Pediatric Gastrointestinal Foreign Bodies Workup

  • Author: John A Sandoval, MD; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: May 11, 2011
 

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.
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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.
    • 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]
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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.
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Diagnostic Procedures

  • No diagnostic procedures outside of the radiology suite are required.
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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  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 is a member of the following medical societies: American Academy of Pediatrics, American Association for the Study of Liver Diseases, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society of Transplant Surgeons, Children's Oncology Group, Colorado Medical Society, International Liver Transplantation Society, International Pediatric Transplant Association, International Society of Pediatric Surgical Oncology, Pacific Association of Pediatric Surgery, Society of Critical Care Medicine, Transplantation Society, 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.

Specialty Editor Board

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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

B UK 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 UK 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.

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, SUNY-Downstate Medical Center

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: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, Inc. Grant/research funds Independent contractor

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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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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