A child ingests a coin and is brought to the emergency room. X-ray reveals the coin to be lodged in oesophagus. Child is otherwise asymptomatic. What should be done now?
Ans: A >> B (Endoscopic removal after 24 hours >> Immediate endoscopic removal)Ref: Bailey and Lovefs Short Practice of Surgery, 26th edition, pg: 117 and Waltzman ML, Management of Esophageal Coins. Curr Opin Pediatr 2006 Oct;18{5}:571-74Explanation:"Objects found within the esophagus should generally be considered impacted So immediate endoscopic removal is necessary.'"Ref: BaileyIn the symptomatic patient with an esophageal coin, immediate removal via endoscopy is recommended. For the asymptomatic patient with an esophageal coin, current data support expectant management for a period of 12-24 hours with the hope of spontaneous passage and avoidance of general anesthesia and surgical procedure." Ref: Curr Opin PediatrSince the child in the given scenario is asymptomatic, Option A is a better answer than B.Esophageal FB in ChildrenObjects found within the esophagus should generally be considered impacted. So immediate endoscopic removal is necessary.Esophageal impaction of paediatric foreign body are usually seen at 1 of 3 typical locations.1 Cricopharyngeus muscle constriction at 15 cm.Bronchoaortic constriction at 25 cm.Diaphragmatic constriction at 40 cm.The most common site of esophageal impaction is at the Cricopharyngeal constriction (thoracic inlet).About 70% of blunt foreign bodies that lodge in the esophagus are seen at the thoracic inlet.Narrowest part of GIT is cricopharyngeus sphincter. FB lodged at that part wont progress downwards.Impacted button batteries are notorious for rapidly causing local necrosis and should be removed from the esophagus without delay.Blunt foreign bodies located at the Lower Esophageal Sphincter often spontaneously pass within several hours of ingestion.Coins lodged in the upper esophagus can be removed using Magills forceps.RememberIn symptomatic children or in case of Button battery ingestion - Immediate endoscopic removal.In asymptomatic children - Wait for 24 hours - If not passed into stomach - Immediate endoscopic removal.
Endoscopic removal after 24 hours
Immediate endoscopic removal
Push it with Ryles tube into stomach
Wait for 48 hours
Diagnostic Evaluation of the Esophagus