophageal coin removal in children. J Clin Gastroenterol. May-Jun 2007;41(5):454-6. [Medline].

  19. Pavlidis TE, Marakis GN, Triantafyllou A, Psarras K, Kontoulis TM, Sakantamis AK. Management of ingested foreign bodies. How justifiable is a waiting policy?. Surg Laparosc Endosc Percutan Tech. Jun 2008;18(3):286-7. [Medline].

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Further Reading

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Keywords

gastrointestinal foreign bodies, GI foreign body, esophageal foreign body, rectal foreign body, esophageal coin, bezoars, foreign body removal, foreign body ingestion, swallow foreign body, swallow coin, swallow object, choking, gagging, drooling, coughing, wheezing, dysphagia, dyspnea, dysphonia, fever, hematochezia, trichobezoar, phytobezoar, rectal pain, pruritus

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Contributor Information and Disclosures

Author

John A Sandoval, MD, Fellow, Pediatric Surgery, University of Colorado School of Medicine
John A Sandoval, MD is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, Association for Academic Surgery, and Surgical Infection Society
Disclosure: Nothing to disclose.

Coauthor(s)

Frederick Merrill Karrer, MD, The David R and Kiku Akers Chair in Pediatric Surgery, The Children's Hospital; Head, Division of Pediatric Surgery, Professor of Surgery and Pediatrics, University of Colorado School of Medicine
Frederick Merrill Karrer, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society of Transplant Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

Casey M Calkins, MD, Assistant Professor of Surgery, Division of Pediatric Surgery, Department of Pediatric Surgery, Medical College of Wisconsin; Consulting Staff, Children's Hospital of Wisconsin
Casey M Calkins, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Pediatric Surgical Association
Disclosure: Nothing to disclose.

Medical Editor

Jayant Deodhar, MD, Associate Professor in Pediatrics, BJ Medical College, India; Honorary Consultant, Departments of Pediatrics and Neonatology, King Edward Memorial Hospital, India
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

B U K Li, MD, Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin
B U K Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition
Disclosure: Nothing to disclose.

CME Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, State University of New York, Downstate Medical Center College of Medicine; Distinguished Lecturer, New York Medical College, School of Public Health
Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership

Chief Editor

Carmen Cuffari, MD, Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine
Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

 
 
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