Foreign body ingestion

Historically, the most commonly ingested FB are coins (up to 70% of cases). Only 10-20% of FBs require endoscopic treatment while the remainder pass through the GI tract spontaneously without complications. Retrieval is indicated with obstructions, batteries, and sharp objects in the esophagus. Up to 50% are asymptomatic. Most common symptoms include vomiting, dysphagia, abdominal pain, drooling, cough and SOB. 

This is a 16-year review of FB ingestions that required endoscopic treatment between 2007-2022. Details from this study:

• 976 total patients identified with FB ingestion over 16 years; only 62 required endoscopy (6.4%)
  
• Median age was 4; 60% were 0-5, 20% were >10. 
  
• 42% of FBs were coins, 16% button batteries, 13% food bolus
  
• 63% had at least one symptom- dysphagia, drooling, FB sensation, vomiting, coughing, pain, dysphonia or dyspnea. 
  
• 37% were asymptomatic; older patients were more likely to be symptomatic as well as those with FBs lodged in the upper-mid esophagus
  
• Only 1/10 of the button battery ingestions were symptomatic 
  
• 27% had a complication (musocal injury), again increasing with age. Upper-mid esophagus more likely to cause complications as well.
  

Bottom Line: have a high suspicion for foreign body ingestion given the relatively high prevalence and the lack of a clear constellation of symptoms. The number that jumps out to me is the 10% of button batteries that were asymptomatic- YIKES. Grab that x-ray if your gut is telling you something seems off. ​