by Adam Herbstritt
So despite HHMD results, both NHMFB's were visualised below the diaphragm. both patients could be discharged to return if developed GI upset.
Take home points
 Schalamon et al, Use of a HHMD for localisation of ingested FBs – a critical investigation. Eur J Pediatr 163: 257-259 2004
Just when you thought there was no more room after all that turkey and Christmas pudding, here are 2 recent cases of non-hazardous metal foreign body (NHMFB) ingestions from the department.
- 6 year old swallowed metal links from a bath plug. Asymptomatic since.
- 11 year old swallowed 2 small magnetic balls. FB sensation in throat since. Examination unremarkable.
Whats your approach?
Step 1; stabilise (ABC / choking child approach)
Step 2; If non hazardous MFB, use a HHMD
Step 3; Xray if hazardous or HHMD doesn't detect below the diaphragm
These were asymptomatic non-hazardous ingestions. The hand held metal detector (HHMD) was used as per local guidelines - detection of a NHMFB below the diaphragm (confirming below the oesophagogastric junction and not in lung) negates further imaging and saves radiation exposure [i]
Unfortunately, both were positive above the diaphragm with the HHMD and required X-rays (to include neck to below diaphragm in one image)...
The Derrifoam Blog
Welcome to the Derrifoam blog - interesting pictures, numbers, pitfalls and learning points from the last few weeks. Qualityish CPD made quick and easy.....