close
In adults, most impactions are distal.
In children and adults, once an object has traversed the pylorus,
it usually continues through the GI tract and is passed without issue.
能過胃, 通常就能自己排出
If, however, the object has irregular or sharp edges
or is particularly wide (> 2.5 cm) or long (> 6 cm),
it may become lodged distal to the pylorus.
Airway obstruction, stricture, or perforation
(direct mechanical erosion or chemical corrosion)
Child : refusal or inability to eat, vomiting, gagging and choking, stridor,
neck or throat pain, and drooling.
A high degree of suspicion is necessary for unwitnessed ingestions in children,
especially in those < 2 years of age.
Coin
Coin : esophagus generally present their circular face on AP films (coronal alignment), 圓的正面
as opposed to coins in the trachea, which show that face on lateral films 側面
Foley catheter technique : should only be attempted in patients with blunt foreign bodies
present for < 24 hours and in patients without underlying esophageal disease.
Button battery ingestion
True emergency
Perforation can occur within 6 hours of ingestion.
Button batteries that have passed the esophagus can be managed expectantly,
as long as follow-up in 24 hours can be ensured.
Sharp objects
Sharp objects at esophagus need immediate removal.
Because intestinal perforation from ingested sharp objects
that pass distal to the stomach is common,
the American Society for Gastrointestinal Endoscopy guidelines
recommend removal of sharp objects by endoscopy
while they are in the stomach or duodenum.
食道/胃/十二指腸都是盡快胃鏡
If intestinal perforation occurs, it is usually at the ileocecal valve.
已經在十二指腸遠端 : if asymptomatic, daily plain films.
Surgical removal should be considered if 3 days elapse without passage.
Symptoms or signs of intestinal injury (e.g., pain, emesis, fever, GI bleeding)
requires immediate surgical consultation
Narcotic ingestion 吞毒品包
Rupture of even one such packet may be fatal, and endoscopy is contraindicated
Observation until the packet reaches the rectum is the favored treatment.
Treatment of esophageal coins
1. Symptomatic : Urgent endoscopic removal
2. Asymptomatic : Endoscopic removal within 24 hours;
repeat radiograph prior to endoscopy
Treatment of coins in stomach
1. Monitor stools for passage; repeat radiograph in 2 weeks
2. Endoscopic removal if no passed in 2-4weeks, repeat radiograph prior to endoscopy
Any patient with symptoms or signs of GI tract injury requires immediate surgical consultation.
Treatment of small bowel coins
1. Observation
2. Enteroscopy/surgical removal if symptomatic
電池, 尖銳物品在胃要緊急 remove
鈕扣電池腐蝕性酸性化學物質
如果電池被卡在喉嚨, 食道內
時間一長容易泄露腐蝕性酸性物質, 造成食道穿孔破裂, 甚至食道氣管廔管
吞入胃裡一旦被胃酸腐蝕, 會導致胃出血
如果鈕扣電池陷進肺部堵塞氣道, 就會引發窒息
急診醫師處理誤食鈕扣電池的建議
1. 鈕扣電池 : 卡在食道應儘快移除
2. 胃部的鈕扣電池若合併症狀時應該儘快移除
3. 沒有合併症狀的話：
若電池直徑 > 2公分且年齡 < 6歲, 留置於胃部超過2天應該移除
若電池直徑 2 ~1.5公分且年齡 < 6歲, 留置於胃部超過4天應該移除
其他大小及年齡的狀況, 應該每10-14天評估電池在消化道的位置及是否已經排出
不論電池仍留在胃部或已下到腸子, 若合併任何可能是電池造成的症狀時則應該移除
Double ring sign or Circumferential halo
當小孩誤吞鈕扣電池時, Chest PA view 可見
Button Battery Ingestion :
• Disc-shaped metallic foreign body
1. Lateral view: Circumferential beveled edge/step-off
2. Frontal view: Circumferential halo or double ring sign
食物在腸胃道停留的時間 ？年紀越小時間越短 ！
吃進食物到將其排泄出來, 平均需要一天的時間
快一點的消化道要8個小時, 而慢的則可能要花三天半
混合飲食的情況
在胃內停留時間大約爲 2-4小時, 最慢可達 10小時
在小腸約停留 3-5小時
在大腸內的停留時間因人而異
常隨著個人的排便習慣不同, 短的只有幾小時, 長的可達十幾小時或更長
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