Consultation with the Specialist
Ingestion of Coins and Batteries
Ian R. Neilson MD1
1 Director, Pediatric Surgery, Swedish Medical Center, and Department of Surgery, Group Health Cooperative, Seattle, WA.
Witnessing the ingestion of a foreign body by a toddler is alarming and immediately raises several questions. What are the risks of aspiration and airway obstruction? Where do foreign bodies get stuck? Are investigations necessary in the absence of symptoms? How long can objects be watched at different locations? What complications can result? When should objects be removed and which procedure should be used? When can cathartics or enemas be given safely?
Predisposing Factors
The peak age range for foreign body ingestion is 6 months to 3 years. There are underlying social, developmental, or psychiatric risk factors in up to 30% of cases. Ingestions in older children usually are accidental. Symptoms occasionally can suggest an underlying abnormality such as an esophageal stricture or might be related to a previous surgical procedure such as the repair of an esophageal atresia or a pyloromyotomy for pyloric stenosis. Children who have had esophageal atresia repaired also have associated dysmotility of the distal segment.
The Need For Radiologic Investigations
The nature of the ingested foreign body obviously influences management. Directed questions or a search of the home for missing objects often will reveal the nature of the ingested object. The presence of symptoms such as choking, dysphagia, substernal discomfort, persistent cough, or of physical findings such as drooling mandates a radiologic search for foreign bodies from oropharynx to anus.
