Esophageal foreign bodies in children: diagnosis, treatment, and complications

We performed this study to identify the role of radiology in the diagnosis, treatment, and complications of esophageal foreign bodies in children. We retrospectively reviewed the charts and radiographs of 123 esophageal foreign bodies seen in 118 children at the Medical University of South Carolina from May 1980 through May 1995. Most foreign bodies were coins in the upper esophagus (69%) in infants less than 2 years old (65%) for fewer than 24 hr (60%). The presenting symptoms varied, with 20% of patients asymptomatic. Respiratory symptoms that mimicked upper respiratory tract infections or croup proved misleading with long-standing foreign body retention. Preexisting esophageal disease was present in 17% of patients. The Foley catheter method of foreign body extraction was attempted in 53 cases (43%) and was successful without complications in 46 (87%). Esophagoscopy was attempted in 72 cases (58%) and was successful without complications in 66 (92%). Three patients had major complications: a fatal aorticoesophageal fistula, an extraluminal migration of a coin, and a large esophageal diverticulum. Significant mucosal erosions were shown in six patients on radiologic studies after extraction. Early recognition and treatment of esophageal foreign bodies is imperative because the complications are serious and can be life-threatening. Radiology plays an important role in the initial diagnosis, in recognition of complications, and in treatment. The Foley catheter method of foreign body extraction can be used on some patients, but esophagoscopy remains the safest method of esophageal foreign body extraction.