Resident Manual of Trauma to the Face, Head and Neck

Chapter 10: Foreign Bodies and Caustic Ingestion

b. Computed Tomography CT studies may confirm or help identify a radiolucent foreign body, such as a food bolus or a fish or chicken bone. Although CT imaging is not required, it may be useful in specific patients: y y Patients with multiple medical problems who are less than ideal surgical candidates. y y Patients who present with worsening symptoms beginning days prior to presentation to rule out submucosal migration of the foreign body or potential abscess formation. E. Management If the patient is in respiratory distress, oxygen, heliox, and either intubation or an emergent surgical airway may be needed before the object can safely be removed. 1. Special Considerations Although some esophageal foreign bodies may be monitored for possible passage, some foreign bodies require emergency removal. a. Disk Battery If a disk battery becomes lodged in the esophagus, immediate action is required. Corrosive material that leaks from the battery will lead to (1) esophageal mucosal injury within 1 hour and (2) perforation with possible mediastinitis in as little as 4–6 hours. b. Pills Some pills are irritating to esophageal mucosa. If the impacted pill falls into this category, endoscopy with removal of all pill remnants is recommended. c. Sharp or Pointed Objects These objects may cause more trauma as they transverse the aerodi- gestive tract. To remove them without causing further damage, disen- gage the point from the mucosa by moving it distally, and sheathe the point within the endoscope during extraction.

2. Endoscopy a. Indications i. Bronchoscopy

Patients with a confirmed foreign body in the airway or a suspicious history, despite negative radiographic imaging, should undergo bronchoscopy.

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Resident Manual of Trauma to the Face, Head, and Neck