A 25-year-old man presents to the emergency room having swallowed two open safety pins 6 h ago. X-rays show the pins to be located in the small intestine. The most appropriate management at this point would be
|A||administration of a broad-spectrum antibiotic intravenous-sly|
|B||a 10000y course of oral metronidazole|
|C||administration of 250 mL of magnesium citrate to induce catharsis and increase the rapidity of passage|
|D||follow-up with serial x-rays and abdominal examinations|
a. The esophagus is a tubular structure approximately 20-25 cm in length.
b. Patients can usually localize foreign bodies in the upper esophagus but localize them poorly in the lower two thirds of the structure.
c. The esophagus has 3 areas of narrowing where foreign bodies are most likely to become entrapped: the upper esophageal sphincter (UES), which consists of the cricopharyngeus muscle; the crossover of the aorta; and the lower esophageal sphincter (LES).
d. Structural abnormalities of the esophagus, including strictures, webs, diverticula, and malignancies, increase the risk of foreign body entrapment, as do motor disturbances such as scleroderma, diffuse esophageal spasm, or achalasia.
Esophageal foreign bodies
a. Adults with esophageal foreign bodies usually present acutely, with a history of ingestion. A foreign body sensation or vague discomfort in the epigastrium suggests that the foreign body is entrapped at the LES.
b. Dysphagia is the norm in adults. If the obstruction is complete, an inability to handle secretions is common.
c. The classic adult presentation is the person with dentures who has had some alcohol and is eating meat. Incomplete chewing leads to an impaction at the LES. Adults should be asked about the use of dentures, alcohol intake, and circumstances surrounding the ingestion.
d. In children with esophageal foreign bodies, the history may be less clear. As many as 35% of children with esophageal foreign bodies are asymptomatic;
e. Children with chronic esophageal foreign bodies may also present with poor feeding; irritability; failure to thrive; fever; stridor; or pulmonary symptoms, such as repetitive pneumonias from aspiration.