Foreign Body Ingestion (Differential Diagnosis)

regu_18a_n.jpg: An esophagography was performed in this 9.5-year-old girl following chronic dysphagia and regurgitation. Picture on the right side: The contrast does not fill completely the distal esophagus. This filling defect corresponds to a foreign body which was extracted endoscopically, and which is shown in the picture on the left side. regu_18b_n.jpg and regu_18c_n.jpg: In both children a chronic vomiting with insufficient feeding was the main complaint. regu_18b_n.jpg: In this 12-year-old girl with trichotillomania an esophagogastrography was performed; it shows the pulled out and swallowed hair as a filling defect of the stomach. regu_18c_n.jpg: In this 14.5-year-old boy the same work-up was performed. regu_18b_n.jpg and regu_18c_n.jpg: The trichobezoar in the girl regu_18b_n.jpg as well as the foreign bodies in the boy collected in the reniform container regu_18c_n.jpg were removed by a gastrotomy. Incidentally, swallowed foreign bodies are mainly observed in older infants and toddlers. Some of them are detected in the acute stage due to the observation of swallowing, the missing of the foreign body, or a fit of suffocation and choking with following hypersalivation and refusal to drink and to swallow, and the remainder later due to chronic signs. With foreign bodies which are radiologically visible a simple x-ray is performed, in the others an esophagraphy with contrast is necessary as in regu_18a_n.jpg and regu_18b_n.jpg. The foreign bodies may also stay undetected in place for a long time as in regu_18a_n.jpg to regu_18c_n.jpg until the already explained work-up examinations are performed. Vomiting, regurgitation and dysphagia due to swallowed foreign bodies are usually not a differential diagnosis of hypertrophic pyloric stenosis due to the different age of the disorders. But during the later infancy a foreign body has always to be considered in vomiting, regurgitation and dysphagia; the same applies to caustic lesions of the gastrointestinal tract not further observed. Beyond the age of small children swallowed foreign bodies are mainly observed for psychical reasons (trichotillomania, mental retardation, self-mutilation, suicide, and others).