Diagnostic imaging should be performed as close to the planned intervention as possible because the location of the injected foreign body may change. Mandatory medical device diagnostics.
- Radiograph of the thorax (X-ray thorax/chest) – lateral if necessary – and abdomen (abdominal cavity) (“from mouth to anus”), in two planes – an ingested foreign body is radiopaque (“impermeable to X-rays”) unless it is a metallic foreign body (shadowing)
- Since swallowed foreign bodies are often located in the upper third of the esophagus, the lower row of teeth must be included in the X-ray!
- If the X-ray is performed close in time to the (suspected) ingestion, an X-ray up to the mid-abdomen is sufficient.
- If the foreign body is located higher: laryngoscopy and hypopharyngoscopy (laryngoscopy and reflection of the lower pharynx).
- For lower-lying esophageal foreign body: esophagoscopy (esophagoscopy) – flexible and/or rigid – or flexible gastroscopy (gastroscopy).
- Esophageal pre-swallow, in two planes – contrast-enhanced imaging of the esophagus and esophagogastric junction.
- Esophagogastroduodenoscopy (endoscopy of the esophagus, stomach, and duodenum), if necessary.
- If necessary, computed tomography (CT; sectional imaging procedure (X-ray images taken from different directions with computer-based evaluation)) – mainly suitable for visualizing fish bones and chicken bones, which are marked by fluid and soft tissue mass and are thus not visible on the X-ray image
Indications for endoscopy:
- Emergency – immediate endoscopic removal of the foreign body:
- Esophagus
- Foreign body in the upper → obstruction of the esophagus (food pipe) → threat of obstruction of the airway and formation of a pressure ulcer (pressure sore) that can perforate (break through) and cause mediastinitis (inflammation in the mediastinum (space in the chest located between the lungs))
- Batteries/button cells – Already after one to two hours, the processes at the button cell can cause deep damage to the mucosa (mucous membrane).
- Stomach
- Multiple magnets – if these cannot be removed endoscopically, a laparatomy (abdominal incision) must be performed
- Dangerous foreign body
- All pointed, sharp-edged objects
- All painful foreign objects
- All toxic foreign bodies
- Esophagus
- Intervention within 8-12 hours:
- Asymptomatic, mechanically harmless foreign bodies in the lower esophagus.
- Surgery the following day (24-48 hours):
- Large foreign body in the stomach (diameter > 2.5 cm or length > 6 cm).
- Button cell in the stomach (low current burns due to short circuit and leakage of toxic components due to the action of gastric acid).
- Schedulable procedure (3-4 weeks):
- Non-toxic, non-hazardous foreign body in the stomach and asymptomatic patient – natural passage of the foreign body through the gastrointestinal tract (GI tract) can last up to 4 weeks.
As a rule, the child is not expected to fast at the time of endoscopy. Since consequential damage can be expected or the child’s life may be acutely threatened, the following risks must be weighed against each other on the part of the disciplines involved:
- Risk of secondary damage from the foreign body.
- In emergency anesthesia induction, risk of regurgitation (backflow) of gastric contents and/or pulmonary aspiration in nonfasting infant
- Risk of performing the procedure with less than optimal team staffing (during emergency operation).
- Waiting for the child to be sober should not be done if:
- The foreign body is lodged in the esophagus (food pipe), especially if it is suspected that it could be batteries/button cells, coins, pointed or sharp objects
- The child’s sobriety should be waited for if:
- The foreign body is in the stomach – it will go away naturally (within three to four days; otherwise X-ray).
- Cave: However, if the foreign body could be sharp or pointed, such as nails, thumbtacks, fish bones, bones or several magnets, do not wait!
