Pediatric Surgery

Esophageal Foreign Bodies

March 23, 2022
What should you do if a child swallows a button battery?
Or has something lodged in their throat? Or accidentally ingests household clearer? Or incurs an esophageal injury?
Today we’re going to talk about best practices for diagnosing and managing esophageal injuries caused by foreign bodies, caustic ingestions and traumatic injuries with Senior Fellow and Pediatric Surgery Specialist at Cincinnati Children’s Hospital, Dr. Aaron Garrison

First, let’s talk about the epidemiology

Here’s Dr. Garrison.

So as we know children sometimes swallow things accidentally, like coins, buttons and beads.
And most pass harmlessly through their digestive system.
But what happens if a child swallows a button battery, one of those small, flat and round things
that power a lot of devices. When ingested, they can cause damage in several different ways.
A single battery can create an electrical current or leak harmful chemicals that can damage or
actually eat through sensitive tissue causing aortoesophageal fistula.
But first things first. How can you differentiate between a button battery and a coin on x-ray?
They look the same, right?

If you see that halo, it turns into an emergency.
Now, suppose a neighbor, who knows you’re a doctor, calls you to say her 3 year old may have
swallowed a button battery. What should you advise her to do immediately before going to the ER?
The best thing is to advise them to give their child 10 mg of honey every 10 minutes on the
way to the hospital.

To check out really good algorithms regarding known or suspected battery ingestions in
younger and older children and what to do, go to the Poison Control website
( www.poison.org/guideline )
So scoping and removing the object is critically important.

Once you’ve determined that the child has ingested a coin vs. a battery, you can wait until the
next day to see if it passes.
About x-rays - some objects such as steak bones and metallic objects are radiopaque,
that is easier to visualize. But other such as fish and chicken bones, wood plastic and glass are
radiolucent and are therefore easy to miss.
So a major take home point: if you have a patient who is symptomatic but has a negative x -ray, you should still take a look.
Let’s look at another issue: caustic ingestion


(explains caustic ingestion, mentions Up To Date info)
What’s the difference between acids and bases? Which is more dangerous?
Most people naturally think acids are.

With a caustic ingestion there’s a worsening possibility of perforation over the course of a
week, so patients need to be monitored closely.

(airway issues in the short term)
Here are some recommendations about what NOT to do to manage the patient following caustic ingestion: inducing vomiting, using neutralizing agents to bring the pH down, diluting it
with milk or water, or using activated charcoal.
Also, don’t place an NG tube until you have characterized the esophagus, but definitely plan for a scope within the first 24 hours.
What about esophageal injuries?

Often diagnosis is delayed because we’re not looking for esophageal injuries but once an injury
is suspected we have to determine exactly where that injury is so we can pick an approach.
Let’s start with cervical injuries.

Here’s another issue, a not uncommon problem. Suppose a nurse needs to pass an NG tube
into a newborn and the cervical esophagus gets perforated.

This raises the point that nearly 60% of all reported esophageal perforations are iatrogenic, but
depending on the cause, perforations can be managed non - operatively if contained and
drained.

Let’s summarize the key points. Button battery ingestion can be fatal, and if this is suspected by parents they should give their child 10 ml of honey every 10 minutes enroute to the hospital.
Also the most common type of caustic ingestion is alkaline, which can cause rapid liquefactionnecrosis until the alkali is neutralized or diluted.
But you want to avoid vomiting or aspiration, which can make the injury worse.
After caustic ingestion, once the patient is stabilized, endoscopy should be performed within 24 hours to evaluate the extent of the injury.
So that was our session on Esophageal Foreign Bodies, Ingestions, Trauma and Perforation:
by Dr Aaron Garrison.


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