Gastrointestinal Radiology > Procedures > Foreign Bodies > Foreign Bodies (10)


Treatment of Food Impactions And Foreign Bodies in the Esophagus

III.  Magnet Catheter Removal of Metallic Foreign Bodies

  • Although most ingested foreign bodies are nonmagnetic, occasionally ferromagnetic metal objects, such as button (disk) batteries, nails, paper clips, and ball bearings are found in the esophagus or stomach.  A button battery lodged in the esophagus constitutes a true emergency because leakage of the alkaline electrolyte may rapidly cause esophageal lye burns, tissue necrosis, and potentially lethal complications, such as perforation, esophagotracheal fistula and esophagoaortic fistula.  These complications have been reported anytime from 4 hours to a few days after the ingestion.  Under no circumstances should a button battery be left in the esophagus in the hope that it will pass spontaneously.

  • The traditional treatment for button batteries in the esophagus has been immediate endoscopic removal.  However, this can be a challenge since a battery is too smooth to be easily grasped with foreign body forceps.  Removal from the esophagus has been more successful using a through-the-scope balloon that is passed distal to the battery and inflated; then the balloon, battery, and endoscope are removed as a unit.  A failure rate of 10%-62.5%  is reported for endoscopic removal.  Several recent reports have advocated removal of  esophageal button batteries under fluoroscopic control using a magnet attached to the end of a catheter.

  • Special Materials.  One of the commercially available magnet catheters: Cook Magnetic Retriever Catheter (Cook, Inc., Bloomington, IN) or FE-EX Orogastric Tube Magnet (Effner & Spreine GmbH, Berlin, Germany)

  • Method.  The method for extracting a metallic foreign body with a magnet catheter is nearly identical to the procedure for removing a coin with a Foley catheter balloon (see section on Foley Catheter Balloon Extraction).  Patient cooperation is essential.  An infant or young child may require secure, but gentle, restraint in an immobilizer.  

    • The posterior oropharynx is sprayed with a small amount of a topical anesthetic.  The magnet catheter is lubricated with viscous lidocaine.  

    • The catheter is then passed through the mouth (not the nose) into the esophagus.  A sterile bite block is placed between the teeth when necessary to prevent the patient from biting the tube.  

    • Under fluoroscopic guidance, the magnet is coupled to the foreign body.  

    • After the object is engaged by the magnet, the patient is turned into the right anterior oblique position (semiprone).  The head end of the x-ray table is lowered approximately 30˚ from the horizontal.  

    • Using a smooth, continuous motion, the magnet with the attached foreign body is withdrawn through the esophagus into the mouth, where it is either removed with the magnet or manually retrieved (Fig 4). 

Figure 4.  Sagittal drawing demonstrates the method for removing a button battery (bold arrow) under fluoroscopic control with a magnet catheter (Medi-tech type.).  The oral route is preferred for foreign body extraction to avoid epistaxis and impacting the foreign body in the nose.  (From Shaffer HA Jr, de Lange EE. , ref. 15.  Reproduced by permission.)

  • If the foreign body disengages from the magnet while in the esophagus, removal can be achieved by passing a Foley catheter beyond the foreign body.  

  • Under fluoroscopic control, the Foley balloon is inflated, sandwiching the foreign body between the magnet above and the balloon below.  

  • Then, the magnet, foreign body, and Foley catheter are withdrawn as a unit (Fig 5).  With the newer, stronger rare-earth cobalt magnets available today, the assistance of a Foley catheter is infrequently needed.

 

Figure 5.  Diagram in the sagittal plane shows the combined use of a Foley catheter balloon with a magnet catheter (Cook type) to extract a foreign body when the magnet alone is not strong enough to remove the object.  The button battery is sandwiched between the Foley catheter balloon below and the magnet above.  During its extraction, the button battery is simultaneously pulled by the magnet and pushed by the balloon.  (From Shaffer HA Jr, de Lange EE., ref. 15.  Reproduced by permission.)

  • Discussion.  Removal of metal foreign bodies with a magnet catheter is relatively safe, effective, and quick.  It is considerably less expensive than endoscopy or surgery.  The method requires neither hospitalization nor general anesthesia.  The success rate is reported to exceed 90%.  No complications have been reported.  The criteria for selecting patients for this procedure include:  1)  the presence of a blunt, metallic ferromagnetic object in the esophagus, and 2) no evidence of perforation, mediastinitis, or peritonitis.

 


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