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Key Points

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  1. Pediatric surgeons should be trained to conduct both rigid and flexible endoscopy of the aerodigestive tract to maximize outcomes for children who have aspirated or ingested a foreign body or toxic substance.

  2. The sequelae of ingestion are usually minimal, but the risk of complications arising from ingestion of even the most benign foreign body, a coin, approaches 5% in children requiring treatment in a hospital.

  3. Ingestion of lithium button batteries should be considered a true emergency, since serious injury to the esophagus can occur in less than 2 hours.

  4. Given the marked variability of symptoms seen with foreign bodies in the aerodigestive tract, ranging from mild dysphagia to perforation with sepsis and shock, the best axiom to follow is always be suspicious and prepared to deal with multiple outcomes.

  5. Treatment options for removal of esophageal foreign bodies depend on the type of foreign body and include (1) rigid esophagoscopy, (2) flexible esophagoscopy, (3) awake bougienage, and (4) balloon extraction.

  6. A wide variety of household chemicals may damage the esophagus, but the most serious injuries are caused by strong alkali products with a pH of >12.

  7. Children with a suspected corrosive esophageal exposure should be given intravenous fluids and antibiotics immediately.

  8. The most reliable method of imaging and determining extent of injury from caustic ingestion is upper endoscopy, ideally performed within the first 24 to 48 hours.

  9. Dilation remains central for managing esophageal strictures following caustic injury.

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Introduction

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Endoscopy, initially scorned as a curiosity by the Vienna Medical Society following Phillip Bozinni's introduction of the Lichtleiter(light conductor) in 1806, has gained widespread acceptance and is indispensible in the modern practice of pediatric surgery. The invention of an electrically generated light source offered the most drastic improvement for the field, and recent technologic advancements in fiber optics and digital imaging have vastly improved its functionality.

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While there were several “early adopters” of this technology, Chevalier Jackson is considered by many as the father of modern bronchoesophagology. His innovative efforts led directly to the development of diagnostic instruments and tools for the removal of foreign bodies. This ultimately decreased the mortality rate for foreign bodies in the aerodigestive tract from 24% to 2%. In Jackson's time, endoscopists were an elite group of subspecialists who tried to limit the widespread use of these techniques, but the drastic improvement in outcome ultimately led to the widespread adoption of endoscopy. To this day, endoscopy remains a vital component of a pediatric surgeon's armamentarium in the treatment of a child or infant who has aspirated or ingested a foreign body or toxic substance. Pediatric surgeons should be trained to conduct both rigid and flexible endoscopy of the aerodigestive tract in order to maximize outcomes and minimize complications.

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This chapter will focus on current diagnostic and treatment modalities for esophageal foreign bodies and caustic ingestions. The preferred intervention for these challenges varies widely and is ...

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