GASTRO/GENSURG
FOREIGN BODIES
PromptBUTTON BATTERY
Response
PromptImmediate management of toddler who swallowed a button battery
ResponseNBM
XR neck/chest/abdo confirm presence/abscence of button battery
Confirm single/multiple/coingestants
Assess for signs of complications - airway compromise, haematemesis, abdo pain
XR neck/chest/abdo confirm presence/abscence of button battery
Confirm single/multiple/coingestants
Assess for signs of complications - airway compromise, haematemesis, abdo pain
PromptIndications for immediate endoscopy for removal
ResponseLodged in oesophagus
Symptomatic patient
Magnet co-ingested
Symptomatic patient
Magnet co-ingested
PromptRequirements for conservative management
ResponseSmall battery <12mm
Single battery ingestion
No pre-existing oesophageal disease
Patient/caregiver is reliable and competent
Able to seek prompt help if symptoms develop
Single battery ingestion
No pre-existing oesophageal disease
Patient/caregiver is reliable and competent
Able to seek prompt help if symptoms develop
PromptDischarge advice
ResponseSeek immediate attention if any symptoms of bowel obstruction or GI bleed
Regular diet, encourage activity
Avoid laxatives
Examine stool to confirm passage
Repeat xr in 10-14 days if not passed
Regular diet, encourage activity
Avoid laxatives
Examine stool to confirm passage
Repeat xr in 10-14 days if not passed
PromptRECTAL FOREIGN BODY
Response
Prompt
ResponseX-Ray:
Rectal FB
No evidence of perforation (insensative as supine XR with diaphragm not visible)
Rectal FB
No evidence of perforation (insensative as supine XR with diaphragm not visible)
PromptList potential complications of rectal foreign bodies
ResponseRectal abrasion/laceration - bleeding ~40%
Perforation ~6% (1% iatrogenic)
Perforation ~6% (1% iatrogenic)
PromptAnaesthesia options for removal
ResponseProcedural sedation (eg: prop/fent)
Regional - perianal block
Regional - perianal block
PromptTechniques for removal
ResponseValsalva manoeuvre with generous lubricant
Gentle traction with generous lubricant
Foley catheter with 50 mL balloon/traction
Gentle traction with generous lubricant
Foley catheter with 50 mL balloon/traction
PromptFactors necessitating removal in theatre
ResponseSharp/dangerous object
Failed ED extraction
Unsuable for ED attempt (anaestetic risk)
Proximal to sigmoid
Signs suggestive of perforation
Failed ED extraction
Unsuable for ED attempt (anaestetic risk)
Proximal to sigmoid
Signs suggestive of perforation