What Is It?
Young children and, sometimes, older children and adults may swallow toys, coins, safety pins, buttons, bones, wood, glass, magnets, batteries or other foreign objects. These objects often pass all the way through the digestive tract in 24 to 48 hours and cause no harm.
But problems may arise when objects are stuck for a long time, are sharp, or contain corrosive materials. Complications can include tears in the esophagus (the tube that connects the mouth and stomach), movement of the object into the tissue of the esophagus, and infection. Small magnets can pose a special problem. If more than one is swallowed, they can stick together and erode through tissue.
Three areas of the esophagus are the most likely places for objects to lodge:
At the level of the collarbones (clavicles) — the most common place
At the center of the chest
Just before the esophagus meets the stomach, near the bottom of the rib cage
Objects also may get stuck in any part of the esophagus that has been injured previously.
If the object gets caught in the esophagus, it can cause:
Inability to swallow or painful swallowing
Chest pain or neck pain
Objects also can become trapped in the intestine or can tear the intestinal walls. The result can be vomiting, abdominal pain, abnormal bowel sounds and dark stools that contain blood.
After your doctor examines your child and asks about his or her recent medical history, the doctor may order a chest X-ray to help show where the object is. Some things cannot be seen with an X-ray. If the X-ray does not show the object, but the symptoms and circumstances still suggest that an object is stuck in the esophagus, the child may need a computerized tomography (CT) scan, or other radiologic tests.
Most objects that do not cause symptoms will pass through the digestive tract in one or two days without causing harm.
Keep all small objects such as coins, pins, magnets, small toy pieces and batteries away from young children, especially those younger than age 3.
If your child has swallowed a foreign object, call your doctor for advice, and:
Do not try to make the child vomit.
Do not panic.
Do not assume that surgery is necessary. Most objects pass through the digestive tract without complications. Surgery for removing foreign objects is not common.
Do not forcefully remove the object. This can cause further injury.
There are several ways for a doctor to remove a lodged object:
An esophagoscope, a telescope-like instrument used to look into the throat and upper gastrointestinal tract, can be either rigid or flexible.
Rigid esophagoscopes make it easier to look at the esophagus and have an almost-perfect success rate for removing objects, because they give the doctor a high degree of control. The procedure is more expensive than other treatments, however, and must be done in an operating room under general anesthesia. The child is intubated to help him or her breathe. The telescope locates the object, a grasper then removes the object, and the doctor uses the telescope again to see if there has been any injury to the esophagus.
Flexible esophagoscopy can be done without intubation and with sedation rather than general anesthesia. This procedure is most useful for removing objects from the middle and lower esophagus, the stomach and the upper part of the small intestine. The view through a flexible esophagoscope is not as clear as with a rigid esophagoscope.
In this procedure, the balloon catheter, a thin tube with an inflatable tip, is passed through the nose or mouth and down the esophagus until it is beyond the object. The balloon is then inflated and the catheter pulled out, bringing up the object ahead of the balloon. The technique also can be used to push the object into the stomach, where it can then pass through the digestive tract on its own.
This technique is becoming more popular. However, because the object is viewed on an X-ray rather than directly, the doctor may find it harder to detect damage to the esophagus. Also, because your child is awake throughout the procedure, he or she may become restless, agitated or distressed. This method can be used only if the object is smooth and has been lodged for no more than 72 hours, and if your child can remain calm during the procedure.
If there are difficulties during this procedure or blood is seen, the doctor may need to perform esophagoscopy to determine if there are any injuries to the esophagus.
Waiting 24 Hours
If the object is smooth and is already in the lowest part of the esophagus, your doctor may suggest watchful waiting. An X-ray will be taken 24 hours after your child has swallowed the object. If the object has passed into the stomach, your doctor will ask you to watch to be sure it comes out. If the X-ray shows that the object is still in the esophagus, one of the first three methods described above can be used to remove it.
When To Call a Professional
If your child swallows a battery, contact your doctor immediately, even if your child has no symptoms. The doctor may want to take an X-ray to see where the battery is located and to make sure that it does not become lodged in the digestive tract.
If your child has swallowed something sharp, such as a piece of glass or an open safety pin, contact your doctor even if your child has no symptoms. Sharp objects sometimes can injure the esophagus, stomach or intestines.
If your child has swallowed a smooth object, such as a coin or a small stone, and has no symptoms, contact your doctor to decide the best course of action. You may be able to wait and see if the object passes through the digestive tract on its own. If more than 24 to 48 hours pass and you do not see the object in the toilet or in your child's diaper, or if your child begins experiencing symptoms of a lodged object, contact your doctor.
In most cases the outlook is excellent; the object will pass on its own or can be removed without complications.
Complications from esophagoscopy can include bleeding, tears in the esophagus or complications from the anesthesia. Complications of the balloon catheter technique include vomiting, short-term blockage of the airway and injury to the esophagus. However, these complications are rare.
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