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.

Plain Radiography

Radiography is mandated for children with suspected GI foreign body ingestion.^[14] 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 a 2-year-old child. Note the coronal alignment on this posteroanterior (PA) radiograph that is suggestive of an esophageal location.

View Media Gallery

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]

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.

Treatment & Management

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Media Gallery

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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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)

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 of Colorado

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, American College of Surgeons, American Pediatric Surgical Association, American Society of Transplant Surgeons, Denver Academy of Surgery, International Pediatric Transplant Association, Pacific Association of Pediatric Surgery, Transplantation Society, Western Surgical Association, Western Trauma Association

Disclosure: Nothing to disclose.

Casey M Calkins, MD 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.

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. for: Abbott Nutritional, Abbvie, speakers' bureau.

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.