# Ingestion of Foreign Bodies — GCMD Library living collection

Updated: n/a · 3 episodes · 52 cited statements

## Episodes
### Tools

### In-depth Review
- [Digestive Foreign Bodies: Diagnosis and Management](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776) — podcast · 17:54 · [machine version](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776.md)

### Work-up and Treatment

### Updates
- [Update Course 2021: APSA PDC UPDATES](https://qa.library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412) — video · [machine version](https://qa.library.globalcastmd.com/watch/update-course-2021-apsa-pdc-updates-5412.md)
- [Button Battery Ingestion](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300) — video · 14:28 · [machine version](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300.md)

## Chapters
- [0:01](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=1) Case presentation and initial management of button battery ingestion (Ep 3)
- [2:33](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=153) Complications and follow-up management challenges (Ep 3)
- [4:41](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=281) Epidemiology, pathophysiology, and vascular complications (Ep 3)
- [8:47](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=527) Management of batteries in the stomach and esophageal injury (Ep 3)
- [13:09](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=789) Emerging treatments and summary (Ep 3)
- [0:00](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=0) Introduction and Episode Overview (Ep 1)
- [1:39](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=99) Common Locations and Age Groups for Foreign Body Ingestion (Ep 1)
- [4:21](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=261) Types of Ingested Objects and Clinical Presentation (Ep 1)
- [6:26](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=386) Physical Examination and Initial Imaging (Ep 1)
- [8:11](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=491) Eosinophilic Esophagitis Considerations (Ep 1)
- [9:11](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=551) Button Battery Management (Ep 1)
- [11:50](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=710) Management of Esophageal and Gastric Coins (Ep 1)
- [13:49](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=829) Sharp Object Management (Ep 1)
- [15:32](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=932) Endoscopic Retrieval Techniques (Ep 1)
- [16:54](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=1014) Summary and Key Takeaways (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Esophageal foreign bodies most commonly lodge at three locations: high at the cricopharyngeus, where the aorta crosses over (less common), and at the lower esophageal sphincter (most common retrieval site). — Vince Mkotta (clinical) [Ep 1 · 2:04](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=124)
- The most common age group for foreign body ingestion is 6 months to 6 years (just mobile infants through toddler age range). — Vince Mkotta (epidemiological) [Ep 1 · 3:29](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=209)
- Foreign body ingestion can occur in very young infants, such as when a toddler tries to feed an infant. — Vince Mkotta (clinical) [Ep 1 · 3:29](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=209)
- Coins are by far the majority of ingested foreign bodies. — Todd (epidemiological) [Ep 1 · 4:23](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=263)
- There has been a rash of issues with magnets where older kids pretend to get piercings by putting magnets across their tongue and swallow them by accident. — Todd (epidemiological) [Ep 1 · 4:23](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=263)
- Many patients who swallow small objects never reach specialists because pediatricians appropriately recognize the object is likely to pass in asymptomatic children. — Vince Mkotta (clinical) [Ep 1 · 5:04](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=304)
- Children with esophageal foreign bodies may present with odynophagia (pain with swallowing), intolerance of secretions and drooling, pointing to one spot on their throat, vomiting after trying to swallow, chest pain, or refusal to eat. — Vince Mkotta (clinical) [Ep 1 · 5:42](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=342)
- Physical examination findings are usually unremarkable in children with ingested foreign bodies. — Vince Mkotta (clinical) [Ep 1 · 6:30](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=390)
- Initial imaging for suspected foreign body ingestion should be a two-view abdomen and chest X-ray. — Vince Mkotta (guideline) [Ep 1 · 7:17](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=437)
- The classic teaching that coins in the esophagus appear coronal and coins in the airway appear sagittal on X-ray is not always the case according to published evidence. — Vince Mkotta (clinical) [Ep 1 · 7:17](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=437)
- For radiolucent objects in asymptomatic patients with strong suspicion, a contrast study may be performed if nothing is seen on plain X-ray, though contrast can make endoscopic retrieval more difficult. — Vince Mkotta (clinical) [Ep 1 · 7:17](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=437)
- Workup for eosinophilic esophagitis is warranted when there is family history of the condition or frequent food impactions, strong atopic history (food allergy, asthma, severe eczema, rhinitis), or when objects that should pass easily become lodged. — Vince Mkotta (guideline) [Ep 1 · 8:20](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=500)
- Button batteries are the biggest and most common need for emergent removal of ingested foreign bodies. — Vince Mkotta (clinical) [Ep 1 · 9:19](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=559)
- On X-ray, button batteries classically show a double-edged sign with a step-off, especially on lateral view, though this may not always be visible depending on how long the battery has been present. — Vince Mkotta (clinical) [Ep 1 · 9:19](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=559)
- Esophageal button batteries are treated as emergencies and should be removed within 2 hours in the operating room. — Vince Mkotta (guideline) [Ep 1 · 9:19](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=559)
- When concerned about a button battery, imaging should include the whole neck and chest to rule out a more proximal battery that may have been cut off the film. — Vince Mkotta (guideline) [Ep 1 · 10:44](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=644)
- For gastric button batteries in asymptomatic patients, guidance suggests they can sometimes be observed, but many practitioners retrieve them immediately due to fatal gastric button battery ingestions. — Vince Mkotta (opinion) [Ep 1 · 11:09](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=669)
- If an esophageal coin has been lodged for 24 hours, it can cause significant problems. — Vince Mkotta (clinical) [Ep 1 · 12:09](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=729)
- Esophageal foreign bodies are generally retrieved rather than observed. — Vince Mkotta (guideline) [Ep 1 · 12:09](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=729)
- For short-duration asymptomatic esophageal foreign bodies, patients are frequently admitted overnight with repeat X-ray in the morning; if the object has not moved, it should be retrieved. — Vince Mkotta (guideline) [Ep 1 · 12:45](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=765)
- Relatively large foreign bodies (4 or 5 centimeters) in the stomach may not pass the pylorus and have higher likelihood of requiring retrieval. — Vince Mkotta (clinical) [Ep 1 · 13:21](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=801)
- Round gastric foreign bodies unlikely to cause injury in asymptomatic children can be observed and allowed to pass, with monitoring of stool. — Vince Mkotta (guideline) [Ep 1 · 13:21](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=801)
- Single-sided sharp objects that reach the stomach generally pass through the GI tract without significant injury, with the theory that they flip and go blunt side down. — Vince Mkotta (clinical) [Ep 1 · 13:52](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=832)
- Double-headed sharp objects like toothpicks should be retrieved if at all possible. — Vince Mkotta (guideline) [Ep 1 · 13:52](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=832)
- Open safety pins should be retrieved if reachable. — Vince Mkotta (guideline) [Ep 1 · 13:52](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=832)
- For sharp objects like nails or pins in the stomach, retrieval is attempted if reachable, but once beyond the stomach they are observed for symptoms rather than pursued. — Vince Mkotta (guideline) [Ep 1 · 13:52](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=832)
- When removing an open safety pin, always pull it out with the point facing downward or away; if the point faces toward the mouth, push it down into the stomach first, then grab and pull it backwards. — Todd (clinical) [Ep 1 · 14:51](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=891)
- Very proximal esophageal foreign bodies are very difficult to retrieve with a flexible scope and are preferably removed by surgery or ENT using a rigid scope. — Vince Mkotta (clinical) [Ep 1 · 15:32](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=932)
- Gastroenterology typically uses flexible scopes for all foreign body retrievals. — Vince Mkotta (clinical) [Ep 1 · 15:32](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=932)
- Proximal esophageal foreign bodies can sometimes be removed with a rigid scope or McGill forceps with a protected airway, without needing to place an airway. — Todd (clinical) [Ep 1 · 16:16](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=976)
- The approach to foreign body removal depends on the age of the child, as rigid scopes can reach distally even in two-year-olds. — Todd (clinical) [Ep 1 · 16:16](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=976)
- Button battery ingestions are becoming more frequent, with national data suggesting increasing numbers of emergency department visits. — Dan (epidemiological) [Ep 3 · 0:01](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=1)
- A radiographic ring around the edge of a circular object on X-ray indicates a button battery rather than a quarter. — Dan (clinical) [Ep 3 · 1:30](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=90)
- The Foley catheter technique may work for button battery removal in limited situations when the operating room cannot be accessed quickly and there is short duration of symptoms without likely perforation. — Dan (clinical) [Ep 3 · 2:10](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=130)
- NASPA and the GI group put together criteria and guidelines around management of button batteries with zero input from surgeons. — Mark (guideline) [Ep 3 · 3:44](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=224)
- The guidelines mandate multiple MRIs and watching these patients because of concern for vascular injury. — Mark (guideline) [Ep 3 · 4:05](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=245)
- The number of ED visits for button battery ingestion has doubled according to data from Colorado. — Dan (epidemiological) [Ep 3 · 4:41](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=281)
- The rate of significant complications from button battery ingestion has increased almost sevenfold. — Dan (epidemiological) [Ep 3 · 4:55](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=295)
- 90% of serious outcomes from button battery ingestion occur with 20 millimeter to 25 millimeter batteries. — Dan (epidemiological) [Ep 3 · 5:05](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=305)
- The problematic batteries are lithium batteries that tend to be 3 volt batteries as opposed to 1.5 volt batteries. — Dan (clinical) [Ep 3 · 5:20](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=320)
- The pathophysiology of button battery injury is caustic injury from hydroxide ions that rapidly raise the pH in tissue, not erosion of the battery itself or electricity. — Dan (clinical) [Ep 3 · 5:35](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=335)
- Complications of button battery ingestion include esophageal perforation, stricture, tracheoesophageal fistula, vocal cord paralysis not associated with perforation, and aortoenteric fistula. — Dan (clinical) [Ep 3 · 6:00](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=360)
- Aortoenteric fistula is the most common cause of mortality in button battery ingestion, accounting for 46% of mortalities in the national data bank. — Dan (epidemiological) [Ep 3 · 6:30](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=390)
- Vascular compromise was identified as the etiology in another 29% of mortalities from button battery ingestion. — Dan (epidemiological) [Ep 3 · 6:50](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=410)
- Aortoenteric fistula from button battery ingestion can happen up to 2 weeks post removal of the battery. — Dan (clinical) [Ep 3 · 7:05](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=425)
- A trauma one activation system for button battery ingestions reduced time from hitting the door to hitting the OR from 1.5 hours to less than 30 minutes. (clinical) [Ep 3 · 8:47](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=527)
- The recommendation to scope patients when the battery is in the stomach completely flies in the face of actual recommendations from poison.gov, which say you do not need to do that. — Mark (guideline) [Ep 3 · 9:28](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=568)
- For relatively minor mucosal injury from button battery, no intervention is needed and symptomatic follow-up is appropriate. — Dan (opinion) [Ep 3 · 10:24](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=624)
- For circumferential erosions that look bad from button battery injury, re-scoping to look for stricture formation is appropriate. — Dan (opinion) [Ep 3 · 10:43](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=643)
- If a patient becomes symptomatic after button battery removal, an esophagram should be done to see if they have narrowing or stricture. — Dan (clinical) [Ep 3 · 10:54](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=654)
- If performing endoscopy and capable of removing a battery from the stomach endoscopically, removal is advocated because you are already there. — Dan (opinion) [Ep 3 · 12:27](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=747)
- There is evolving work in animal models using 0.25% acetic acid applied to the area of injury to neutralize caustic damage from button batteries. (clinical) [Ep 3 · 13:34](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=814)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The majority of ingested foreign bodies will eventually make it into the stomach, but esophageal foreign bodies are the primary concern for emergency removal. — Rae Hanke summarizing the discussion [Ep 1 · 1:43](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=103)
- Certain batteries can cause esophageal damage within 2 to 6 hours by causing liquefactive necrosis. — Rod summarizing the discussion [Ep 1 · 10:10](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=610)
- If a magnet is ingested, assume there is more than one magnet present. — Rod summarizing the discussion [Ep 1 · 16:54](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=1014)
- If magnets pass the pylorus, the patient must be watched to ensure the magnets do not stick to each other in a way that compromises the bowel. — Rod summarizing the discussion [Ep 1 · 16:54](https://qa.library.globalcastmd.com/watch/digestive-foreign-bodies-diagnosis-and-management-3776?t=1014)
- Authors of a paper presenting 16 cases recommended getting an MRI study after removal of the battery to look at potential impact on surrounding vasculature. — Dan summarizing the discussion [Ep 3 · 7:25](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=445)
- Authors advocate that patients should be scoped even if the battery is in the stomach because patients had significant esophageal injuries despite the battery passing to the stomach. — Dan summarizing the discussion [Ep 3 · 8:47](https://qa.library.globalcastmd.com/watch/button-battery-ingestion-2300?t=527)

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