Management of gastric metallic foreign bodies in children.

QUESTION

A 2-year-old boy presented to my clinic after a caregiver witnessed him swallow a foreign body. The caregiver recalls seeing a small metallic object but is unsure exactly what was ingested. The child was asymptomatic upon examination. How should I identify and localize the foreign body? Do metal foreign bodies need to be removed endoscopically?

ANSWER

Foreign body ingestion is very common in children. Considerations must be made for the type of foreign body and site of impaction. A clear patient history and radiographs should be used to localize and identify the object. Handheld metal detectors can also be used to localize known metallic foreign bodies. Most metallic objects that pass the esophagus and reach the stomach will continue to pass without complication. Bowel perforation, sepsis, and even death have been documented in extremely rare cases of multiple magnets, button batteries, and long, angular, or 2-pointed sharp objects. These objects must be removed. Other metallic foreign bodies including coins and single magnets can be managed conservatively with stool monitoring.