Pediatric Gastrointestinal Foreign Body

  • Etiology: children love to put anything in their mouth and swallow it and the ingestion is usually unwitnessed, is a dynamic process of migration / penetration / reactive inflammation, may be present for a long time
  • Imaging: obtain AP mouth to anus radiograph and use lateral radiograph of foreign body to localize and characterize it, foreign bodies get stuck at cricopharyngeal sling at C6 / aortic arch / lower esophageal sphincter / pylorus of stomach / ileocecal valve
  • Complications: long standing esophageal foreign bodies can cause retropharyngeal soft tissue swelling leading to airway compression and narrowing + esophageal erosion / fistula
  • Note: on AP radiograph a sagitally oriented coin is more likely in the esophagus than in the trachea
  • Imaging of button battery: has beveled edge / halo / double rim on AP view + step off on lateral view while coin does not, two adjacent coins can mimic a button battery
  • Complications of button battery: button battery in esophagus very susceptible to causing injury and must be removed immediately, button battery distal to esophagus is less susceptible to causing injury but it could have caused esophageal injury before it left esophagus, esophageal injuries from button battery include tracheoesophageal fistula / perforation / stricture / aortoenteric fistula
  • Imaging of rare earth magnets: suspect when multiple magnets attract each other or 1 magnet and 1 metallic foreign body attract each other
  • Complications of rare earth magnets: rare earth magnets must be removed immediately as they can cause ulceration / ischemia / obstruction / perforation when two rare earth magnets in adjacent bowel loops attract each other

Radiology Cases of Gastrointestinal Foreign Body

CXR and Upper GI of esophageal foreign body
Lateral spot images from an upper GI show fixed narrowing of the trachea (left + middle) with an esophageal perforation / fistula arising from the anterior wall of the esophagus (right). Endoscopy done earlier in the day removed a set of plastic wheels from a toy car which was felt to have been present for a long time as the esophagus was ulcerated and edematous in the area of perforation.