Pediatric Foreign Body Ingestion Workup

Updated: Oct 04, 2018
  • Author: Gregory P Conners, MD, MPH, MBA, FAAP, FACEP; Chief Editor: Dale W Steele, MD, MS  more...
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Laboratory Studies

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  • Children with foreign body ingestion typically do not require laboratory testing.

  • Laboratory studies may be indicated for workup of specific complications, such as potential infection.


Imaging Studies

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  • Chest/abdominal radiography

    • Most ingested foreign bodies are radiopaque (in contrast to inhaled foreign bodies which usually are radiolucent).

    • If the swallowed object may be radiopaque, a single frontal radiograph that includes the neck, chest, and entire abdomen is usually sufficient to locate the object. Subsequent, focused radiographs may then be used to more fully evaluate the patient, as noted below.

    • If the object is below the diaphragm, further radiographs are generally unnecessary (in the absence of previous GI disorders, such as repaired pyloric stenosis).

    • If the object is in the esophagus, frontal and lateral chest radiographs are necessary to precisely locate and better identify the object and to be sure that the foreign body is not, in fact, two adherent objects.

    • Button (disk) batteries typically have distinctive appearances on radiographs. A lateral view reveal a distinctive 2-step border, as opposed to the smooth borders of most coins (although this may also be the result of 2 adherent coins of different size [19] ). Frontal views may suggest a corresponding ring just inside the outermost ring of the battery. A magnified digital radiographic image of an object may reveal identifying characteristics allowing identification of the swallowed object, such as the distinctive design of a well-known coin. [20]

    • Coins and similarly shaped objects in the chest may be localized to either the esophagus or the airway by their position on a frontal radiograph. With rare exceptions, [21] coins in the esophagus appear in the coronal orientation (ie, coin seen as a disk on frontal view), while coins in the trachea appear in the sagittal orientation (ie, coin seen from the side on frontal view).

    • If the ingested object is radiolucent, the object's location may be inferred from effects (eg, airway compression) seen on plain radiographs. However, such findings are not reliable.

    • Radiolucent objects in the esophagus may be better visualized by repeating the study after having the child drink a small amount of dilute contrast (esophagram). This should not be done if endoscopy is planned. Special care must be taken if the esophagus could possibly be obstructed or perforated.

    • When a foreign body is strongly suspected on clinical grounds, visualization by endoscopy, which has the added advantage of allowing removal of the object, may be the most efficient method of management.

  • CT scan or MRI is rarely indicated but may enhance the detection of foreign bodies or complications (eg, perforations) in special cases.


Other Tests

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  • Metal detectors

    • The use of handheld metal detectors to identify the location of ingested metallic objects (especially coins) has proven sensitive and specific. [22] In the case of aluminum (eg, flip top of a soda can), a metal detector may be more sensitive since aluminum is often radiolucent. [23] The operator should have experience with this modality before using it for patient care.

    • Patients with coins localized to the abdomen may be safely observed. However, patients with coins localized in the esophagus probably should have confirmatory plain radiographs.



See the list below:

  • Endoscopy

    • Endoscopy (esophagoscopy) may be diagnostic and therapeutic.

    • Children who require extensive radiologic investigation may be best served by referral to a pediatric gastroenterologist or surgeon for endoscopy, which is safe and highly effective.