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Foreign Body Aspiration
Everything in the library about foreign body aspiration — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Diagnosis & Workup
2 items
A systematic review and meta-analysis of computed tomography in the diagnosis of pediatric foreign body aspiration
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A new article you should know by Cecilia Gigena
"A systematic review and meta-analysis of computed tomography in the diagnosis of pediatric foreign body aspiration"
Authors: Jayson Lee Azzi, Chanhee Seo, Graham McInnis, Matthew Urich
video · Aug 2023
Una revisión sistemática y metanálisis de la tomografía computarizada en el diagnóstico de aspiración de cuerpo extraño pediátrico
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Otro articulo que tenes que conocer por Cecilia Gigena
"Una revisión sistemática y metanálisis de la tomografía computarizada en el diagnóstico de aspiración de cuerpo extraño pediátrico"
Autores: Jayson Lee Azzi, Chanhee Seo, Graham
video · Aug 2023
In-Depth Reviews
1 item
Airway and esophageal foreign bodies: Update Course 2015
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During the 3rd Annual Stay Current in Pediatric Surgery Update Course in 2015, Dr. David Rothstein gives a presentation on esophageal foreign bodies. Dr. Rothstein provides specific cases as examples, focusing on imaging, timing of retrieva
video44:16 · Jan 2019
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Airway and esophageal foreign bodies: Update Course 2015
Aerodigestive foreign bodies present training challenges due to unstandardized treatment, intersection of multiple specialties (pediatric surgery, gastroenterology, ENT), and variable equipment familiarity.
opinionDavid0:02 ↗
There are tens of thousands of ED visits annually for foreign body ingestions; magnet injuries are on the rise, possibly peaking.
host_summaryDavid1:00 ↗
Peak age for foreign body ingestion is 2-3 years, due to distraction while eating, incomplete dentition, and poor swallowing coordination.
host_summaryDavid1:20 ↗
Plain radiography for airway foreign bodies is neither sensitive nor specific; hyperinflation on decubitus films may indicate foreign body but can also be mucus plug or congenital stenosis.
clinicalDavid3:00 ↗
Virtual bronchoscopy by high-resolution CT is emerging for foreign body detection; it is quick but carries radiation exposure.
host_summaryDavid3:30 ↗
If clinical suspicion for airway foreign body is high, bronchoscopy is indicated even with normal or equivocal imaging.
clinicalDavid4:00 ↗
Flexible bronchoscopy via LMA is less invasive than rigid bronchoscopy and appropriate for low-suspicion cases; if foreign body is found, can convert to rigid instrumentation.
clinicalDavid5:00 ↗
The 3-volt 20mm button battery is the key offender in esophageal injuries; higher voltage causes higher rates of electrochemical damage.
host_summaryDavid9:00 ↗
Esophageal tissue damage from button batteries begins within one hour; immediate retrieval is mandatory.
host_summaryDavid9:20 ↗
The double-disc sign on AP radiograph (two concentric circles) is pathognomonic for button battery; lateral X-ray is not required for diagnosis.
clinicalDavid10:20 ↗
After button battery removal from esophagus, bronchoscopy should be performed to assess for tracheal erosion before assuming the airway is intact.
clinicalDavid13:00 ↗
Post-removal management of esophageal battery injury may include esophagography, NG tube placement, and surveillance endoscopy for stricture; steroids peri- and post-operatively may reduce airway swelling.
clinicalDavid14:00 ↗
Aorto-esophageal fistula can occur days to weeks after button battery removal, presenting as sentinel bleed or sudden death; advanced imaging (MRI/CT) may be warranted in high-risk cases.
host_summaryDavid15:00 ↗
Endovascular repair (stent) is the treatment for aorto-enteric fistula in pediatric patients; angiography is performed first to localize the fistula.
clinicalDavid17:00 ↗
The negative (smaller disc) side of a button battery causes the necrosis; the outer disc with the plus sign is the positive terminal.
host_summaryDavid18:00 ↗
For button batteries that reach the stomach: AAP algorithm recommends endoscopic removal if diameter >2.5cm or length >6cm; smaller batteries can be observed.
host_summaryDavid19:00 ↗
Even if a battery reaches the stomach, esophageal evaluation (endoscopy or esophagography) may be warranted because transient esophageal lodgment can cause delayed perforation or fistula.
clinicalDavid20:00 ↗
Once a battery is in the stomach, it is electrically shorted out and poses less immediate risk than in the esophagus.
clinicalDavid22:00 ↗
There is a case report of a battery found in the stomach, observed, and the child later died of aorto-esophageal fistula from erosion at the lower esophageal sphincter.
host_summaryDavid23:00 ↗
Magnet ingestions have increased nine-fold in the last 10 years.
host_summaryDavid25:00 ↗
Single magnet ingestions can be observed; the child should avoid MRI.
clinicalDavid28:00 ↗
Multiple magnets in the stomach that are clearly joined on X-ray can be observed with serial imaging to confirm they pass as a pair.
clinicalDavid28:40 ↗
Multiple magnets in different bowel segments (e.g., one in RUQ, one in LLQ) should be removed operatively due to risk of pressure necrosis and entero-enteric fistula.
clinicalDavid29:40 ↗
Magnets can cause gastro-splenic flexure colonic anastomosis or duodeno-mesenteric anastomosis by eroding through bowel walls.
clinicalDavid31:00 ↗
Thirty percent of coins lodged in the upper esophagus will pass spontaneously within 6-19 hours; 60% of coins in the lower esophagus will pass spontaneously.
host_summaryDavid33:00 ↗
Milwaukee Children's Hospital reported 1200 cases of esophageal coin extraction over 20 years using Foley catheter in the ED by senior residents/fellows, with high success rate, no major complications, and 10-fold cost savings vs. OR.
host_summaryDavid35:00 ↗
Foley catheter extraction of esophageal coins is performed under fluoroscopy: catheter is passed beyond the coin, balloon inflated with contrast, and coin flipped out.
clinicalDavid36:40 ↗
Foley extraction is generally limited to coins lodged <24 hours; if duration is unknown, endoscopic retrieval in OR is preferred.
clinicalDavid37:40 ↗
Rare catastrophic complications of Foley extraction include esophageal or tracheal tear, massive hemoptysis, and need for ECMO.
host_summaryDavid38:40 ↗
Alabama and Indiana groups implemented level-1 trauma activation protocol for button battery ingestions, reducing door-to-OR time from 3 hours to 30 minutes.
host_summaryDavid40:20 ↗
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