Foreign body ingestion

Overview

History and details specific to ingestion

• Witnessed or Suspected? Are there concerns surrounding supervision or possible NAI?

• Choking episode?

• Time of ingestion?

• Size and quantity (if width >2cm, length >5cm less likely to pass pylorus/duodenum)?

• Does it have a sharp end?

• Last ate/drank?

• Any history of pain, vomiting and/or anorexia?

• Do family have similar object with them or know what it’s made from?

Hazardous objects include button batteries, multiple magnets, sharp objects and objects larger than 5cm length or x2cm width- these warrant radiography if emergent management not necessary.

Foreign Body Specifics

Button battery suspected by history or confirmed on X-ray

Pre-hospital recommendations
Children > 1 yrs & battery swallowed within past 12 hours.

• Keep NBM but administer honey 10ml every 10mins (up to 6 doses)

• Proceed to ED immediately

• National poisons centre notification

Important recommendations for the surgical team removing button battery:

Removal of an oesophageal button battery under general anaesthetic is a time critical emergency.
In theatre, as soon as the button battery is removed, it is recommended to gently irrigate the oesophagus with 120-150ml of 0.25% acetic acid.

This can be done using a luer-lock syringe attached to a 5 French suction catheter introduced via the lumen of the oesophagoscope. Simultaneously, a rigid suction can be used to continuously remove excess irrigant.

Magnets (single or multiple): suspected from history or confirmed on X-ray

Other hard objects: suspected from history or confirmed by X-ray (eg Lego® coins, beads)

FBs located in ear or nose

Button battery in nose or ear

• Emergency removal in ED (or ORL referral if unable to retrieve)

• If successful removal in ED, ORL referral still required (to assess severity of burn)

• Even if removed - Keep NBM until ORL review
  

Other FBs in nose or ear (Eg: Single magnet, Lego®, coins, beads)

• Removal in ED (or ORL referral if unable to retrieve)

• If otitis externa present treat accordingly

Tips for using the handheld metal detector

• May not be accurate in children >50kg (false negatives) or children with known metallic implants (false positives)

• Very good at picking up coins- presence and absence of beep strongly corresponds to presence/absence and location of coin.

• Less reliable with small metallic objects, button batteries etc- This means if it beeps, you can be confident of position, but absence of beep should never be interpreted as absence of a hazardous metallic object. In these situations, a prompt positive metal detector result may be useful at triage to mobilise teams early, but should not slow down the timeliness of your usual management.

• Can be useful in identifying location of aluminium objects (e.g. ringpulls), which won’t show up on X-ray.

• Safe (no radiation) and will not adversely affect function of pacemakers, medical devices or bank cards.

• Can be used to avoid serial X-rays in children who have a previously proven ingested metallic object.

• To use the metal detector:

  • Test it’s working against a metal object

  • Remove stethoscope/metallic interference from near you and child

  • Position child standing upright or lying flat on bed

  • Sweep from nose to pubis, horizontally across hypocondrium and posteriorly from occiput to sacrum

  • If beep is more than 2cm below the Xiphisternum, indicates that object is beyond gastro-oesophageal junction.

  • If beep is at level of umbilicus or on right side of abdomen, indicates that object is beyond the stomach.