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reason, rigid endoscopy is still recommended in pediatric patients for

aspirated and ingested foreign bodies.

b. Flexible Endoscopy

Advances in flexible endoscopy with improved instrumentation have

allowed for comparable foreign body retrieval and may be considered in

adults or patients who are not ideal candidates for general anesthesia.

Flexible endoscopy may be used for removal of blunt objects or meat

impaction, but is not recommended for sharp objects due to inability to

sheath the object and protect the mucosa on retrieval. Gastric foreign

bodies are most successfully removed with flexible endoscopes.

4. Postoperative Management

a. Monitoring

Patients, particularly children, should be monitored for approximately 4

hours for fever, tachycardia, or tachypnea.

b. Airway Edema

If airway edema is noted during the case, consider racemic epinephrine

with or without steroids.

c. Reflux Precautions and Medical Therapy

Reflux precautions and medical therapy are prescribed, depending on

the extent of mucosal injury from esophageal foreign bodies.

d. Perforation or Heightened Symptoms

If a perforation is suspected or symptoms worsen, obtain a chest x-ray

immediately postoperatively (see II.D.2.b, Computed Tomography).

F. Prevention and Management of Complications

1. Indications for Antibiotics

Consider using antibiotics for the following conditions:

Aspirated vegetable matter or retained foreign bodies with thick

mucoid secretions.

Esophageal perforation, mediastinitis, or abscess formation.

Patients with underlying pulmonary issues or poor lung compliance.

Broad-spectrum antibiotic selection should include coverage for gram-

negative bacilli and methicillin-resistant

Staphylococcus aureus.

Anaerobe

coverage should be considered for patients with significant periodontal

disease, alcoholism, or foul smelling sputum. Antibiotic coverage may be

adjusted based on culture results and continued for 7 days.