Pathway for the Evaluation/Treatment of the Child with Foreign Body Ingestion

Button Battery Ingestion Confirmed By X-Ray
ESOPHAGUS*
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EMERGENT ENDOSCOPIC REMOVAL
Consult: GI, ENT
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Notify OR 4-5444
Transfer to OR IMMEDIATELY
General Surgery Consult (OR back-up)
PCC 4-2100
Stomach/Beyond Stomach
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Consult GI
Evaluate Symptoms
  • Anorexia, vomiting
  • Abdominal pain
  • Fever
  • Magnet co-ingestion
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No Symptoms
Single Battery
No Magnet Co-ingestion
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Battery ≥ 15mm
Battery < 15mm
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Evaluation of Esophagus
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Esophagram
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Abnormal
Normal
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Admit GI
Discharge
  • Confirm ability to po
  • Repeat X-ray 2-3 days until battery passed (PMD or GI)
  • Pt should return sooner if any symptoms
  • Repeat X-ray 10-14 days if not passed (PMD or GI)
  • Pt should return sooner if any symptoms
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Discharge
Symptoms
Multiple Batteries
Magnet Co-ingestion
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Admit GI
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URGENT
ENDOSCOPIC REMOVAL
If object within reach
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Surgical Consult
If object not within reach
ESOPHAGEAL BATTERIES*
  • Serious burns can occur within 2 hrs of ingestion
  • Symptoms may be delayed
  • If mucosal injury is present after removal, observe for delayed complications (esophageal perforation, TEF, vocal cord paralysis, tracheal stenosis, mediastinitis, aspiration pneumonia, perforation into a large vessel)
  • Complications may be delayed weeks, months
BATTERY FACTS
  • Lithium cell batteries are most frequently involved in esophageal injuries
  • Determination of battery diameter prior to removal or passage is unlikely in at least 40% of cases
  • Assume hearing aid batteries are < 12 mm
  • X-ray overestimates the diameter
Posted: July 2013
Authors: B. Sahn, MD, P. Mamula, MD, F. Henretig MD, J. Collins, MD, S. Sobol, MD, C. Ford, MD