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Chapter 10: Foreign Bodies and Caustic Ingestion
2. Pulmonary
a. Atelectasis
Atelectasis is usually asymptomatic and will resolve with patient
mobility or incentive spirometer.
b. Pneumonia
Pneumonia may be the presenting symptom or may develop a few days
following removal of the foreign body. Treat with antibiotic coverage as
noted in I.F, above. If the patient’s symptoms do not improve with
adequate therapy, a missed second foreign body should be considered.
c. Bleeding
Bleeding is usually from mucosal trauma or granulation tissue. This is
often self-limiting. In rare instances, vessel erosion may lead to a
significant bleed, requiring urgent thoracic surgery intervention.
d. Pneumothorax or Pneumomediastinum
Pneumothorax or pneumomediastinum is usually from a small perfora-
tion in the airway that heals spontaneously and does not require further
intervention. Symptomatic patients may be treated with oxygen and
serial chest x-rays. If the pneumothorax or pneumomediastinum
increases in size or is large on initial identification, a thoracic surgery
consult should be called for further intervention.
3. Esophageal
a. Bleeding
Bleeding is usually from direct mucosal trauma and is self-limiting.
Consider proton pump inhibitors and/or H2 blockers to prevent further
injury to the damaged mucosa.
b. Esophageal Perforation
y
y
Early recognition and management of esophageal perforations have
decreased the mortality rate from 60 percent to 9 percent from
complications, such as a retroesophageal abscess or mediastinitis.
y
y
Cervical subcutaneous emphysema, fever, tachycardia, tachypnea,
and increased pain may all be early signs of a perforation.
y
y
If a small esophageal perforation is suspected intraoperatively, place
a nasogastric tube and perform a barium swallow or gastrografin
study. If esophageal perforation is confirmed, keep the patient NPO,
and consider broad-spectrum antibiotics.
III. Caustic Ingestion
The incidence of caustic ingestion has decreased since the Federal
Hazardous Substances Act of 1960 and the Poison Prevention