Browse categories and answer follow-up questions to refine your symptom profile.
Immediate priorities
Airway and hemodynamic stabilization
Immediate high-acuity location triggers
Stridor
Respiratory distress
Inability to handle secretions
Cyanosis
Shock
Airway protection
If persistent drooling with declining respiratory status, intubate
If impending obstruction, consult anesthesia and ENT for advanced airway backup
Aspiration risk mitigation
Upright positioning if tolerated
Continuous suction setup
NPO status
Access and monitoring
Cardiac monitor
Pulse oximetry
Blood pressure cycling
Two large-bore IV lines if unstable or high-risk object
High-risk object recognition
Object-risk stratification
Emergent removal triggers
Button battery in esophagus
Multiple magnets or magnet with metal object
Sharp or pointed object in esophagus
Complete obstruction
Inability to swallow saliva
Profuse drooling
Urgent removal triggers
Esophageal foreign body without complete obstruction
Food bolus with persistent symptoms
Long object
Length > 6 cm
Wide object
Diameter > 2.5 cm
Consultation and escalation
Activation and coordination
Gastroenterology for endoscopic removal
Emergent GI notification for battery, magnets, sharp object, complete obstruction
ENT involvement triggers
Suspected proximal esophageal or hypopharyngeal impaction
Failed endoscopic removal
Airway compromise with suspected upper airway foreign body overlap
Surgery or thoracic surgery involvement triggers
Perforation concern
Mediastinitis concern
Persistent severe chest pain with systemic toxicity
Suspected aortoesophageal fistula
Key concepts
Time-critical principles
Button battery esophageal injury progression within hours
Liquefaction necrosis from local hydrolysis and alkaline injury
Complete obstruction as an airway and aspiration emergency
Secretions accumulation
Aspiration during emesis or sedation
Radiolucent objects as a diagnostic pitfall
Plastic
Thin fish bones
Wood
Focused history
Symptom pattern
Dysphagia
Odynophagia
Drooling
Chest pain
Globus sensation
Regurgitation
Cough
Wheeze
Stridor
Timeline
Time of ingestion or onset
Duration of impaction symptoms
Interval since last normal swallow
Object characteristics
Button battery possibility
Magnet possibility
Sharpness
Size estimate
Food bolus type
Meat bolus
Pill impaction
High-risk background
Known esophageal disease
Eosinophilic esophagitis
Stricture
Schatzki ring
Achalasia
Esophageal cancer
Prior food impactions
Prior esophageal surgery
Dentures
Alcohol intoxication
Neurologic impairment
Complication clues
Fever
Severe neck pain
Severe chest pain
Crepitus sensation
Hematemesis
Melena
Syncope
Targeted exam
Airway and breathing
Work of breathing
Stridor
Voice quality
Wheeze
Oxygen saturation trend
Oropharynx and neck
Drooling
Trismus
Oropharyngeal pooling
Neck tenderness
Subcutaneous emphysema
Cardiovascular and perfusion
Heart rate
Blood pressure
Capillary refill
Shock index trend
Chest and abdomen
Chest wall tenderness
Mediastinal crunch
Abdominal tenderness
Peritoneal signs
Red-flag findings
Toxic appearance
Altered mental status
Hematemesis
Hypotension
PITFALLS
Common misses
Minimal early symptoms with button battery
Symptom resolution with distal migration despite mucosal injury
Radiolucent foreign body with normal plain films
Food bolus as first presentation of eosinophilic esophagitis
Life-threatening and mimics
Obstructive and airway
Epiglottitis
Retropharyngeal abscess
Anaphylaxis
Angioedema
Esophageal emergencies
Esophageal perforation
Boerhaave syndrome
Caustic ingestion injury
Esophageal malignancy obstruction
Cardiac and thoracic
Acute coronary syndrome
Aortic dissection
Pulmonary embolism
Functional and inflammatory
Esophageal spasm
GERD with severe esophagitis
Eosinophilic esophagitis flare
Coding considerations
ICD-10 and SNOMED CT alignment
ICD-10 T18.1XXA foreign body in esophagus, initial encounter
SNOMED CT foreign body in esophagus
Labs for complications and procedural readiness
Targeted laboratory evaluation
Complete blood count for fever, toxicity, or bleeding
Leukocytosis as supportive of mediastinitis or aspiration pneumonia
C-reactive protein for suspected deep infection
Rising trend as supportive of complication
Basic metabolic panel for dehydration and pre-sedation status
Potassium and bicarbonate abnormalities with poor intake and vomiting
Serum glucose in altered mental status
Hypoglycemia as alternate cause of symptoms
Coagulation studies if anticoagulated or planned high-risk endoscopy
INR for warfarin exposure
Anti-Xa level availability dependent for factor Xa inhibitors
Type and screen for suspected perforation or significant bleeding
Crossmatch if hemodynamic instability or GI hemorrhage
Venous blood gas for respiratory distress or impending airway intervention
pH
pCO2 mmHg
Lactate mmol/l for shock or sepsis concern
PITFALLS
Limitations
Normal labs do not exclude perforation early
Lactate can be normal early in contained perforation
Scoring Systems
Urgency stratification framework
Emergent endoscopy pathway
Button battery in esophagus
Multiple magnets
Sharp or pointed object in esophagus
Complete esophageal obstruction
Urgent endoscopy pathway
Esophageal foreign body without complete obstruction
Food bolus with persistent symptoms
Non-urgent pathway
Small blunt object beyond esophagus with no symptoms
Known passage of foreign body with reassuring exam
MRI
MRI role and contraindications
Limited role in acute evaluation
Time delay compared with CT and endoscopy
Contraindications
Suspected metallic foreign body
Uncertain object composition
Potential indications
Selected radiolucent foreign bodies with stable patient and no endoscopy access
CT
CT indications and interpretation
Indications
Suspected perforation
Severe pain with systemic toxicity
Radiolucent foreign body with persistent symptoms and negative radiographs
Suspected complications after removal
Mediastinitis
Abscess
Vascular injury concern
Protocol considerations
CT neck and chest for esophageal level localization
IV contrast for perforation and vascular complications
Oral contrast individualized for perforation evaluation and aspiration risk
Key findings
Extraluminal air
Mediastinal fluid
Esophageal wall thickening
Periesophageal fat stranding
Ultrasound
Ultrasound applications
Limited utility for intraluminal esophageal objects
Operator dependence
Air artifact limitations
Adjunctive uses
Pleural effusion assessment in suspected perforation complications
Lung ultrasound for aspiration pneumonitis
Neck soft tissue ultrasound for superficial collections when CT not available
Plain radiography
X-ray strategy
Views by suspected location
Neck soft tissue
Chest
Abdomen
Two-view principle for key objects
AP and lateral for coin versus button battery differentiation
Button battery radiographic signs
Double rim or halo on AP
Step-off on lateral
Magnet assessment
Multiple objects alignment
Separation distance suggesting multiple pieces
Level of care and follow-up
Admission and monitored care
ICU or step-down triggers
Airway intervention
Hemodynamic instability
Significant aspiration
Perforation or mediastinitis
Inpatient admission triggers
Button battery ingestion with esophageal involvement
Multiple magnets ingestion
Sharp object injury with mucosal damage
Deep ulceration or necrosis on endoscopy
Persistent dysphagia after removal
Transfer criteria
No urgent endoscopy capability with high-risk object
Button battery
Multiple magnets
Sharp object
Complete obstruction
Airway risk requiring higher-level anesthesia support
Discharge criteria
Complete symptom resolution
Tolerating oral intake
No red-flag exam findings
Reliable return precautions and follow-up
Follow-up planning
Gastroenterology follow-up for suspected underlying pathology
Recurrent food bolus
Dysphagia history
Suspected eosinophilic esophagitis
Repeat evaluation timeline for mucosal injury
Endoscopy-based plan if ulceration or necrosis
Initial management
Supportive care
NPO status
No oral trials in ongoing impaction symptoms
Suction and secretion control
Yankauer suction at bedside
Oxygen and ventilation support
Supplemental oxygen for hypoxemia
If respiratory fatigue, intubate
Antiemetic therapy
Ondansetron IV 4 mg
Repeat dosing per local protocol
Analgesia
Fentanyl IV 25 to 50 micrograms
Titration every 5 to 10 minutes to comfort and respiratory safety
Definitive removal
Endoscopic removal strategy
Timing targets
Emergent endoscopy within 2 hours for button battery in esophagus
Emergent endoscopy within 2 hours for complete obstruction
Emergent endoscopy within 2 hours for sharp object in esophagus
Urgent endoscopy within 24 hours for non-sharp esophageal foreign body
Urgent endoscopy within 24 hours for persistent food bolus
Technique considerations
Overtube use for multiple passes and aspiration reduction
Particularly for sharp objects and large bolus extraction
Distal advancement of food bolus
Only if no bone and low perforation risk
Retrieval devices
Rat-tooth forceps
Retrieval net
Snare
Basket
Protective accessories
Transparent distal cap
Overtube
Hood for sharp object shielding
Pharmacologic temporization for food bolus
Non-endoscopic options with limited evidence
Glucagon IV 1 mg
If partial obstruction and stable airway
Lower success rates with structural esophageal disease
If no response, proceed to endoscopy without delay
Avoided therapies
Carbonated beverages for impaction
Aspiration risk
Perforation risk with forceful emesis
Proteolytic enzymes
Mucosal injury risk
Button battery specific measures
Pre-endoscopy mitigation
Honey by mouth in children older than 12 months
If able to swallow
10 ml every 10 minutes while awaiting endoscopy
If symptoms of complete obstruction, no oral intake
Sucralfate suspension by mouth as alternative when available
If able to swallow
Post-removal injury management
High-dose proton pump inhibitor for mucosal injury
Pantoprazole IV 40 mg daily
Broad-spectrum antibiotics if deep ulceration or perforation concern
Piperacillin-tazobactam IV 4.5 g every 6 hours
Antibiotics and perforation management
Suspected perforation pathway
Broad-spectrum IV antibiotics
Piperacillin-tazobactam IV 4.5 g every 6 hours
Alternative for severe penicillin allergy
Antifungal therapy considerations
Immunocompromised host with mediastinitis
Surgical consultation
Immediate for free perforation or unstable patient
Imaging reassessment
CT with IV contrast for mediastinal contamination extent
Post-removal and prevention
Underlying disease evaluation
Eosinophilic esophagitis evaluation planning
Biopsy strategy per gastroenterology
Stricture evaluation planning
Dilation timing individualized based on mucosal injury
Acid suppression
Proton pump inhibitor for esophagitis or mucosal injury
Pantoprazole PO 40 mg daily
Duration per endoscopic findings
Pregnancy
Pregnancy considerations
Imaging selection
Plain radiographs with shielding when indicated
CT use for suspected perforation or life-threatening complication
Sedation considerations
Obstetric consultation for viable gestation when procedural sedation planned
Left lateral tilt positioning if supine intolerance
Medication considerations
Avoid hypotension during sedation
Antiemetic selection with pregnancy safety in mind
Geriatric
Geriatric considerations
Higher prevalence of dentures related impaction
Airway aspiration risk with poor gag reflex
Comorbidity and anticoagulation
Bleeding risk with mucosal trauma
Coagulation assessment when high-risk removal anticipated
Atypical presentation
Minimal pain despite significant injury
Pediatrics
Pediatric considerations
High-risk ingestion patterns
Button battery common in toddlers
Magnet ingestion with bowel injury risk even after esophageal passage
Emergent management emphasis
Button battery in esophagus as immediate removal indication
Honey mitigation only if age appropriate and able to swallow
Weight-based medication dosing
Analgesia and sedation per pediatric protocols
Non-accidental injury consideration
Inconsistent history
Recurrent ingestion episodes
Epidemiology
Epidemiologic features
Common objects by age group
Children
Coins
Button batteries
Small toys
Magnets
Adults
Food bolus
Dentures
Pills in blister packs
Common impaction sites
Upper esophageal sphincter
Aortic arch level
Lower esophageal sphincter
Pathophysiology
Mechanisms of injury
Obstruction physiology
Salivary pooling
Aspiration risk
Mucosal injury patterns by object
Button battery
Local alkaline generation
Rapid liquefaction necrosis
Sharp object
Laceration
Perforation
Food bolus
Pressure necrosis with prolonged impaction
Complication pathways
Perforation to mediastinitis
Tracheoesophageal fistula
Aortoesophageal fistula
Stricture formation
Therapeutic Considerations
Treatment principles
Endoscopy as definitive therapy for esophageal foreign bodies
Time-to-removal as key modifiable factor for high-risk objects
Sedation and airway protection
Higher aspiration risk with full esophagus and pooled secretions
Pharmacologic relaxation therapies
Limited efficacy in structural disease
Avoided if delaying definitive care
Post-injury mitigation
Acid suppression for mucosal healing
Antibiotics for deep injury or perforation concern
Copy discharge instructions
Discharge counseling
Expected course
Mild throat discomfort for 24 to 48 hours possible
Soft diet progression as tolerated if advised
Medications
Proton pump inhibitor as prescribed
Avoid NSAIDs if mucosal injury documented
Return to ED immediately
Trouble breathing
Drooling or inability to swallow liquids
Worsening chest pain
Fever
Vomiting blood
Black stools
Severe neck pain
Fainting
Follow-up
Gastroenterology appointment if dysphagia history or recurrent impactions
Primary care follow-up for risk factor evaluation
Guidelines and key sources
Professional society guidance
ASGE guideline on management of ingested foreign bodies and food impactions
Endoscopic timing stratified by battery, magnets, sharp objects, and obstruction severity
ESGE guideline on removal of foreign bodies in the upper gastrointestinal tract
Timing and device selection recommendations
NASPGHAN guidance on button battery ingestion in children
Honey and sucralfate mitigation guidance while awaiting removal
Clinical review topics
Esophageal perforation recognition and management reviews
Imaging findings and antibiotic strategies
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.