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You ate what? Swallowed foreign bodies
Case presentation
A 4-year-old male presents to the emergency department after his parents witnessed the ingestion of a coin. His mother states that he grabbed one out of her purse that was lying on the ground nearby. The patient is resting comfortably in the room, in no acute distress. His lungs are clear to auscultation, there is no stridor, and he is managing his secretions. His vitals are all within normal limits.
Imaging considerations
Plain radiography
Anteroposterior and lateral x-rays of the neck, chest, and abdomen should be the initial diagnostic choice when there is concern for foreign body ingestion. , This recommendation is regardless of whether the object is thought to be radiolucent or if symptoms indicate a particular location of the foreign body. Radiography will help determine the size, location, and shape of radiopaque foreign bodies and the management plan. Although radiolucent objects may not be seen on plain radiographs, there are secondary signs such as relative radiolucency, air fluid levels, free air, air trapping in lung, bowel obstruction, or soft tissue swelling that can be appreciated.
Computed tomography (CT)
A CT scan should be considered for further evaluation of foreign body ingestion when no foreign body is found on radiographs and the child is exhibiting symptoms such as difficulty breathing, wheezing, or inability to tolerate secretions, or if the likely ingestion has high-risk characteristics (such as a large object [≥25 mm in diameter or >5 cm in length]), concern for radiolucent foreign object ingestion, or a history of esophageal strictures. Although a small radiolucent foreign body could still potentially be missed, CT has been shown to be highly effective at identifying ingested foreign bodies. CT has also been found to be useful in identifying perforation, abscess formation, inflammation, peritonitis, and other complications from foreign body impaction. ,
Upper gastrointestinal series (UGI)
UGI is another useful option for foreign body ingestion, including radiolucent objects that might not appear on plain radiographs. The use of barium is not recommended due to the potential for obscuration if endoscopy is performed afterward. A water-soluble contrast should be used instead.
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