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

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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:

Patients with multiple medical problems who are less than ideal

surgical candidates.

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.