0071643192.pdf

Foreign bodies that pass the pylorus are rarely problematic and can be managed
expectantly. Button batteriesare problematic due to the alkali contents and
may cause liquefaction necrosis or rupture of the esophagus within 4–6 hours.

SYMPTOMS

■ Children may present with signs of acute airway obstruction.
■ Other symptoms include retching or vomiting, coughing or gagging.
■ Retrosternal pain may be a sign of esophageal perforation.

EXAM

■ Examine the neck for crepitus or subcutaneous air, suggesting esophageal
perforation.
■ Examine the abdomen for peritonitis indicative of GI perforation.

IMAGING

■ CXR and soft-tissue lateral neck to identify radio-opaque objects.
■ AP view: Coins in the esophagus will be seen in the coronal plane
(see Figure 11.1).
■ Lateral view: Coins in the trachea will be seen in the sagittal plane.
■ CT scan is better than plain films for locating the foreign body.

TREATMENT

■ Direct laryngoscopy if airway compromise and retrieval of foreign body
■ Endoscopy for diagnosis and treatment
■ Button batteries in the esophagus require emergent removal secondary to
alkali contents. Once in the stomach, they can be allowed to pass but close
follow-up is warranted because if they do not pass in 48 hours, endoscopic
removal is indicated.
■ Smooth objects <5 cm (length) and <2 cm (width) will usually pass
spontaneously.
■ Food boluses may be removed via endoscopy or pharmacologically with
nitroglycerin or nifedipine to relax the sphincter; IV glucagon may also be
used to expel food boluses. Proteolytic enzymes such as papain are no
longer recommended.
■ Sharp objects, eg, razor blades, need to be removed via endoscopy to prevent
perforation.

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

TABLE 11.2 Dysmotility Syndromes

OROPHARYNGEALDYSPHAGIA ESOPHAGEALDYSPHAGIA

Etiology Neurological lesions Motility or obstruction

Differential CVA, multiple sclerosis, Parkinson Achalasia, esophageal spasm, obstructions (tumors),

disease, myasthenia gravis, neuropathy strictures

Presentation Gagging and drooling, liquids more Chest pain, food sticking, painful swallowing, solids

difficult than solids worse than liquids

Treatment Swallow evaluation Spasm may be treated with Ca channel blockers or

nitrates to relax smooth muscle. Achalasia may need

esophageal dilatation as do strictures.