CT Scan: Indicated if FB is radiolucent (e.g., plastic, wood, thin glass, food boluses) and patient is symptomatic, or if perforation/abscess is suspected.
Barium Contrast Studies: Contraindicated due to risk of aspiration and interference with subsequent endoscopy.
Management by Object Type
Button Batteries:
In esophagus: Emergent EGD (<2 hours) due to risk of rapid liquefactive necrosis, perforation, and aortoesophageal fistula.
In stomach/intestines:
Asymptomatic + <20-25 mm: Outpatient observation; repeat X-ray in 7-14 days to confirm passage.
Symptomatic OR >20-25 mm OR battery remains in stomach >48 hours: Endoscopic removal.
In esophagus or stomach/duodenum: Emergent EGD due to high risk of mucosal perforation.
Beyond duodenum: If asymptomatic, follow with daily serial X-rays. Surgical intervention if FB fails to progress for 3 consecutive days or symptoms of perforation develop.
Magnets:
Single magnet: If asymptomatic, serial X-rays to monitor transit.
Multiple magnets (or 1 magnet + 1 metallic object): Emergent EGD/surgical removal due to risk of bowel walls attracting, causing pressure necrosis, perforation, obstruction, and fistula.
Asymptomatic: Observation for up to 24 hours (often pass spontaneously into stomach).
Symptomatic OR >24 hours since ingestion: Endoscopic removal.
In stomach: Asymptomatic coins can be monitored with weekly radiographs; endoscopically retrieve if they fail to pass within 2-4 weeks.
Superabsorbent Polymers (e.g., expand-in-water toy beads): Emergent removal regardless of location due to risk of rapid expansion and bowel obstruction.