Fast Five Quiz: Are You Prepared to Confront Foreign Bodies in Patients?

Richard H. Sinert, DO

Disclosures

April 28, 2017

Esophageal button batteries may cause substantial mucosal injury in as few as 2 hours.

Once a swallowed foreign body reaches the stomach of a child with a normal gastrointestinal (GI) tract, it is much less likely to lead to complications. Most complications of pediatric foreign body ingestion are due to esophageal impaction, usually at one of three typical locations. The most common site of esophageal impaction is at the thoracic inlet. Defined as the area between the clavicles on chest x-ray, this is the site of anatomic change from the skeletal muscle to the smooth muscle of the esophagus. The cricopharyngeus sling at C6 is also at this level and may "catch" a foreign body. About 70% of blunt foreign bodies that lodge in the esophagus do so at this location. Another 15% become lodged at the mid esophagus, in the region where the aortic arch and carina overlap the esophagus on chest x-ray. The remaining 15% become lodged at the LES at the gastroesophageal junction.

A foreign body lodged in the GI tract may have little or no effect; cause local inflammation leading to pain, bleeding, scarring, and obstruction; or erode through the GI tract. Migration from the esophagus most often leads to mediastinitis but may involve the lower respiratory tract or aorta and create an aortoenteric fistula.

For more on pediatric foreign bodies, read here.

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