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Baby swallowed broken piece of glass

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  • Avatar Wiscoblue 
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    I’m sorry to hear this. I don’t have much to offer. Hope it comes out ok.

    #198513 Reply
    Liked by kdeva
    Avatar kdeva 
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    A 1cm piece of glass is often not going to be visible on an x-ray.  If it is lodged in the neck, it may be seen on a soft tissue neck x-ray, but if it is in the esophagus, it’s probably not going to be visible on a chest x-ray, and is less likely to be visible on abdominal x-ray if it has passed into the stomach or small intestine. I’ve done hundreds of x-ray series for ingested foreign bodies, including dozens for glass specifically, and most of the time we don’t see glass, even if we know it is there.   Glass doesn’t block most of the the x-ray beams, so it doesn’t show up as a dense spot on an x-ray.  Since we don’t see the glass itself very well, what we are looking for is an interface between tissue and the glass.  If it is stuck in the esophagus, for example, on an x-ray taken from the front, superimposed on the area are the airways, the heart, the spine, etc, which makes it really hard to see.

    Click to expand…

    Based on the cases you have seen, does glass usually pass through or get stuck?

    The glass that broke was tempered glass, but I found several pieces with sharp corners. I don’t know if that makes it more likely to pass through or not.

    #198514 Reply
    ENT Doc ENT Doc 
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    While not a radiologist I do have some specific questions:

    1. How do you know the glass is there when the X-ray is negative? Could it be that it just isn’t?

    2. Why does this article state that all glass is radiopaque and puts the lower limit on detection down to a few mm?
    https://radiopaedia.org/articles/glass-foreign-bodies?lang=us

    The fact that it’s tempered makes me feel a lot better.

    #198522 Reply
    Liked by kdeva
    Avatar G 
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    Just to chime in.  As others have said: There is nothing to do right now other than wait and see.  I am going to take the contrary opinion to Rollie, a 1-2 cm piece of tempered glass is likely to be seen on XR (especially if you’re looking for it).  As noted, it will almost def be seen in the neck and should be seen in the stomach.  If it is not in those places, there is nothing to be done right now.  A CT is not needed because what would you do about it?  You would wait and see.  Which is already what you are doing.

    Hopefully, the worst part is going to be sifting the poo.

    Over the years, I’ve had a couple dogs swallow huge shards of bone–didn’t know about it until the final countdown.  Suffice it to say it was a gross mess, but they did great.

    Fingers crossed your little one will do great as well!

    I’m looking forward to the photo of the end result.

    #198526 Reply
    Avatar G 
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    While not a radiologist I do have some specific questions:

    1. How do you know the glass is there when the X-ray is negative? Could it be that it just isn’t?

    2. Why does this article state that all glass is radiopaque and puts the lower limit on detection down to a few mm?
    https://radiopaedia.org/articles/glass-foreign-bodies?lang=us

    The fact that it’s tempered makes me feel a lot better.

    Click to expand…

    Case 8 looks like a normal study to me.

    #198529 Reply
    Avatar pierre 
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    The study they reference talks about glass wounds and finding glass in the subcutaneous tissues, not ingested foreign bodies.

    To me, finding glass in a finger can be difficult. Finding ingested glass may be near impossible.

    When someone swallows a pen, typically all you can see is the ball point tip not the rest of the pen, even though you know it’s there.

    #198535 Reply
    Liked by Zaphod
    ENT Doc ENT Doc 
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    I’m assuming sarcasm font was intended.

    #198544 Reply
    Liked by SLC OB
    CordMcNally CordMcNally 
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    I agree with continued watchful waiting. The fact that she is taking oral intake is a good sign. If there are complications, she isn’t going to have a low grade fever but otherwise look fine…she’s going to be SICK and it will be obvious. Our GI system is ridiculously resilient. I wouldn’t ask for a CT because the risks outweigh the benefits.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #198557 Reply
    Liked by kdeva
    Zaphod Zaphod 
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    Its been a long time since I took that kind of call but I recall a couple of cases (I think) where the glass wasnt visible on xray for upper extremity wounds, and they werent always small. The idea that all glass is the same might have been true at some point, but I wouldnt be comfortable with just an xray from my admittedly poor recollection.

    I also remember tending to some pt in residency that was not getting better in the ICU, TBI and such and they wanted me to examine them. Walk in thinking a normal consult for face fractures/etc….look at CTs/Reports etc…go and examine her and I started pulling out giant pieces of wood out of her eye and scalp, whole right eye socket was basically pieces of a tree. She’d been there almost a month.

    I went back to the CT and after knowing it was there I could kind of make it out, but no one said anything about it on the reads. Pretty crazy.

    Also its hard to tell where glass goes or what size from the entry wound, it can be small and you’ll find a large piece of glass thats gone all over.

    #198560 Reply
    ENT Doc ENT Doc 
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    I wouldnt be comfortable with just an xray from my admittedly poor recollection.

    Click to expand…

    Admittedly, I had to look this up.  I never had a kid who swallowed glass before.  But Radiopedia, an AAFP article on foreign bodies, and the following all state that glass should be radiopaque and detectable on standard x-rays:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1487487/?page=1

    #198564 Reply
    Liked by kdeva
    Avatar trebizond 
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    Concur on watch and wait. I don’t think a CT will be helpful because it’s almost certainly moved out of the stomach. Finding the glass anywhere else is not going to prompt anyone to get invasive to chase it. Concur with softening her stool to keep things moving and reduce any straining. Naturally, be vigilant.

    #198578 Reply
    Liked by kdeva
    Avatar wideopenspaces 
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    I’m so sorry OP! I effing hate glass for this reason. Any time it breaks I go nuts, vacuum the whole room and adjoining room, then down on my hands and knees, running my hands over every surface. I know it sounds crazy. But basically I’m saying I’d be freaked out too. I’m sending good vibes your way and I hope your daughter has an uncomplicated few weeks. Hang in there. Please update us as well, I’ll be thinking about you and your daughter.

    #198587 Reply
    Liked by hatton1, kdeva, Zaphod
    Zaphod Zaphod 
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    I do the same and try to have as little glass as possible in the house.

    #198593 Reply
    Liked by kdeva
    The White Coat Investor The White Coat Investor 
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    I’m guessing no news is good news.

    Site/Forum Owner, Emergency Physician, Blogger, and author of The White Coat Investor: A Doctor's Guide to Personal Finance and Investing
    Helping Those Who Wear The White Coat Get A "Fair Shake" on Wall Street since 2011

    #198674 Reply
    Liked by kdeva, ENT Doc
    Avatar kdeva 
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    Things are the same, she is behaving as usual and playing. she still has the cough and mild fever. She went poopy but didn’t find anything. Her pediatrician asked us to come in today and again on Monday to check on her.

    #198718 Reply

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