Esophageal Foreign Bodies

Poisonings and ingestions tend to occur in younger kids, those less than five years old.

A single button battery can create an electrical current or leak harmful chemicals that can damage or erode through esophageal tissue and cause an aorto-esophageal fistula.

For suspected button battery ingestion, parents should give their child 10 milliliters of honey every 10 minutes on the way to the hospital to minimize tissue damage.

For endoscopic removal of esophageal foreign bodies, the chest should be elevated with a roll so the scope can go down without meeting the posterior esophagus.

If a patient is symptomatic but has a negative x-ray for foreign body, you should still perform endoscopy.

Coca-Cola has a pH of two, while dangerous substances like sodium hydroxide and Drano have pH up to 14.

Alkali ingestions tend to be less painful than acids, so kids will spit out acids because they taste bad, whereas basic substances don't cause the same reaction.

With caustic ingestion, there is a worsening possibility of perforation over the course of a week, requiring close monitoring.

In the first day or two after caustic ingestion, patients can have a reactive injury to the epiglottis causing airway obstruction, which can be life-threatening.

For caustic ingestion management, do not induce vomiting, use neutralizing agents, dilute with milk or water, or use activated charcoal.

Do not place an NG tube after caustic ingestion until the esophagus has been completely characterized, and plan for endoscopy within the first 24 hours.

Diagnosis of esophageal injury is often delayed because clinicians are not looking for it.

Cervical esophageal injuries can be managed less invasively with drainage, and are rarely isolated—often accompanied by airway or vascular injuries.

Management of cervical esophageal injury includes keeping the patient NPO, antibiotics, and drainage if there is an injury.

Surgical management principles for esophageal injury include obtaining adequate exposure, debriding non-viable tissue, performing layered closure, buttressing with muscle (strap muscle or intercostal), and placing adequate tube drainage.