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Pediatric Gastrointestinal Foreign Bodies Workup

  • Author: John A Sandoval, MD; Chief Editor: Carmen Cuffari, MD  more...
 
Updated: Nov 19, 2015
 

Laboratory Studies

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  • 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.
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Imaging Studies

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  • Plain radiography[13, 14]
    • 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. See the image below.
      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.[15]
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Other Tests

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

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  • No diagnostic procedures outside of the radiology suite are required.
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Contributor Information and Disclosures
Author

John A Sandoval, MD Assistant Member of Surgery and Pediatrics, St Jude Children’s Research Hospital; Assistant Professor, Departments of Pediatrics and Surgery, University of Tennessee Health Science Center College 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, Surgical Infection Society

Disclosure: Nothing to disclose.

Coauthor(s)

Casey M Calkins, MD Associate Professor of Surgery, Division of Pediatric Surgery, Medical College of Wisconsin; Consulting Staff, Department of Pediatric Surgery, 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, American Pediatric Surgical Association

Disclosure: Nothing to disclose.

Frederick Merrill Karrer, MD, FACS Professor of Surgery and Pediatrics, Head, Division of Pediatric Surgery, University of Colorado School of Medicine; The Dr David R and Kiku Akers Chair in Pediatric Surgery, Surgical Director, Pediatric Transplantation, The Children’s Hospital

Frederick Merrill Karrer, MD, FACS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Study of Liver Diseases, Children's Oncology Group, International Liver Transplantation Society, Transplantation Society, International Society of Paediatric Surgical Oncology, Pacific Association of Pediatric Surgery, International Pediatric Transplant Association, Colorado Medical Society, Society of Critical Care Medicine, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society of Transplant Surgeons, Western Surgical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

B UK Li, MD Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin; Attending Gastroenterologist, Director, Cyclic Vomiting Program, Children’s Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

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, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching.

Additional Contributors

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.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Casey M Calkins, MD and Denis Bensard, MD, to the original writing and development of this article.

References
  1. Kirsner JB. The 1994 G. Brohee Lecture (Los Angeles). The scientification of gastroenterology during the 20th century. Acta Gastroenterol Belg. 1995 Jan-Feb. 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. 2007 Jun. 21(6):838-53. [Medline].

  3. Boškoski I, Tringali A, Landi R, Familiari P, Contini AC, Pintus C, et al. Endoscopic retrieval of a duodenal perforating teaspoon. World J Gastrointest Endosc. 2013 Apr 16. 5(4):186-8. [Medline]. [Full Text].

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

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

  6. Teisch LF, Tashiro J, Perez EA, Mendoza F, Sola JE. Resource utilization patterns of pediatric esophageal foreign bodies. J Surg Res. 2015 Oct. 198 (2):299-304. [Medline].

  7. Timmers M, Snoek KG, Gregori D, Felix JF, van Dijk M, van As SA. Foreign bodies in a pediatric emergency department in South Africa. Pediatr Emerg Care. 2012 Dec. 28(12):1348-52. [Medline].

  8. Denney W, Ahmad N, Dillard B, Nowicki MJ. Children will eat the strangest things: a 10-year retrospective analysis of foreign body and caustic ingestions from a single academic center. Pediatr Emerg Care. 2012 Aug. 28(8):731-4. [Medline].

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

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

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

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

  13. Pugmire BS, Lim R, Avery LL. Review of Ingested and Aspirated Foreign Bodies in Children and Their Clinical Significance for Radiologists. Radiographics. 2015 Sep-Oct. 35 (5):1528-38. [Medline].

  14. Pinto A, Lanza C, Pinto F, Grassi R, Romano L, Brunese L, et al. Role of plain radiography in the assessment of ingested foreign bodies in the pediatric patients. Semin Ultrasound CT MR. 2015 Feb. 36 (1):21-7. [Medline].

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

  16. Lee JH, Lee JS, Kim MJ, Choe YH. Initial location determines spontaneous passage of foreign bodies from the gastrointestinal tract in children. Pediatr Emerg Care. 2011 Apr. 27(4):284-9. [Medline].

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

  18. Tavarez MM, Saladino RA, Gaines BA, Manole MD. Prevalence, clinical features and management of pediatric magnetic foreign body ingestions. J Emerg Med. 2013 Jan. 44(1):261-8. [Medline].

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

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

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

  22. Joyamaha D, Conners GP. Managing Pediatric Foreign Body Ingestions. Mo Med. 2015 May-Jun. 112 (3):181-6. [Medline].

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

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

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

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

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

  28. 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. 2008 Jun. 18(3):286-7. [Medline].

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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.
Lateral radiograph of impacted esophageal coin in the thoracic inlet of a 2-year-old child.
A 3-year-old girl with a buffalo-shaped pendant lodged in the esophagus at the thoracic inlet.
A 7-month-old child with broken razor blade (yellow arrow) lodged at the thoracic inlet of the esophagus.
A trichobezoar within the stomach of a 14-year-old girl with trichotillomania. This intraoperative photograph demonstrates the bezoar being delivered through a longitudinal gastrotomy made along the body of the stomach.
A 4-year-old child presented with an impacted coin in the mid jejunum. A mini laparotomy revealed evidence of a dilated jejunum with decompressed distal bowel. An eroded coin (penny) was found just proximal to an incomplete intestinal web.
 
 
 
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