An Unvaccinated Girl With Wheezing After Foreign Body Removal

Jesse Borke, MD

Disclosures

February 10, 2020

Discussion

The patient's x-ray reveals bilateral upper-lobe pneumonia. In the context of the recent removal of button battery from the esophagus, tracheoesophageal fistula must be considered.

The pediatric surgery and otolaryngology services were consulted. Antibiotics were ordered, and barium-enhanced radiography was performed. The child was taken to the operating room, and endoscopy revealed esophageal injury and tracheoesophageal fistula.

Children, especially those with developmental delay, often place inedible objects in their mouth. The incidence of foreign body ingestion is highest from about age 6 months to 4 years, with a slight predilection for males among older children.[1] More than 63,000 ingestions of foreign bodies by children aged 5 years or younger were reported to US Poison Control Centers in 2017.[2] Objects of primary concern include those that are toxic, pointy or sharp, large, or magnetic. Some of the more commonly encountered worrisome ingestions include fish bones; thumbtacks; magnets; and, as in this patient, button batteries (disk batteries).

Children with esophageal foreign bodies may present in various clinical scenarios. A caregiver or parent may witness the ingestion, a child may report the ingestion to their caregiver, or a child may exhibit signs and symptoms of a possible or suspected unwitnessed ingestion. Unfortunately, children often present with vague symptoms that are not specific for foreign body ingestion. When present, symptoms of esophageal foreign bodies may include dysphagia, poor feeding, drooling, gagging, vomiting, sore throat, chest pain, cough, stridor or abnormal breathing, fever, or general abnormal behavior.

The physical examination of such patients is often normal; however, the physician should be on the lookout for stridor, rhonchi, or rales, blood in the mouth, and drooling or pooling of secretions. The patient in this case had only scant wheezing and rales in the upper lung fields.

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