Foreign Body Ingestion — Food Impaction Suspected by History and PE — Clinical Pathway: Emergency, ICU and Inpatient

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

Main Pathway
Foreign Body
Ingestion Pathway
Food Impaction
Suspected by History and Physical Exam
No History of Upper GI Tract Surgery
History of Upper GI Tract Surgery
Mild/Moderate Symptoms
Severe Symptoms
Consult
  • General Surgery
  • ENT, GI after General Surgery Consult
    as indicated
  • Food Impaction
    Screening Radiographs
  • Use ED FB order set
    1. AP chest, abdomen prior to Omnipaque
    2. Patient to drink 50 mL Omnipaque as tolerated
    3. AP chest, abdomen
      after Omnipaque
  • Consult GI and ENT to determine:
    • Need for additional imaging
    • Urgency of removal
    • Admitting service:
      • Proximal, mid-esophagus — ENT
      • Distal esophagus — GI
Symptoms Resolved
Partial Obstruction
Complete Obstruction
  • EDECU vs. Inpatient
  • Consider fluoroscopic esophagram
  • OR as indicated
  • Emergent OR
  • vs.
  • Admit for urgent OR in a.m.
Discharge
  • Expedited outpatient GI follow-up
    • High incidence of underlying esophageal pathology
      (stricture, achalasia, eosinophilic esophagitis)