Diagnostic Considerations

Other conditions to consider in the differential diagnosis of patients with suspected gastrointestinal foreign bodies include the following:

Dysphagia
Esophageal carcinoma
Esophageal stricture
Failure to thrive
Intestinal perforation
Odynophagia
Peritonitis
Pneumomediastinum

Important considerations

The following are important things to consider in patients with gastrointestinal foreign bodies:

Toothpicks, when ingested, have a high risk of complications, and persons with this foreign body should be treated with early endoscopy.
Patients with button batteries in the esophagus are at a high risk for esophageal necrosis.^[17]Urgent removal is mandatory.
Aluminum soda can tabs are not visualized on plain radiographs and are frequently entrapped in the esophagus. Early endoscopy is indicated if the ingestion is definitive; if unclear, localization of the soda can tab can be visualized via CT scanning.
Foley catheter removal of esophageal foreign bodies should be performed only in carefully selected patients and only by those who are experienced in its use who have emergency airway equipment immediately available.
Children with esophageal foreign bodies may present with minimal or no symptoms. Evaluate all children who may have swallowed an object.
Children with chronic esophageal foreign bodies may present with vague symptoms such as irritability, poor feeding, or pulmonary symptoms. Maintain a high index of suspicion for an esophageal foreign body.

Differential Diagnoses

Disk Battery Ingestion
Esophageal Rupture and Tears in Emergency Medicine
Mediastinitis in Emergency Medicine
Pediatric Foreign Body Ingestion
Pediatrics, Gastrointestinal Bleeding
Rectal Foreign Bodies
Retropharyngeal Abscess
Small-Bowel Obstruction
Trachea Foreign Bodies

Workup

Lee EJ, Yang HR, Cho JM, Ko JS, Moon JS. Two cases of colonoscopic retrieval of a foreign body in children: a button battery and an open safety pin. Pediatr Gastroenterol Hepatol Nutr. 2017 Sep. 20 (3):204-9. [QxMD MEDLINE Link]. [Full Text].
Silverman JA, Brown JC, Willis MM, Ebel BE. Increase in pediatric magnet-related foreign bodies requiring emergency care. Ann Emerg Med. 2013 Dec. 62(6):604-608.e1. [QxMD MEDLINE Link].
Rosenfield D, Strickland M, Hepburn CM. After the recall: reexamining multiple magnet ingestion at a large pediatric hospital. J Pediatr. 2017 Jul. 186:78-81. [QxMD MEDLINE Link].
Altokhais TI, Al-Saleem A, Gado A, Al-Qahtani A, Al-Bassam A. Esophageal foreign bodies in children: emphasis on complicated cases. Asian J Surg. 2017 Sep. 40(5):362-6. [QxMD MEDLINE Link]. [Full Text].
Balci AE, Eren S, Eren MN. Esophageal foreign bodies under cricopharyngeal level in children: an analysis of 1116 cases. Interact Cardiovasc Thorac Surg. 2004 Mar. 3(1):14-8. [QxMD MEDLINE Link].
Nadir A, Sahin E, Nadir I, Karadayi S, Kaptanoglu M. Esophageal foreign bodies: 177 cases. Dis Esophagus. 2011 Jan. 24(1):6-9. [QxMD MEDLINE Link].
Hurtado CW, Furuta GT, Kramer RE. Etiology of esophageal food impactions in children. J Pediatr Gastroenterol Nutr. 2011 Jan. 52(1):43-6. [QxMD MEDLINE Link].
Conway WC, Sugawa C, Ono H, Lucas CE. Upper GI foreign body: an adult urban emergency hospital experience. Surg Endosc. 2007 Mar. 21(3):455-60. Epub 2006 Nov 28. [QxMD MEDLINE Link].
Kim SY, Park B, Kong IG, Choi HG. Analysis of ingested foreign bodies according to age, type and location: a retrospective observational study. Clin Otolaryngol. 2016 Dec. 41 (6):640-5. [QxMD MEDLINE Link].
Stack LB, Munter DW. Foreign bodies in the gastrointestinal tract. Emerg Med Clin North Am. 1996 Aug. 14(3):493-521. [QxMD MEDLINE Link].
Chinski A, Foltran F, Gregori D, Ballali S, Passali D, Bellussi L. Foreign bodies in the oesophagus: the experience of the Buenos Aires Paediatric ORL Clinic. Int J Pediatr. 2010. 2010:[QxMD MEDLINE Link]. [Full Text].
Baral BK, Joshi RR, Bhattarai BK, Sewal RB. Removal of coin from upper esophageal tract in children with Magill's forceps under propofol sedation. Nepal Med Coll J. 2010 Mar. 12(1):38-41. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Ghimire A, Bhattarai M, Kumar M, Wakode PT. Descending necrotizing mediastinitis: a fatal complication of neglected esophageal foreign body. Kathmandu Univ Med J (KUMJ). 2007 Jan-Mar. 5(1):98-101. [QxMD MEDLINE Link].
Macchi V, Porzionato A, Bardini R, Parenti A, De Caro R. Rupture of ascending aorta secondary to esophageal perforation by fish bone. J Forensic Sci. 2008 Sep. 53(5):1181-4. [QxMD MEDLINE Link].
Kunishige H, Myojin K, Ishibashi Y, Ishii K, Kawasaki M, Oka J. Perforation of the esophagus by a fish bone leading to an infected pseudoaneurysm of the thoracic aorta. Gen Thorac Cardiovasc Surg. 2008 Aug. 56(8):427-9. [QxMD MEDLINE Link].
Semple T, Calder AD, Ramaswamy M, McHugh K. Button battery ingestion in children-a potentially catastrophic event of which all radiologists must be aware. Br J Radiol. 2018 Jan. 91 (1081):20160781. [QxMD MEDLINE Link].
Rodrigues FG, Campos JB, Silva GD, Wexner SD. Endoscopic ultrasound in the diagnosis of foreign bodies of the colon and rectum. Rev Assoc Med Bras (1992). 2016 Dec. 62 (9):818-21. [QxMD MEDLINE Link].
Little DC, Shah SR, St Peter SD, Calkins CM, Morrow SE, Murphy JP, et al. Esophageal foreign bodies in the pediatric population: our first 500 cases. J Pediatr Surg. 2006 May. 41(5):914-8. [QxMD MEDLINE Link].
Louie JP, Alpern ER, Windreich RM. Witnessed and unwitnessed esophageal foreign bodies in children. Pediatr Emerg Care. 2005 Sept. 21(9):582-5. [QxMD MEDLINE Link].
Kim N, Atkinson N, Manicone P. Esophageal foreign body: a case of a neonate with stridor. Pediatr Emerg Care. 2008 Dec. 24(12):849-51. [QxMD MEDLINE Link].
Miller RS, Willging JP, Rutter MJ, Rookkapan K. Chronic esophageal foreign bodies in pediatric patients: a retrospective review. Int J Pediatr Otorhinolaryngol. 2004 Mar. 68(3):265-72. [QxMD MEDLINE Link].
Hosokawa T, Yamada Y, Sato Y, et al. Role of sonography for evaluation of gastrointestinal foreign bodies. J Ultrasound Med. 2016 Dec. 35 (12):2723-32. [QxMD MEDLINE Link].
Chung CH, Fung WT. Detection of gastric drug packet by ultrasound scanning. Eur J Emerg Med. 2006 Oct. 13(5):302-3. [QxMD MEDLINE Link].
Lee SC, Ebert CS Jr, Fordham L, Rose AS. Plain films in the evaluation of batteries as esophageal foreign bodies. Int J Pediatr Otorhinolaryngol. 2008 Oct. 72(10):1487-91. [QxMD MEDLINE Link].
Hergan K, Kofler K, Oser W. Drug smuggling by body packing: what radiologists should know about it. Eur Radiol. 2004 Apr. 14(4):736-42. Epub 2003 Oct 18. [QxMD MEDLINE Link].
Palme CE, Lowinger D, Petersen AJ. Fish bones at the cricopharyngeus: a comparison of plain-film radiology and computed tomography. Laryngoscope. 1999 Dec. 109(12):1955-8. [QxMD MEDLINE Link].
Eliashar R, Dano I, Dangoor E, Braverman I, Sichel JY. Computed tomography diagnosis of esophageal bone impaction: a prospective study. Ann Otol Rhinol Laryngol. 1999 Jul. 108(7 Pt 1):708-10. [QxMD MEDLINE Link].
Kuzmich S, Burke CJ, Harvey CJ, et al. Perforation of gastrointestinal tract by poorly conspicuous ingested foreign bodies: radiological diagnosis. Br J Radiol. 2015 Jun. 88 (1050):20150086. [QxMD MEDLINE Link].
Bassett KE, Schunk JE, Logan L. Localizing ingested coins with a metal detector. Am J Emerg Med. 1999 Jul. 17(4):338-41. [QxMD MEDLINE Link].
Lin HH, Lee SC, Chu HC, Chang WK, Chao YC, Hsieh TY. Emergency endoscopic management of dietary foreign bodies in the esophagus. Am J Emerg Med. 2007 Jul. 25(6):662-5. [QxMD MEDLINE Link].
Lin CH, Chen AC, Tsai JD, Wei SH, Hsueh KC, Lin WC. Endoscopic removal of foreign bodies in children. Kaohsiung J Med Sci. 2007 Sep. 23(9):447-52. [QxMD MEDLINE Link].
Pokharel R, Adhikari P, Bhusal CL, Guragain RP. Oesophageal foreign bodies in children. JNMA J Nepal Med Assoc. 2008 Oct-Dec. 47(172):186-8. [QxMD MEDLINE Link].
Geraci G, Sciume' C, Di Carlo G, Picciurro A, Modica G. Retrospective analysis of management of ingested foreign bodies and food impactions in emergency endoscopic setting in adults. BMC Emerg Med. 2016 Nov 4. 16 (1):42. [QxMD MEDLINE Link]. [Full Text].
Zhang YB, Gao ZG, Xiong QX, Zhang LF, Cai DT, Cai JB. Clinical experience in the treatment of children who swallowed multiple magnetic foreign bodies: A report of five cases. World J Pediatr. 2017 Jun. 13 (3):274-7. [QxMD MEDLINE Link].
Geng C, Li X, Luo R, Cai L, Lei X, Wang C. Endoscopic management of foreign bodies in the upper gastrointestinal tract: a retrospective study of 1294 cases. Scand J Gastroenterol. 2017 Nov. 52 (11):1286-91. [QxMD MEDLINE Link].
Lue AJ, Fang WD, Manolidis S. Use of plain radiography and computed tomography to identify fish bone foreign bodies. Otolaryngol Head Neck Surg. 2000 Oct. 123(4):435-8. [QxMD MEDLINE Link].
Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging battery-ingestion hazard: clinical implications. Pediatrics. 2010 Jun. 125(6):1168-77. [QxMD MEDLINE Link].
Litovitz T, Whitaker N, Clark L. Preventing battery ingestions: an analysis of 8648 cases. Pediatrics. 2010 Jun. 125(6):1178-83. [QxMD MEDLINE Link].
Sharpe SJ, Rochette LM, Smith GA. Pediatric battery-related emergency department visits in the United States, 1990-2009. Pediatrics. 2012 Jun. 129(6):1111-7. [QxMD MEDLINE Link]. [Full Text].
Garcia Fernandez FJ, Leon Montanes R, Bozada Garcia JM. Caustic esophageal injury by impaction of cell batteries. Rev Esp Enferm Dig. 2016 Dec. 108 (12):811-2. [QxMD MEDLINE Link].
Waltzman ML. Management of esophageal coins. Curr Opin Pediatr. 2006 Oct. 18(5):571-4. [QxMD MEDLINE Link].
Calkins CM, Christians KK, Sell LL. Cost analysis in the management of esophageal coins: endoscopy versus bougienage. J Pediatr Surg. 1999 Mar. 34(3):412-4. [QxMD MEDLINE Link].
Bonadio WA, Jona JZ, Glicklich M, Cohen R. Esophageal bougienage technique for coin ingestion in children. J Pediatr Surg. 1988 Oct. 23(10):917-8. [QxMD MEDLINE Link].
Dashan AH, Kevin Donovan G. Bougienage versus endoscopy for esophageal coin removal in children. J Clin Gastroenterol. 2007 May-Jun. 41(5):454-6. [QxMD MEDLINE Link].
Cetinkursun S, Sayan A, Demirbag S, Surer I, Ozdemir T, Arikan A. Safe removal of upper esophageal coins by using Magill forceps: two centers' experience. Clin Pediatr (Phila). 2006 Jan-Feb. 45(1):71-3. [QxMD MEDLINE Link].
Bhargava R, Brown L. Esophageal coin removal by emergency physicians: a continuous quality improvement project incorporating rapid sequence intubation. CJEM. 2011 Jan. 13(1):28-33. [QxMD MEDLINE Link].
Al-Haddad M, Ward EM, Scolapio JS, Ferguson DD, Raimondo M. Glucagon for the relief of esophageal food impaction does it really work?. Dig Dis Sci. 2006 Nov. 51(11):1930-3. [QxMD MEDLINE Link].
Metha D, Attia M, Cronan K. Glucagon for esophageal coin dislodgement in children: a prospective, double-blind, placebo-controlled study. Acad Emerg Med. 2001 Feb. 8(2):200-3. [QxMD MEDLINE Link].
Leopard D, Fishpool S, Winter S. The management of oesophageal soft food bolus obstruction: a systematic review. Ann R Coll Surg Engl. 2011 Sep. 93(6):441-4. [QxMD MEDLINE Link].
Conners GP. A literature-based comparison of three methods of pediatric esophageal coin removal. Pediatr Emerg Care. 1997 Apr. 13(2):154-7. [QxMD MEDLINE Link].
Arms JL, Mackenberg-Mohn MD, Bowen MV, Chamberlain MC, Skrypek TM, Madhok M, et al. Safety and efficacy of a protocol using bougienage or endoscopy for the management of coins acutely lodged in the esophagus: a large case series. Ann Emerg Med. 2008 Apr. 51(4):367-72. [QxMD MEDLINE Link].
Conners GP, Chamberlain JM, Ochsenschlager DW. Conservative management of pediatric distal esophageal coins. J Emerg Med. 1996 Nov-Dec. 14(6):723-6. [QxMD MEDLINE Link].
Soprano JV, Fleisher GR, Mandl KD. The spontaneous passage of esophageal coins in children. Arch Pediatr Adolesc Med. 1999 Oct. 153(10):1073-6. [QxMD MEDLINE Link].
Conners GP, Chamberlain JM, Ochsenschlager DW. Symptoms and spontaneous passage of esophageal coins. Arch Pediatr Adolesc Med. 1995 Jan. 149(1):36-9. [QxMD MEDLINE Link].
Weiland ST, Schurr MJ. Conservative treatment of ingested foreign bodies. J Gastrointest Surg. 2002 May-Jun. 6(3):496-500. [QxMD MEDLINE Link].
Durko A, Czkwianianc E, Bak-Romaniszyn L, Malecka-Panas E. [Accidental ingestion of two magnets--aggresive or prolonged approach?]. Pol Merkur Lekarski. 2007 May. 22(131):416-8. [QxMD MEDLINE Link].
Baliga SK, Hussain D, Sarfraz SL, Hartung RU. Magnetic attraction: dual complications in a single case. J Coll Physicians Surg Pak. 2008 Jul. 18(7):440-1. [QxMD MEDLINE Link].
Cortes C, Silva C. [Accidental ingestion of magnets in children. Report of three cases]. Rev Med Chil. 2006 Oct. 134(10):1315-9. [QxMD MEDLINE Link].
Hou SK, Chern CH, How CK, Wang LM, Huang CI, Lee CH. Press through package mis-swallowing. Int J Clin Pract. 2006 Feb. 60(2):234-7. [QxMD MEDLINE Link].
Lee KI, Wang CP. Images in emergency medicine. Press-through package mis-swallowing. Ann Emerg Med. 2008 Aug. 52(2):98, 115. [QxMD MEDLINE Link].
Butterworth JR, Wright K, Boulton RA, Pathmakanthan S, Goh J. Management of swallowed razor blades-retrieve or wait and see?. Gut. 2004 Apr. 53(4):477, 486. [QxMD MEDLINE Link].

Media Gallery

Coin (quarter) lodged at the level of the cricopharyngeus muscle.
Coin lodged at the level of the aortic crossover.
Coin lodged at the lower esophageal sphincter.
A screw in the stomach; peristaltic action will carry the screw through the GI tract with the blunt end (head) leading and the sharp end trailing.