What is the management plan for a 7-year-old male who swallowed a marble?

Management of a 7-Year-Old Who Swallowed a Marble

Most swallowed foreign bodies like marbles will pass through the gastrointestinal tract without intervention, and an abdominal X-ray is sufficient to confirm location while observation is the recommended management approach. 1

Initial Assessment

• Obtain detailed history about:

  • Time of ingestion
  • Size and composition of the marble
  • Any symptoms (difficulty swallowing, drooling, vomiting, abdominal pain)
  • Respiratory symptoms (choking, coughing, stridor)

• Physical examination focusing on:

  • Vital signs
  • Respiratory status
  • Abdominal examination
  • Signs of obstruction or perforation (fever, abdominal tenderness)

Diagnostic Approach

• Neck, chest, and abdominal radiographs are recommended to assess the presence, location, and size of the marble 1

  • Most marbles are radiopaque and will be visible on X-ray
  • Biplanar radiography (AP and lateral) may be helpful to confirm location

• CT scan is NOT routinely indicated unless:

  • Suspicion of complications (perforation, obstruction)
  • Uncertainty about location after X-ray 1

Management Algorithm

1. If the marble is in the esophagus:

   • Urgent endoscopic removal (within 24 hours) is indicated 1
   • Emergent removal (within 2-6 hours) if complete obstruction or respiratory symptoms

2. If the marble is in the stomach or beyond:

   • Observation is appropriate as most foreign bodies pass spontaneously 1, 2
   • Serial abdominal X-rays may be considered if symptoms develop
   • Expected transit time: 24-48 hours through the GI tract

3. If complications are present:

   • Signs of perforation, obstruction, or peritonitis require surgical consultation
   • Complete obstruction requires emergent intervention 1

Special Considerations

• Marbles are typically smooth, round objects that generally pass through the GI tract without complications
• Unlike sharp objects or button batteries, marbles do not typically cause tissue damage
• Unlike coins which may lodge in the esophagus, marbles typically pass to the stomach quickly if they can pass through the esophagus

Follow-up Recommendations

• Observe for passage of the marble in stool
• Return for evaluation if:
  • Abdominal pain develops
  • Vomiting occurs
  • Fever develops
  • No passage of marble within 7 days

Pitfalls to Avoid

• Ordering unnecessary CT scans when plain radiographs are sufficient
• Pursuing aggressive interventions for asymptomatic patients with foreign bodies in the stomach or beyond
• Failing to distinguish between high-risk foreign bodies (batteries, sharp objects, magnets) and lower-risk objects like marbles 1
• Overlooking the possibility of aspiration rather than ingestion (if respiratory symptoms are present)

Parent Education

• Explain the expected natural course (likely passage within 48 hours)
• Discuss warning signs that require immediate return
• Provide age-appropriate choking prevention education 1
• Emphasize supervision during play with small objects for younger siblings