Visual Diagnosis: Button versus Battery: Foreign Body Ingestions in Pediatrics

Joran Clute; Teresa Frey; Jennifer Reed

doi:10.1542/pir.2017-0263

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Joran Clute, MD*
Teresa Frey, DO^†
Jennifer Reed, MD, FAAP^†

^*Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
^†Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sanford Children’s Hospital, Sioux Falls, SD

AUTHOR DISCLOSURE
Drs Clute, Frey, and Reed have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 3-year-old girl is brought to the emergency department by her mother with a 1 hour history of sudden-onset abdominal pain and drooling. The child frequently places objects in her mouth, and her mother believes that she has swallowed a coin, although the event was unwitnessed. Her pain occurred intermittently before presentation.

On physical examination she is in no acute distress. Her abdominal examination is significant for epigastric tenderness. Her vital signs are as follows: pulse, 100 beats/min; respiratory rate, 26 breaths/min; and blood pressure, 109/56 mm Hg.

An anteroposterior abdominal radiograph (Fig 1) shows a radiopaque 2.5-cm round object in the distal esophagus; the appearance is consistent with a coin. After the initial radiograph she vomits twice; both pain and drooling resolve. She is transferred by private vehicle to an outside hospital for an esophageal foreign body removal by endoscopy (esophagogastroduodenoscopy). On arrival, a repeated abdominal radiograph is normal, with no foreign body visible. An oral challenge in the emergency department results in severe abdominal pain.

Figure 1.

Abdominal radiograph significant for a 2.5-cm round radiopaque foreign body with a double …