Overview

Children and infants

• Peak incidence: 6–36 months

• Approx. 80% of FB ingestion cases occur in pediatric patients.

Adult

• Less common (adults account for approx. 20% of all FB ingestion cases)

• Prevalence highest in the prison population and in individuals with psychiatric conditions

Accidental ingestion of a FB

• Coins (most commonly ingested FB)

• Button batteries

• Toy parts

• Small magnets from toys and household appliances

• Sharp objects (e.g., pins, paperclips, fish bones)

Toddlers are prone to examining objects with their mouths.

Accidental ingestion (e.g., of small bones with a meal)

Intentional FB ingestion may have psychiatric causes or may be criminally motivated (e.g., drug smuggling).

Dysphagia

Drooling

Refusal to eat

Retrosternal pain

Respiratory symptoms (e.g., wheezing, choking)

Signs of esophageal perforation (e.g., pneumomediastinum, crepitus in the suprasternal notch and neck region)

Small FB are often asymptomatic

Nausea, vomiting

Refusal to eat

Usually asymptomatic

Late complications (chronic inflammation, perforation) can occur if the FB is retained

Patient history: careful history to elicit the type and number of FB ingested

Physical examination

• Chest examination to rule out esophageal perforation

• Abdominal examination to assess for bowel obstruction or perforation

Imaging

• X-ray of the neck, chest, and abdomen (AP and lateral view)

  • Identify the location and dimensions of radiopaque FB (e.g., metal objects)

  • Indirect signs of radiolucent FB (e.g., plastic, wood, fish bones): air-fluid levels

  • Free air indicates perforation

• CT: indicated in symptomatic patients, if the FB poses a risk for complications (sharp objects, large FB ) or x-ray was inconclusive

• MRI

  • Indicated to visualize radiolucent FB and assess surrounding tissue

  • Contraindicated if a metallic FB is suspected or the type of FB is unknown.

General: Prioritize airway management and stabilization over diagnostics if there are any signs of respiratory distress or gastrointestinal perforation.

Expectant management (80–90% of cases): in asymptomatic patients with a small, blunt FB (e.g., coin) located either in the esophagus for < 24 hours or in the stomach/intestine

Endoscopy (10–20% of cases): flexible or rigid endoscopy

• Emergency endoscopy (< 2 hours of ingestion)

  • Any FB that causes severe symptoms (e.g., respiratory distress, difficulty swallowing)

  • Button battery lodged in the esophagus

  • Multiple magnets located in the esophagus or stomach that cause symptoms

  • Sharp objects in the esophagus with suspected obstruction/perforation (e.g., pain, vomiting, fever, hematemesis)

• Urgent endoscopy (< 24 hours of ingestion)

  • Any FB that causes symptoms

  • FB lodged in the esophagus for > 24 hours

  • Large (> 20 mm) button battery or any size button battery in patients < 5 years of age that is located in the stomach/duodenal bulb and does not cause symptoms

  • Magnets or sharp objects located in the stomach/duodenal bulb

• Elective endoscopy: failed expectant management (FB is retained in the stomach for > 4 weeks)

Surgery (1% of cases)

• Any type of FB located in the intestine with signs of intestinal obstruction or perforation

• Multiple magnets or sharp objects lodged in the intestine (symptomatic or absent progression on serial radiographs)

• Unsuccessful endoscopic removal of a FB