Resident Manual of Trauma to the Face, Head and Neck

Chapter 10: Foreign Bodies and Caustic Ingestion

4. Place Nasogastric Feeding Tubes under Supervision Nasogastric feeding tubes may be placed during endoscopy. Placement without direct supervision may increase the risk of a perforation. 5. Use Imaging a. Radiographic Imaging Radiographic imaging plays a minimal role in initial presentation. A barium esophagram is inadequate to detect mucosal irregularities and motility disturbances, leading to a significant false negative rate. It may be used to rule out a suspected perforation, but should not replace an endoscopic exam, unless the patient presented more than 48 hours after the inciting event. b. Nuclear Medicine Nuclear medicine may be used in detecting esophageal injury after pediatric ingestion. Technetium 99m-labeled sucralfate has high sensitivity and specificity in determining the presence of an esophageal injury, which allows for screening of injuries, but does not determine severity or enable intervention. 6. Consider Endoscopy a. Indications for Endoscopy y y Endoscopy is recommended for any adult having ingested a strong alkali or acid, regardless of the lack of presenting signs or symptoms. y y Pediatric endoscopy can be reserved for children with significant oral burns, dysphagia, or stridor. Studies have shown asymptomatic children were not found to develop sequelae. However, if glucose test tablets or a battery is suspected, the patient should be taken emer- gently to the operating room, despite the absence of symptoms. y y In children who lack a strong history and have only one presenting sign or symptom, the risk of significant injury is low, and endoscopy can be deferred or held, pending the results of a nuclear medicine study. If a technetium 99m-labeled sucralfate study results in positive findings, the patient should undergo endoscopy. b. Timing of Endoscopy In stable patients, upper endoscopy should be performed during the first 24–48 hours after ingestion. The full extent of mucosal injury will not be visible in the first 24 hours. After several days, necrotic tissue sloughs off, the esophageal wall becomes weak, and the patient is at higher risk of perforation during endoscopy or nasogastric tube placement.

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