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Information ⬇

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RistoRintala

Foreign Body in the Gastrointestinal Tract of a Child

Essentials

  • The type, consistency, and form of a swallowed foreign body determine the intensity of attempts to locate and remove it.
    • A foreign body stuck in the oesophagus may cause severe symptoms and may even be life-threatening.
    • A foreign body that has passed through the oesophagus into the stomach usually exits spontaneously without causing symptoms. Batteries and other foreign bodies stuck in the oesophagus are always removed endoscopically as an emergency intervention.
    • So called coin cell batteries are particularly dangerous, since they may, when getting stuck in the oesophagus, even very rapidly corrode the oesophageal wall.
    • Most button batteries contain an alkaline electrolyte that may damage the mucous membranes when dissolved. The electrolyte is released into the gastrointestinal tract if the battery casing is broken. The breakage of the casing is accelerated if there is much charge left in the battery. Therefore, it is advisable to follow up a patient who has swallowed a button battery even if he/she is symptomless. Endoscopy should be considered if the battery is not spontaneously excreted within 48 hours.
  • Round mini magnets, if there are more than one, may cause intestinal fistulae or intestinal perforation when they atttach to each other.
  • Foreign body in the respiratory passages: see Foreign Body in the Respiratory Passages; foreign body in the nose: see Foreign Body in the Nose.

Treatment Detection of Coins Ingested by Children Using a Handheld Metal Detector

  • Children who have swallowed any foreign body and have symptoms (e.g. gagging) should be referred to a hospital. X-ray examinations are not necessary at the primary care level.
  • If the swallowed object is known or suspected to be a mercury battery the child should immediately be referred to a hospital where the battery can be removed endoscopically. In unclear cases a neck, chest and abdominal plain x-ray can be taken in the referring unit to confirm the presence of a foreign body. It is important to take a chest x-ray because the newer button cell batteries that are flat and coin-sized get easily stuck in the oesophagus.
    • Mercury batteries are rare because their sale is forbidden in many countries (e.g. within the European Union). In other countries, mercury-containing batteries may still be marketed.
  • If a child who has swallowed a button battery is completely symptomless, follow-up may be carried out at home. The passing of the battery may be assisted e.g. by administration of sodium picosulphate drops.
  • If the battery is not seen in the stools within 48 hours, a plain x-ray of the abdomen is taken. If the battery is still seen in the stomach at this phase, it should be removed endoscopically.
  • Batteries and other foreign bodies stuck in the oesophagus are always removed endoscopically as an emergency intervention.
  • If the foreign body is large (> 20 mm), e.g. a coin, it may stick to the mucous membrane of the stomach. If the object is not passed with the stools, its course should be followed up radiologically (1 to 2 weeks after the incident) and it should be removed endoscopically if necessary.
  • A child who has swallowed more than one mini magnet should be monitored by repeated plain abdominal x-rays. If the magnets are still in the stomach, removal through emergency endoscopy is warranted.
  • A child who has swallowed a small object and is symptomless requires medical examination and radiography only if symptoms should appear.

Evidence Summaries ⬆