A child swallow a button battery and on radiological imaging studies it is located in the stomach. Which is the next step in management
Swallowed or inhaled foreign bodies Coins are the most frequently swallowed foreign bodies in children. Once beyond the cardia, they are usually passed in a few days. A plain radiograph of the abdomen, chest and neck should establish the site of radio-opaque objects. Oesophageal objects can be removed endoscopically under general anaesthesia. Button batteries must be removed within hours because if they remain in the oesophagus they can perforate into the trachea or aoa. Batteries in the stomach are either removed urgently or followed very closely with repeat x-rays over a couple of days. The need to remove sharp objects depends on their size, the age of the child and their position in the gut. Ingested magnets can cause entero-enteric fistulae when they fix to one another in adjacent loops of bowel. Battery ingestion in older children and young people may be a manifestation of self-harm. Inhaled foreign bodies cause sudden-onset coughing and stridor. If there is worsening dyspnoea or signs of hypoxia then the infant should be given back blows in a head-down position. Abdominal thrusts (Heimlich manoeuvre) can be used in older children. A foreign body is suggested by: a unilateral wheeze, decreased transmitted breath sounds and a hyperinflated lung from air trapping on an expiratory CXR.A rigid bronchoscopy with a ventilating bronchoscope and appropriate optical forceps is needed to assess and remove objects. Ref: Bailey and love 27th edition Pgno: 132
Endoscopic guided retrieval
Open laparotomy and retrieval
Emetics and removal of battery
Assure and repeat X-Ray after 24 hrs
General surgery