Oesophageal and gastrointestinal foreign-body ingestion — formative SAQs

1. Radiographic diagnosis and urgency tier

The combination of a disc-shaped radiopacity at the thoracic inlet with a concentric ring or halo (double-ring) sign on the anteroposterior view is diagnostic of a button battery lodged in the upper oesophagus. A lateral view should be obtained to confirm the step-off at the rim that distinguishes a battery from a stacked pair of coins. This is an emergency within two hours: endoscopic removal is required regardless of symptoms because alkaline necrosis is already underway. ^{[10] [3]}

2. Resuscitation, time target, and parallel calls

Keep the child nil by mouth and upright, suction oral secretions, and place the child on continuous monitoring. The definitive time target is endoscopic removal within two hours of presentation. In parallel, call the paediatric anaesthetic team, the paediatric gastroenterology or surgical endoscopist, and the paediatric intensive care or retrieval team if the local service cannot guarantee two-hour removal. A child who is drooling continuously and unable to handle secretions has a threatened airway and must not wait for further imaging. ^{[1] [3]}

3. Temporising agent

Because the child is over twelve months, has no evidence of perforation, and the battery is confirmed in the oesophagus with removal delayed beyond two hours, I would give honey by mouth at approximately 10 millilitres every ten minutes up to six doses while awaiting endoscopy, as endorsed by the ESPGHAN 2021 position paper. The contraindications are: infants under twelve months (botulism risk), suspected oesophageal perforation, inability to protect the airway, and a battery that has already passed the pylorus. Honey is an adjunct to, never a substitute for, emergency endoscopy. ^[3]

4. Disposition and safety net

A deep oesophageal burn mandates admission for inpatient observation because delayed perforation and fistula can declare days to weeks after removal. I schedule follow-up endoscopy to assess for stricture, involve the paediatric gastroenterology and surgical teams, and start a proton-pump inhibitor. The written safety net tells the family to return immediately with any haematemesis, coffee-ground vomit, melaena, chest pain, fever, dyspnoea or dysphagia, because a sentinel herald bleed is the presentation of aorto-oesophageal fistula and is a maximal emergency. ^{[5] [3]}