Pediatric Esophageal Foreign Body: Possible Role for Digital Tomosynthesis

Pediatric Foreign Body Ingestion: Complications and Patient and Foreign Body Factors

Background: Management of the child who has swallowed a foreign body should be guided by the risk of complication. Objective of the Review: This review discusses the patient and foreign body characteristics most likely to be associated with complications. Discussion: Most swallowed foreign bodies will pass through the GI tract without complication. Children with pre-existing GI tract abnormalities of any sort, or those who swallow higher-risk foreign bodies, are at higher risk. Higher-risk foreign bodies include long, sharp, or pointed objects, button batteries, and small magnets. Nearly any child who presents to an Emergency Department or other acute care setting after foreign body ingestion should undergo plain radiography; other forms of imaging may also be appropriate. Primary care providers may opt for an initial observation period when there is lower risk of complication. Esophageal button batteries should be emergently removed; other esophageal objects should be promptly removed or, if low risk, allowed a brief period to pass spontaneously. Most lower GI tract foreign bodies will pass spontaneously. Prevention, while not always possible, is preferable to management of foreign body ingestion. Conclusions: Management strategies for children who have swallowed foreign bodies can be optimized by considering relevant patient and foreign body factors, and how they contribute to the risk of complication.

Digital tomosynthesis for detection of ingested foreign objects in the emergency department: a case of razor blade ingestion

A 46-year-old schizophrenic male presented to the emergency department (ED) after deliberate ingestion of an undetermined number of open razor blades. Abdominal radiograph revealed one razor blade but raised suspicion of a second blade which was subsequently confirmed by digital tomosynthesis (DTS), seen as two razor blades superimposed upon each other placed at slightly different angles. A careful search was made during endoscopy and the two razor blades were retrieved from the stomach and duodenum, respectively. This case illustrates the use of digital tomosynthesis as a smart, timely, cost-effective, and low-dose alternative to conventional computed tomography (CT) that can be conveniently employed in the ED for foreign body localization.