Facts About Foreign Objects That Have Been Swallowed
- It is especially children between 6 months and 6 years who swallow foreign object
- In the vast majority of cases, the foreign body passes through the gastrointestinal tract without giving symptoms, this also applies to sharp objects
- If symptoms develop, there is often respiratory irritation, irritability or abdominal pain. In such cases remove the foreign body. This is especially about foreign objects that are stuck
- Certain items such as magnetic toys and small button batteries should always be removed as they can cause a hole in the bowel
- In the case of removal of foreign body, it is most often a binocular examination (endoscopy), but surgery may occur in few cases
It is most often children between six months and six years who swallow foreign bodies. Normally, a foreign body will pass through the digestive tract without causing problems. However, some foreign bodies may become stuck in the oesophagus, and even less often, problems occur further down the gastrointestinal tract.
There are fewer than one percent of all children who have swallowed a foreign body who is having serious problems. It is estimated that almost half of cases of strangled foreign body among children occur without anyone discovering it, and in just as many cases the child develops no symptoms.
A foreign body that passes through the gastrointestinal tract will pass the following organs: throat, oesophagus, stomach ache, duodenum, small intestine, colon and rectum.
Most sharp objects will pass on without complications, even though the risk of complication is slightly greater than with other swollen foreign bodies. Before access to endoscopy (binoculars – flexible tubing that can be passed through the oesophagus and as you can see through), 93-99% of blunt objects passed completely unproblematic through the gastrointestinal tract, and only about 1% required surgical intervention. In endoscopy, foreign matter in the oesophagus and stomach can usually be removed without difficulty.
Today, 10-20% of children who have swallowed a foreign body with endoscopy are treated. The reason why there are so many that are being treated today, compared to earlier, is that button batteries and magnetic toys have become more widespread.
What symptoms can occur?
Foreign bodies that have passed the oesophagus do not usually give symptoms. Children with foreign body that have stuck in the oesophagus can be without symptoms or they may have symptoms that vary from vomiting to respiratory distress with wheezing to general irritability and altered behavior.
What complications can occur?
Complications, as mentioned, are rare. However, in a few, but serious cases, the foreign body may pierce or etch the oesophagus. This is a life threatening condition.
Similarly, a foreign body may pierce the stomach ache or bowel, causing fever, abdominal pain and tenderness. Foreign bodies that get stuck in the oesophagus for a long time can cause poor well-being in the child, cause repeated pneumonia and cause permanent damage to the oesophagus.
If the intestine becomes clogged by a foreign body, it causes inflated stomach, pain and tenderness. The most common places where clogging can occur is in the lower part of the throat, middle third of the oesophagus, lower oesophagus obstruction, at the end of the stomach and in the transition between small intestine and colon.
How can a foreign body be detected?
X-ray is usually the first survey that is being conducted. However, only 2/3 of all foreign bodies can be seen on the X-ray. Foreign objects of wood, plastic, glass, fish and chicken legs can not be seen in X-rays.
However, all children suspected of having swallowed a foreign body should have taken an X-ray of the throat, chest and upper part of the stomach , or a scab (endoscopy) of oesophagus and stomach ache.
Some recommend the countercurrent (where the child should sink a little contrast cry or fluid) if you suspect that the child has a non-X-ray foreign body in the oesophagus. Non-X-ray means that it can not be seen on X-ray.
You can also use CT scan, ultrasound and MRI scan to detect X-ray transparent objects. However, these types of studies are used relatively rarely.
How is a child who has swallowed a foreign body treated?
Foreign body stuck in the oesophagus
If the doctor suspects that a child has a foreign body in the oesophagus but usually has a x-ray, the child should have a binoculars examination, if such examination is available. If endoscopy is not available, your doctor will consider performing the countercurrent x-ray after consulting with a gastrointestinal specialist.
Children who have worn a sharp X-ray-transparent object (eg a fish leg) will first undergo a study where the doctor looks down into the laryngoscopy. If the laryngoscopy is normal and the symptoms persist, endoscopy will be performed.
If the child has small button batteries (such as a calculator or hearing aid), magnetic toys or sharp objects in the oesophagus, these should be removed immediately by an endoscopy.
Most blunt objects in the oesophagus can be observed for up to 24 hours. If the item does not pass into the stomach, it should be removed or if there are food items they can be pushed into the stomach.
Items that have been in the oesophagus for more than 24 hours or of unknown duration should be removed by endoscopy. If the article has been in the oesophagus for more than two weeks, there is a significant risk of damage to the mucous membrane and adjacent organs. Coins are one of the most common items that children sink. The coin is removed by endoscopy.
Foreign body located below the oesophagus
Although 90% of the foreign body that passed the oesophagus will pass through the gastrointestinal tract by itself, it is recommended that sharp objects be removed by endoscopy before passing through the duodenum. Sharp objects that can not be removed by endoscopy should be followed by daily X-rays. The doctor will consider surgery if the item has not moved within three days.
Large objects that have not passed the duodenum should be removed with endoscopes due to increased risk of clogging of the intestine. Some experts recommend surgical removal in children under 1 year when the diameter of the article is over 2 cm or longer than 3 cm.
In children of 1 year or older, objects longer than 3-5 cm may have trouble passing and your doctor will consider removing these by endoscopy. Magnetic toys should always be removed due to the risk of a hole in the intestinal wall.
Small, blunt objects, and objects that do not give symptoms and which are out of reach of endoscopes should be observed. Most items will pass over 4-6 days, but sometimes it may take up to 4 weeks. X-ray objects should be followed by X-rays and, as a parent, keep an eye on whether the item passes out with the baby’s stool.
Any foreign body that has not passed the stomach within 3-4 weeks should be removed by endoscopy. Stupid objects located below the stomach and remain in the same place for more than one week should be removed during surgery. Any foreign body that causes fever, vomiting, abdominal pain or significant symptoms should be removed immediately.
It is necessary to act quickly with children who have swallowed a button battery. This is because there is a risk of fire damage caused by electric current and direct corrosive effect. Burns may occur as early as four hours after the child has taken a button battery.
Button batteries, which remain in the stomach for more than 48 hours, or have a diameter greater than 2 cm, should be removed by endoscopy. If the battery has passed the duodenum, 85% of the batteries will pass uncomplicated through the gastrointestinal tract within less than 72 hours. The child should usually have taken x-ray every 3 to 4. day to follow the passage of the battery until it has expired.
Is there any need for post-check?
It is estimated that two-thirds of the parents fail to detect the object in the stool when it passes out. Therefore, there are some experts who recommend countercurrent x-ray if an X-ray transparent object has not been seen in the stool two weeks after ingestion. However, contrast testing is unnecessary in a child without symptoms that have worn a harmless X-ray transparent object.