Pediatric emergency medicine trisk 0672 0672

similarly sized inorganic object While the ingestion of a single blunt magnet may cause few problems, the ingestion of more than one can lead to magnetic attraction across bowel walls, resulting in bowel necrosis, perforation, or obstruction DIFFERENTIAL DIAGNOSIS Gastrointestinal Foreign Body Esophagus The esophagus is the most common site of lodgment for an ingested foreign body Most childhood esophageal foreign bodies are round or spherical objects, with coins accounting for 50% to 75% of these ( Fig 32.1 ) This contrasts with adults, whose impacted esophageal foreign bodies tend to be food (meat) and bones (e.g., fish or chicken), and are often associated with underlying conditions of the esophagus, such as strictures, dysmotility, or extrinsic compression Most children with an esophageal foreign body have a structurally and functionally normal esophagus Children with acquired esophageal strictures (e.g., secondary to caustic ingestions) or repaired congenital conditions (e.g., esophageal atresia, tracheoesophageal fistula) are at increased risk for recurrent esophageal impaction with food Foreign bodies of the esophagus tend to lodge at three sites The thoracic inlet ( Fig 32.1 ) is the most common location, accounting for 60% to 80% of esophageal foreign bodies The next most common sites are the gastroesophageal junction (10% to 20%) and the level of the aortic arch (5% to 20%) The level of lodgment in children with underlying esophageal abnormalities varies based on the location of the constricting lesion Foreign bodies that remain lodged in the esophagus may lead to potentially serious complications, including respiratory distress, upper airway compromise, esophageal perforation, mediastinitis, and aortic or tracheal fistula formation Stomach and Lower Gastrointestinal Tract Objects that pass safely into the stomach usually traverse the remainder of the GI tract without complications Various foreign objects, including sharp objects such as screws, tacks, and staples, have been documented to pass safely In the younger child, long objects (greater than cm) may be unable to negotiate the turns of the small intestine and become impacted in the duodenum or ileocecal region However, no definitive age or length guidelines exist In addition, some very