Case by Kammeron Brissett, CNH PEM Fellow

6 -year-old female with a history of autism and ADHD who presents for concern of foreign body ingestion. Parents report that she swallowed a button battery from a laser pointer at about 30 minutes prior to arrival. They endorse that she frequently puts non-food objects into her mouth, but that this was the first episode of her accidentally ingesting something. Denies any abdominal pain or emesis. No pain with swallowing or difficulties breathing.

Medications : methylphenidate.

No known drug allergies.

Up-to-date on vaccines.

Physical Exam– 

Vitals

T 36.8 C HR 110 RR 18 BP 109/68 SpO2 100 %

General: Alert appropriate for age interactive minimally verbal

Skin: Warm, dry

Head: Normocephalic. atraumatic.

Neck: Supple. trachea midline. no tenderness. no lymphadenopathy.

Eye: Pupils are equal, round and reactive to light. extraocular movements are intact. normal conjunctiva.

Ears, nose, mouth and throat: Oral mucosa moist. No pharyngeal erythema or exudate. No drooling, or coughing, tolerating oral secretions.

Cardiovascular: Regular rate and rhythm. No murmur. Normal peripheral perfusion.

Respiratory: Lungs are clear to auscultation. respirations are non-labored. breath sounds are equal.

Gastrointestinal: Soft. Nontender. Non distended. Normal bowel sounds.

Musculoskeletal: Normal ROM

Neurological: Alert. No focal neurological deficit observed. 

Xray results: Foreign Body: Single 12 mm rounded foreign body likely representing a button battery/magnet is seen in the left upper quadrant likely within the stomach opposite the T11-T12 vertebral bodies

GI consulted with recommended patient to be discharged home. Parents were encouraged to monitor stool for passage of button battery and to return ED in 48 hours for repeat x-rays.

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