AUTHOR AND EDITOR INFORMATION

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INTRODUCTION

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Background

People with foreign bodies in the gastrointestinal (GI) tract commonly present to the ED for evaluation. Foreign bodies in the upper GI tract are usually swallowed, purposefully or accidentally.

Presentations of patients with GI foreign bodies can range from the patient in extremis to the patient with subtle or chronic findings without a clear history. Most of the literature covering GI foreign bodies is anecdotal, with the exception of some recent studies on esophageal foreign body removal techniques.

Pathophysiology

The entire GI tract can be involved. The oropharynx is well innervated, and patients can typically localize oropharyngeal foreign bodies. Scratches or abrasions to the mucosal surface of the oropharynx can create a foreign body sensation. Chronic foreign bodies or perforations can cause infections in surrounding soft tissues of the throat and neck.

The esophagus is a tubular structure approximately 20-25 cm in length. Patients can usually localize foreign bodies in the upper esophagus but localize them poorly in the lower two thirds of the structure. The esophagus has 3 areas of narrowing: the upper esophageal sphincter (UES), which consists of the cricopharyngeus muscle; the crossover of the aorta; and the lower esophageal sphincter (LES). These areas are where most esophageal foreign bodies become entrapped. Structural abnormalities of the esophagus, including strictures, webs, diverticula, and malignancies, increase the risk of foreign body entrapment, as do motor disturbances such as scleroderma, diffuse esophageal spasm, or achalasia.

Once a foreign body has reached the stomach, it has greater than a 90% chance of passage. Once coins reach the stomach, they have virtually a 100% chance of passage. Objects longer than 6 cm may become entrapped by either the pylorus or the duodenal sweep, and objects larger than 2 cm in diameter also may fail to pass the pylorus. When a foreign body has reached the small bowel, the only structural impediment to passage is the ileocecal valve. Rarely, a foreign body may become entrapped in a Meckel diverticulum.

Mortality/Morbidity

An estimated 1500 deaths occur annually from foreign bodies in the upper GI tract.¹

• Potential complications of oropharyngeal foreign bodies include abrasions, lacerations, and punctures, with associated abscesses, perforations, and soft-tissue infections.
• Esophageal foreign bodies can also cause abrasions, punctures, and perforations, with resultant injuries or infections to surrounding structures, including abscesses, pneumomediastinum or mediastinitis, pneumothorax, pericarditis or tamponade, fistulas, or even vascular injuries to the aorta or pulmonary vasculature. Additionally, button batteries can rapidly create esophageal necrosis.
• Complications from foreign bodies in the stomach and small intestine typically involve perforation and associated infection, including peritonitis.

Sex

In children with swallowed foreign bodies, the incidence in males and females is equal. In adults, the incidence of accidentally swallowed foreign bodies is slightly higher in men than in women, and the incidence of intentionally swallowed foreign bodies is much higher in men than in women.

Age

Patients with foreign bodies in the upper GI tract usually fall into 1 of 3 categories: (1) children, (2) psychiatric patients and prisoners, and (3) edentulous patients.

• Children account for 75-80% of patients with foreign bodies in the upper GI tract, with a preponderance at age 18-48 months.
• The objects involved also differ by group. Children typically ingest objects they pick up and place in their mouths, such as coins, buttons, marbles, crayons, and similar items. In contrast, adults are more prone to ingest food boluses, chicken or fish bones, fruit pits, dentures, or toothpicks. Prisoners and psychiatric patients may present with bizarre objects, including multiple objects.
• The site of entrapment of esophageal foreign bodies also differs with age groups, with about 75% of children having entrapment at the UES and about 70% of adults having entrapment at the LES.

CLINICAL

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History

• Oropharyngeal foreign bodies
• • Patients with oropharyngeal foreign bodies normally present with a foreign body sensation, especially after eating chicken or fish, although a variety of other objects, including toothpicks, may be involved.
  • They may have variable degrees of discomfort, from minor to more severe, such as drooling or an inability to swallow.
  • Rarely, patients may have airway compromise, typically in delayed presentations with subsequent infection or perforation.
  • Patients can usually localize the foreign body sensation in the oropharynx.
• Esophageal foreign bodies
• • Adults with esophageal foreign bodies usually present acutely, with a history of ingestion. A foreign body sensation or vague discomfort in the epigastrium suggests that the foreign body is entrapped at the LES.
  • Dysphagia is the norm in adults. If the obstruction is complete, an inability to handle secretions is common. The classic adult presentation is the person with dentures who has had some alcohol and is eating meat. Incomplete chewing leads to an impaction at the LES. Adults should be asked about the use of dentures, alcohol intake, and circumstances surrounding the ingestion.
  • In children with esophageal foreign bodies, the history may be less clear. As many as 35% of children with esophageal foreign bodies are asymptomatic; the history is given by a parent who has seen the child with an object in his or her mouth and suspects the child might have swallowed it. Such reports must be taken seriously and investigated. Gagging, vomiting, and neck or throat pain are common presentations. Children with chronic esophageal foreign bodies may also present with poor feeding; irritability; failure to thrive; fever; stridor; or pulmonary symptoms, such as repetitive pneumonias from aspiration. Large esophageal foreign bodies at the UES can cause tracheal impingement in children, with resultant stridor or respiratory compromise.
• Stomach/small intestine foreign bodies
• • Patients with foreign bodies in the stomach or small intestine may present with a history of swallowing an object, which has passed through the esophagus.
  • Patients may present with vague symptoms such as fever, abdominal pain, or vomiting.

Physical

• The physical examination typically is not helpful, but the oropharynx, neck, chest, lungs, heart, and abdomen should be carefully examined.
• Occasionally, a foreign body in the oropharynx can be visualized and removed. In cooperative patients, indirect laryngoscopy or fiberoptic nasopharyngoscopy provides better information than a direct examination.
• In children, tracheal compression and stridor suggest a large foreign body at the UES.
• Complete obstructions can cause drooling and the inability to swallow.
• Delayed presentations may be accompanied by signs of infection, including peritonitis.

Causes

The typical cause of swallowed GI foreign bodies is accidental.

• Young children often put any object they find into their mouths and may accidentally swallow them.
• Older children also put smooth objects, such as coins or marbles, in their mouths and may swallow them. However, because their esophagi are greater in diameter than those of young children, foreign body lodgment in this location is less common in older children.
• Children who are abused may present with GI foreign bodies after being forced to swallow objects; however, this is rare.
• The most common cause of GI foreign bodies in adults involves food that does not pass through the esophagus because of underlying mechanical problems.
• In adults, accidental swallowing involves toothpicks, dentures, and other objects.
• Psychiatric patients may swallow a wide variety of objects, including multiple objects, large objects, and bizarre items.
• Prisoners may swallow objects either to hide them from authorities or to seek medical care. In the case of razor blades, they often tape the sharp edge to avoid injury.
• People who smuggle drugs may swallow multiple condoms (usually double wrapped) filled with cocaine or heroin. This is called "body packing," as opposed to "stuffing," which occurs when the patient attempts to elude arrest by swallowing packets of drugs in their possession.

DIFFERENTIALS

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Other Problems to be Considered

Dysphagia
Esophageal carcinoma
Esophageal stricture
Failure to thrive
Intestinal perforation
Odynophagia
Peritonitis
Pneumomediastinum

WORKUP

Section 5 of 11  

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Lab Studies

• Most patients with GI foreign bodies do not require any laboratory studies. Exceptions are patients who present with signs and symptoms consistent with infection or complications, in which case a CBC may be indicated, and patients who require preoperative studies.

Imaging Studies

• Radiography
• • Plain radiographs are indicated for every patient with a known or suspected radiopaque foreign body in the oropharynx, esophagus, stomach, or small intestine. Plain radiographs are also mandated for children in whom any ingestion of a radiopaque foreign body is suspected. Keep in mind, however, that in cases of nonradiopaque foreign bodies, imaging studies rarely have any influence on management, except in delaying endoscopy or CT scanning.
  • In small children, a mouth-to-anus radiograph can be obtained. In older children and adults, posteroanterior (PA) and lateral chest radiographs provide better localization.
  • Radiopaque objects are easily seen and localized on the radiograph.
  • Plain radiographs typically have been used in patients who have swallowed bones, although the yield is low, with only 20-50% of endoscopically proven bones visible on plain radiographs. Xeroradiography does not increase this yield.
  • Coins are usually seen in a coronal alignment on anteroposterior (AP), or frontal, radiographs (see Media files 1-3).
  • If the foreign body is in the trachea, it presents in a sagittal orientation because the tracheal rings are incomplete in the posterior aspect.
  • In adults with food impactions, a plain radiograph may be indicated to search for imbedded bony fragments if techniques, such as LES-relaxing agents or bougienage, are being considered. If endoscopy is used to treat the patient, plain radiographs are not indicated.
• Barium or Gastrografin swallow
• • Barium swallow may be indicated in cases of ingestion of nonopaque foreign bodies, such as toothpicks or aluminum soda can tabs, although CT scanning is a much better imaging modality and should be used as the first choice when available.
  • A barium or Gastrografin swallow, without cotton balls, can sometimes outline the foreign body, but, again, the yield is very low.
  • Barium swallow can be used for food impactions; however, most authorities believe that it adds nothing to the evaluation and delays definitive treatment.
  • Contrast studies are not useful in detecting foreign bodies in the stomach or small intestine.
  • Barium is contraindicated in cases in which esophageal perforation is suspected. Gastrografin may be used if a study is needed.
• CT scanning
• • In one study, CT scanning was superior to plain radiographs for localization and identification of foreign bodies in 83-100% of cases. CT scanning is highly reliable in localizing foreign bodies in the esophagus.^{2, 3}
  • CT scanning is now considered the imaging modality of choice to locate nonradiopaque foreign objects in the oropharynx or esophagus. However, the application is probably unwarranted in every case of acute bone dysphagia, as only a minority (17-25%) of patients who sense a foreign body after eating chicken or fish has a bone present.
  • CT scanning is also the imaging modality of choice in cases of suspected perforation or abscess.
• Metal detectors: Handheld metal detectors have been shown to be accurate in determining if a coin has been swallowed and may be a useful noninvasive screening tool in children with a suspected coin ingestion. However, the specificity of localization is poor, especially in differentiating LES impaction from coins in the stomach.

Procedures

• Endoscopy
• • Emergent endoscopy is indicated for patients whose airway is compromised or who show signs of complications.
  • Urgent endoscopy is indicated for patients who have swallowed aluminum soda can tabs or toothpicks, since these objects are not visible on plain radiographs and both have a relatively high incidence of complications. If the history is clear, proceed to endoscopy; if unclear, CT scanning may be used to confirm the presence of the foreign body before endoscopy.
  • Endoscopy is absolutely indicated for foreign bodies that are sharp, nonradiopaque, or elongated; for multiple foreign bodies; or for possible esophageal injuries.
  • Endoscopy is the most commonly used technique for active management of impacted esophageal foreign bodies. Endoscopy has been traditionally used for the visualization of the esophagus and the removal of foreign bodies.
  • Endoscopy is indicated for patients with foreign bodies in the stomach or proximal duodenum if the foreign bodies are larger than 2 cm in diameter or longer than 5-7 cm or for oddly shaped foreign bodies such as open safety pins.
  • Endoscopy is safe and effective but relatively expensive.

TREATMENT

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Prehospital Care

The patient should be transported in a comfortable position. Patients with airway compromise may need acute airway management. Patients unable to tolerate secretions are often most comfortable in the sitting position, holding a suction catheter that they may use intermittently.

Emergency Department Care

The treatment of patients with suspected foreign bodies can be straightforward in cases such as those that involve ingestions of radiopaque objects that can be easily localized on plain radiographs.

In cases involving suspected oropharyngeal foreign bodies, which usually present with a foreign body sensation, the evaluation and treatment is complicated by the fact that the physical examination is usually unhelpful; only a minority (26% in one study) of patients have any pathology at all as seen on endoscopy, and imaging studies are either unhelpful (plain radiography or barium swallow) or expensive (CT scanning).^{4, 5, 6}

For nonradiopaque foreign objects, plain radiographs are not helpful, and while studies, such as barium swallows or CT scanning, may help to confirm or localize a foreign body, they may only delay definitive treatment.

Because of the broad range of presentations of GI foreign bodies, a tiered approach is appropriate.

• Patients in an unstable condition
• • Patients with airway compromise; drooling; inability to tolerate fluids; or evidence of sepsis, perforation, or active bleeding are considered to be in an unstable condition.
  • Treatment includes airway management as indicated, followed by urgent endoscopy (see Procedures).
  • Patients who have ingested button batteries are considered to be in an unstable condition. The presence of a button battery in the esophagus is a medical emergency because necrosis of the esophageal wall may occur within hours. These button batteries must be expeditiously removed. Button batteries in the stomach can be allowed to pass but must be monitored radiographically to observe for disruption of the battery. Follow-up radiographs are needed in 24-48 hours. If the battery is still in the stomach, endoscopic removal is indicated.
  • Patients who are drooling may be more comfortable holding a suction catheter and using it as needed.
• Patients in a stable condition
• • For patients who sense an oropharyngeal foreign body, perform direct and indirect oropharyngeal examination and fiberoptic nasopharyngoscopy, if available in the ED; remove any visualized foreign bodies.
  • Radiographically localize radiopaque objects. If the foreign body is sharp, elongated (>5 cm in esophagus, >6 cm in stomach or small intestine), or multiple in number, refer for endoscopy. Sharp objects, such as pins, razor blades, toothpicks, and chicken bones, should be removed endoscopically on an urgent basis because up to 35% of these sharp objects perforate the bowel wall if not removed. Most smaller, sharp foreign bodies, such as straight pins, transit the GI tract without difficulty, as the peristaltic action carries the blunt end first (see Media file 4); however, many authorities recommend endoscopic removal for these as well.⁷ If the foreign body is smooth or blunt, consider the following modalities (endoscopy is discussed in Procedures; the other 3 techniques are discussed in detail below):
  • • Endoscopy (see Procedures)
    • Foley catheter removal
    • Bougienage
    • Sphincter relaxation if lodged at LES
  • For patients whose history strongly suggests an ingestion of a nonopaque foreign body such as a plastic object, toothpick, or aluminum soda can tab, consider CT scanning and refer for endoscopy. When the history is less clear about the definitive swallowing of a nonradiopaque foreign body, obtain CT scanning and refer for endoscopy if the foreign body is localized in the oropharynx or esophagus.
  • Button batteries in the stomach can be allowed to pass but must be followed radiographically to observe for disruption of the battery. Follow-up radiographs are needed in 24-48 hours. If the battery is still in the stomach, endoscopic removal is indicated.
  • Smooth foreign bodies, such as coins or marbles, almost always transit the GI tract without any difficulties. Coins lodged in the distal esophagus of healthy children spontaneously pass into the stomach in up to 60-80% of cases, usually within several hours of presentation.
  • Note that the use of meat tenderizer is contraindicated in patients with food boluses at the LES, as meat tenderizer may cause necrosis of the esophagus.
  • People who body pack, those who ingest carefully wrapped packets of drugs, such as heroin or cocaine, should be admitted for observation. Whole-bowel irrigation is frequently used to aid passage. Endoscopy is generally avoided because instrumentation of the packets may result in rupture.
• Foley catheter removal
• • Foley catheter removal is another widely used technique for the removal of single, smooth, blunt, radiopaque foreign bodies.
  • Foley catheter removal is contraindicated in patients with foreign bodies that have been present for more than 72 hours, those with a history of esophageal disease or surgery, those who are experiencing respiratory distress, and those who are uncooperative.
  • This procedure is performed under fluoroscopy with immediate availability of emergency airway equipment and personnel capable of emergency airway management.
  • In this procedure, the patient is placed in a head-down position, and a #12-#16 Foley catheter is passed orally past the foreign object under fluoroscopic guidance. The balloon is inflated, and the catheter is pulled out with the foreign body. The success rate for this procedure has been reported as 85-100%. Complications, including epistaxis, dislodgment of the foreign body into the nose, laryngospasm, hypoxia, and aspiration, have been reported at rates of 0-2%.
  • Foley catheter removal should be attempted only by those familiar with its use. Until ED personnel become comfortable with this procedure, it should be performed under controlled conditions with immediate backup available for complications.
• Bougienage
• • Smooth esophageal foreign bodies, such as coins, lodged at the LES in children have been advanced successfully into the stomach by using bougienage.
  • Indications for this procedure are a smooth foreign body, lodged less than 24 hours, with no underlying esophageal disease or respiratory distress.
  • Dilator size is selected according to the patient's age; the dilator is advanced gently through the mouth and esophagus to the stomach with the child in a sitting position, essentially in the same manner as is used in passing a nasogastric tube. Often, topical anesthesia is used for the oropharynx.
  • A repeat radiograph is used to confirm passage into the stomach.
  • Published success rates for this procedure are 83-100%, and complication rates in limited studies are 0%.^{8, 9, 10, 11}
• Relaxation of the lower esophageal sphincter
• • Foreign bodies lodged at the LES can be managed by relaxation of the LES, although in some studies, success rates associated with this technique are no greater than those associated with watchful waiting.
  • Typically, glucagon is used, with or without a gas-forming compound. The patient is administered 1-2 mg of glucagon intravenously (0.02-0.03 mg/kg in children, not to exceed 0.5 mg) followed by ingestion of E-Z Gas mixed with 240 mL of water. The use of carbonated beverages if E-Z Gas is not available in the ED has been reported.
  • The published success rates for this procedure range from 12-50%, which may not be any better than spontaneous passage with no interventions, especially with coin ingestions in children.¹²
  • Nitrates, such as sublingual nitroglycerin and nifedipine, have been used less widely; a risk involved with this procedure is creating significant hypotension in the patient.
  • This procedure does not work in patients with structural abnormalities.
• Cost is always a consideration when selecting a procedure. In one study, endoscopy averaged $2700; Foley catheter removal, $660; and bougienage, $614.¹³
• If the workup is negative for a foreign object, discharge the patient with analgesics as needed and refer for follow-up in 24 hours. If the patient is still symptomatic at recheck, refer for endoscopy.
• Esophageal coins: Four generally broadly accepted approaches to management of esophageal coins in children are as follows: endoscopic removal, Foley catheter removal, bougienage, and "watchful waiting," which is based on the fact that up to 80% of coins at the LES will pass spontaneously within 24-48 hours with no interventions. The watchful waiting approach is used only in patients with single coins, who are able to handle secretions with no difficulties, and who have no pain or distress, and no stridor or drooling. After ascertaining location of the coin at the LES, the child is discharged with follow-up arranged in 24 hours for repeat radiography. Each of the 4 modalities is relatively site or regionally accepted based on training and experience of local practitioners. 

MEDICATION

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Smooth-muscle relaxation agents may be used to relax the LES, thereby allowing the passage of foreign bodies lodged in this location.

Drug Category: Gastrointestinal agents

These agents may improve peristaltic activity in the GI tract.

FOLLOW-UP

Section 8 of 11  

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Further Inpatient Care

• Patients in an unstable condition including drooling, stridor, inability to handle secretions, signs of perforation or bleeding:
• • Manage airway and refer for urgent endoscopy.
  • Patients with button batteries in the esophagus are considered to be in an unstable condition.
• Patients in a stable condition
• • Oropharyngeal foreign bodies: If ED evaluation is negative for a foreign body, discharge with follow-up, generally with an ear, nose, and throat (ENT) specialist in 24 hours. If ED evaluation is positive for a foreign body that cannot be removed under direct visualization, refer to an ENT specialist for endoscopy.
  • Esophageal foreign bodies: In cases that involve sharp, elongated, or multiple foreign bodies, refer the patient to a gastroenterologist for urgent removal. For patients with entrapped smooth foreign bodies, if treatment in the ED does not result in removal or passage into the stomach, refer to a gastroenterologist for endoscopy. In children with coins at the LES, watchful waiting may be used if the patient is stable, with follow-up and repeat radiography in 12-24 hours; if the coin has not advanced to the stomach by that time, refer for endoscopy.
  • Stomach or small intestine foreign bodies: Patients with smooth, blunt objects that are less than 2 cm in width or 6 cm in length should be discharged to home. Serial radiographs are generally not needed. Instruct patient to return if fever, vomiting, or abdominal pain occurs. Those with sharp or large foreign bodies in the stomach should be referred to a gastroenterologist for endoscopic removal. Serial radiographs are indicated for sharp or large foreign bodies in the duodenum or small intestine. In most cases, refer to a surgeon or gastroenterologist in 24 hours for follow-up examinations, radiographs, and intervention.
  • People who body pack should be admitted to a monitored setting and are typically treated with whole-bowel irrigation or observation alone. If they develop signs of drug toxicity, this indicates rupture of one of the drug-containing packages and mandates resuscitative measures and surgical consultation for possible surgical removal.

Further Outpatient Care

• For adults with resolved esophageal foreign bodies, referral to a gastroenterologist in 24-72 hours is mandatory because a large percentage of these patients have underlying structural abnormalities, including malignancies, and follow-up endoscopy is needed.
• In children with resolved esophageal foreign bodies, no follow-up is needed.

Complications

• Oropharyngeal foreign bodies - Esophageal or pharyngeal scratches, abrasions, lacerations, or perforations; retropharyngeal abscess; soft-tissue infection or abscess
• Esophageal foreign bodies - Mucosal scratches or abrasions; esophageal necrosis; retropharyngeal abscess; esophageal stricture; esophageal perforation leading to paraesophageal abscess, mediastinitis, pericarditis/tamponade, pneumothorax, pneumomediastinum, tracheoesophageal fistula, and vascular injuries, including aortoesophageal fistulas
• Stomach and small intestine foreign bodies - Small-bowel obstruction; perforation with intra-abdominal infection, peritonitis, and sepsis

MISCELLANEOUS

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Medical/Legal Pitfalls

• Toothpicks, when ingested, have a high risk of complications, and persons with this foreign body should be treated with early endoscopy.
• Patients with button batteries in the esophagus are at a high risk for esophageal necrosis. Urgent removal is mandatory.
• Aluminum soda can tabs are not visualized on plain radiographs and are frequently entrapped in the esophagus. Early endoscopy is indicated if the ingestion is definitive; if unclear, localization of the soda can tab can be visualized via CT scanning.
• Foley catheter removal of esophageal foreign bodies should be performed only in carefully selected patients and only by those who are experienced in its use who have emergency airway equipment immediately available.
• Children with esophageal foreign bodies may present with minimal or no symptoms. Evaluate all children who may have swallowed an object.
• Children with chronic esophageal foreign bodies may present with vague symptoms such as irritability, poor feeding, or pulmonary symptoms. Maintain a high index of suspicion for an esophageal foreign body.

MULTIMEDIA

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Media file 1:  Coin (quarter) lodged at the level of the cricopharyngeus muscle.
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Media type:  X-RAY

Media file 2:  Coin lodged at the level of the aortic crossover.
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Media type:  X-RAY

Media file 3:  Coin lodged at the lower esophageal sphincter.
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Media type:  X-RAY

Media file 4:  A screw in the stomach; peristaltic action will carry the screw through the GI tract with the blunt end (head) leading and the sharp end trailing.
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Media type:  X-RAY

REFERENCES

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1. Webb WA. Management of foreign bodies of the upper gastrointestinal tract. Gastroenterology. Jan 1988;94(1):204-16. [Medline].
2. Palme CE, Lowinger D, Petersen AJ. Fish bones at the cricopharyngeus: a comparison of plain-film radiology and computed tomography. Laryngoscope. Dec 1999;109(12):1955-8. [Medline].
3. Eliashar R, Dano I, Dangoor E, Braverman I, Sichel JY. Computed tomography diagnosis of esophageal bone impaction: a prospective study. Ann Otol Rhinol Laryngol. Jul 1999;108(7 Pt 1):708-10. [Medline].
4. Braverman I, Gomori JM, Polv O, Saah D. The role of CT imaging in the evaluation of cervical esophageal foreign bodies. J Otolaryngol. Aug 1993;22(4):311-4. [Medline].
5. Sundgren PC, Burnett A, Maly PV. Value of radiography in the management of possible fishbone ingestion. Ann Otol Rhinol Laryngol. Aug 1994;103(8 Pt 1):628-31. [Medline].
6. Lue AJ, Fang WD, Manolidis S. Use of plain radiography and computed tomography to identify fish bone foreign bodies. Otolaryngol Head Neck Surg. Oct 2000;123(4):435-8. [Medline].
7. Davidhoff E, Towne JB. Ingested foreign bodies. NY State Med J. 1975;75:1003-7.
8. Kelley JE, Leech MH, Carr MG. A safe and cost-effective protocol for the management of esophageal coins in children. J Pediatr Surg. Jul 1993;28(7):898-900. [Medline].
9. Calkins CM, Christians KK, Sell LL. Cost analysis in the management of esophageal coins: endoscopy versus bougienage. J Pediatr Surg. Mar 1999;34(3):412-4. [Medline].
10. Bonadio WA, Jona JZ, Glicklich M, Cohen R. Esophageal bougienage technique for coin ingestion in children. J Pediatr Surg. Oct 1988;23(10):917-8. [Medline].
11. Emslander HC, Bonadio W, Klatzo M. Efficacy of esophageal bougienage by emergency physicians in pediatric coin ingestion. Ann Emerg Med. Jun 1996;27(6):726-9. [Medline].
12. Metha D, Attia M, Cronan K. Glucagon for esophageal coin dislodgement in children: a prospective, double-blind, placebo-controlled study. Acad Emerg Med. Feb 2001;8(2):200-3. [Medline].
13. Conners GP. A literature-based comparison of three methods of pediatric esophageal coin removal. Pediatr Emerg Care. Apr 1997;13(2):154-7. [Medline].
14. Al-Haddad M, Ward EM, Scolapio JS, Ferguson DD, Raimondo M. Glucagon for the relief of esophageal food impaction does it really work?. Dig Dis Sci. Nov 2006;51(11):1930-3. [Medline].
15. Bassett KE, Schunk JE, Logan L. Localizing ingested coins with a metal detector. Am J Emerg Med. Jul 1999;17(4):338-41. [Medline].
16. Butterworth JR, Wright K, Boulton RA, Pathmakanthan S, Goh J. Management of swallowed razor blades-retrieve or wait and see?. Gut. Apr 2004;53(4):477, 486. [Medline].
17. Cheng W, Tam PK. Foreign-body ingestion in children: experience with 1,265 cases. J Pediatr Surg. Oct 1999;34(10):1472-6. [Medline].
18. Conners GP, Chamberlain JM, Ochsenschlager DW. Conservative management of pediatric distal esophageal coins. J Emerg Med. Nov-Dec 1996;14(6):723-6. [Medline].
19. Conners GP, Chamberlain JM, Ochsenschlager DW. Symptoms and spontaneous passage of esophageal coins. Arch Pediatr Adolesc Med. Jan 1995;149(1):36-9. [Medline].
20. Conway WC, Sugawa C, Ono H, Lucas CE. Upper GI foreign body: an adult urban emergency hospital experience. Surg Endosc. Mar 2007;21(3):455-60. Epub 2006 Nov 28. [Medline].
21. Dashan AH, Kevin Donovan G. Bougienage versus endoscopy for esophageal coin removal in children. J Clin Gastroenterol. May-Jun 2007;41(5):454-6. [Medline].
22. Eisen GM, Baron TH, Dominitz JA, et al. Guideline for management of ingested foreign bodies. Gastrointest Endosc. May-Jun 2002;55(7):802-6. [Medline].
23. Guitron A, Adalid R, Huerta F. [Extraction of foreign bodies in the esophagus. Experience in 215 cases]. Rev Gastroenterol Mex. Jan-Mar 1996;61(1):19-26. [Medline].
24. Hergan K, Kofler K, Oser W. Drug smuggling by body packing: what radiologists should know about it. Eur Radiol. Apr 2004;14(4):736-42. Epub 2003 Oct 18. [Medline].
25. Hess GP. An approach to throat complaints. Foreign body sensation, difficulty swallowing, and hoarseness. Emerg Med Clin North Am. May 1987;5(2):313-34. [Medline].
26. Louie JP, Alpern ER, Windreich RM. Witnessed and unwitnessed esophageal foreign bodies in children. Pediatr Emerg Care. Sept 2005;21(9):582-5. [Medline].
27. Macpherson RI, Hill JG, Othersen HB. Esophageal foreign bodies in children: diagnosis, treatment, and complications. AJR Am J Roentgenol. Apr 1996;166(4):919-24. [Medline].
28. Miller RS, Willging JP, Rutter MJ, Rookkapan K. Chronic esophageal foreign bodies in pediatric patients: a retrospective review. Int J Pediatr Otorhinolaryngol. Mar 2004;68(3):265-72. [Medline].
29. Schunk JE, Harrison AM, Corneli HM. Fluoroscopic foley catheter removal of esophageal foreign bodies in children: experience with 415 episodes. Pediatrics. Nov 1994;94(5):709-14. [Medline].
30. Smith SA, Conners GP. Unexpected second foreign bodies in pediatric esophageal coin ingestions. Pediatr Emerg Care. Aug 1998;14(4):261-2. [Medline].
31. Soprano JV, Fleisher GR, Mandl KD. The spontaneous passage of esophageal coins in children. Arch Pediatr Adolesc Med. Oct 1999;153(10):1073-6. [Medline].
32. Stack LB, Munter DW. Foreign bodies in the gastrointestinal tract. Emerg Med Clin North Am. Aug 1996;14(3):493-521. [Medline].
33. Traub SJ, Kohn GL, Hoffman RS, Nelson LS. Pediatric "body packing". Arch Pediatr Adolesc Med. Feb 2003;157(2):174-7. [Medline].
34. Waltzman ML. Management of esophageal coins. Curr Opin Pediatr. Oct 2006;18(5):571-4. [Medline].
35. Weiland ST, Schurr MJ. Conservative treatment of ingested foreign bodies. J Gastrointest Surg. May-Jun 2002;6(3):496-500. [Medline].

Article Last Updated: Jul 19, 2007