That was delicious...

by Adam Herbstritt

So despite HHMD results, both NHMFB's were visualised below the diaphragm. both patients could be discharged to return if developed GI upset.

Take home points

• Xray if MFB is hazardous OR if HHMD detects above the diaphragm OR doesn’t detect
  
• Safety net children to return return if GI upset.
  
• Hazardous MFB’s that need imaging / referral +/- removal include; button batteries, magnets, large (>2cm) or sharp objects

[1] Schalamon et al, Use of a HHMD for localisation of ingested FBs – a critical investigation. Eur J Pediatr 163: 257-259 2004    

Just when you thought there was no more room after all that turkey and Christmas pudding, here are 2 recent cases of non-hazardous metal foreign body (NHMFB) ingestions from the department.

  -  6 year old swallowed metal links from a bath plug. Asymptomatic since.
  -  11 year old swallowed 2 small magnetic balls. FB sensation in throat since. Examination unremarkable.

Whats your approach?

Step 1; stabilise (ABC / choking child approach) 
Step 2; If non hazardous MFB, use a HHMD
Step 3; Xray if hazardous or HHMD doesn't detect below the diaphragm

These were asymptomatic non-hazardous ingestions. The hand held metal detector (HHMD) was used as per local guidelines - detection of a NHMFB below the diaphragm (confirming below the oesophagogastric junction and not in lung) negates further imaging and saves radiation exposure [i] 

Unfortunately, both were positive above the diaphragm with the HHMD and required X-rays (to include neck to below diaphragm in one image)...