1. FOREIGN BODIES IN THE GI TRACT Rajeev Nagpal M.D.

5. OBJECTIVES Common foreign bodies in the GI tract Clinical symptoms at presentation Clinical examination findings How to confirm the diagnosis Should we remove it or let it pass How to remove and when to remove it And lastly how a tooth brush can turn into a shaving razor

6. CASE HISTORY 7 WKS OLD MALE PRESENTED TO THE ER COUGH AND RUNNY NOSE FOR 2 DAYS POOR FEEDING FOR 1 DAY NO HISTORY OF VOMITING PAST HISTORY UNREMARKABLE

7. CHEST X RAY: METALLIC WASHER IN THE ESOPHAGUS FLEXIBLE/RIGID ENDOSCOPY UNSUCCESSFUL EDEMA AROUND THE WASHER WASHER DROPPED INTO THESTOMACH RETRIEVED AFTER 3 MONTHS, GOLD PLATED

9. GOLD PLATED WASHER

10. CLINICAL PRESENTATION Peak incidence 6 months to 3 yrs Very uncommon under 6 months May occur in adolescent age group also Autistic and also non autistic teenagers Older children: food bolus common agent

11. CLINICAL SYMPTOMS ASYMPTOMATIC HISTORY OF INGESTION HODGE ET AL: 31% CASES OF FB IN ESOPHAGUS ASYMPTOMATIC LOCATION DICTATES THE SYMPTOMS CHEST XRAY IN ALL CASES WITH A HISTORY

12. SYMPTOMS UES : DROOLING MID ESOPHAGUS; NS, CHEST PAIN, DYSPHAGIA LES : NS, CHEST PAIN, DYSPHAGIA STOMACH, SMALL INTESTINES,COLON NO SYMPTOMS

13. UPPER ESOPHAGEAL SPHINCTER

14. CONFIRM THE DIAGNOSIS CONFIRM WITH CXR FOR RADIO OPAQUE OBJECTS RADIOLUCENT : CT SCAN VS ENDOSCOPY

15. MANAGEMENT SHOULD WE REMOVE IT WHEN SHOULD WE REMOVE IT HOW SHOULD WE REMOVE IT

16. ESOPHAGEAL FB SHOULD WE REMOVE IT Esophageal fbs should be removed: why

17. MANAGEMENT OBSTRUCTIVE SYMPTOMS URGENT REMOVAL: ENT MID/LOWER ESOPHAGUS WAIT LOWER 3RD SMOOTH MUSCLE relaxant: GLUCAGON EGD REMOVAL

18. GLUCAGON FOR LES RELAXATION Glucagon 1 mg iv

19. GLUCAGON FOR LOWER ESOPHAGEAL FBS Glucagon 1mg IV

20. HOW TO REMOVE DO NOT FEED THE CHILD RIGID ENDOSCOPY FLEXIBLE ENDOSCOPY FOLEY CATHETER

21. HOW TO REMOVE Coin retriever Rat tooth foceps Roth Net Over tube for sharp object

22. SHARP OBJECTS IN ESOPHAGUS Sharp objects such as safety pins etc Remove as soon as possible

23. FOREIGN BODIES IN STOMACH Blunt objects less than2.5 -3 cm will pass thru May take weeks Sharp objects should be removed(over tube) objects in SI, leave it alone Experimental evidence small bowel dilates when exposed to a sharp object like a pin

24. LITHIUM BATTERIES Simple round structure

25. ESOPHAGEAL BATTERY

26. LITHOUM BATTERIES

27. BUTTON BATTERIES Liquefaction necrosis: due to sodium hydroxide produced by the generated current Perforation has occurred in 6 hrs 20 mm batteries are 3 V and produce a higher current

28. MANAGEMENT Urgent removal Always in the OR ENT : rigid scopes are better Thoracic surgeons; support on site

29. FOREIGN BODIES: MAGNETS If it looks pretty, it’s a toy, and if it’s little, it might be candy. Young children will put anything in their mouths, including shiny, highly powerful magnets smaller than a pea

32. MAGNETS WHEN INGESTED AS A SINGLE MAGNET: NO RISK MORE THAN ONE MAGENT OBSTRUCTION PERFORATION

34. MAGNETS ENSURE THAT THE MAGNET IS STILL IN THE STOMACH ENSURE SURGICAL SUPPORT

35. A TOOTHBRUSH TURNED INTO A RAZOR 16 yrs old female Swallowed her tooth brush She was really trying to clean her wisdom teeth Asymptomatic ER : CAT scan showed a tooth brush like structure in the stomach Under GA, with a over tube, we struggled to pull out it out, with surgeons as standby It was the oddest tooth brush we had seen

38. FOREIGN BODIES We presented the razor to the parents But where is the tooth brush ?