Foreign body ingestion

Last reviewed: 9 Nov 2022
Last updated: 22 Nov 2018

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • dysphagia
  • non-specific abdominal pain
  • stridor and wheezing
  • drooling
More key diagnostic factors

Other diagnostic factors

  • gagging, nausea/vomiting, neck/throat pain
  • atypical chest pain or non-cardiac chest pain
  • choking
  • signs of upper gastrointestinal obstruction
  • lower gastrointestinal bleeding
  • odynophagia
  • fever, poor feeding, failure to thrive, and irritability (in children)
  • acute or chronic asthma-like symptoms or recurrent pneumonia
  • signs of sepsis
  • sign of acute drug intoxication
Other diagnostic factors

Risk factors

  • age <15 years
  • male sex (adults)
  • gastrointestinal tract narrowing
  • mechanical disorders of the gastrointestinal tract
  • chemical dependence
  • intellectual disability
  • mental illness
  • inmates or people engaged in criminal activities
  • dental disorders
  • hurried eating
  • impaired gag reflex
  • history of underlying oesophageal disease, surgery, or procedure
  • seizure disorder
More risk factors

Diagnostic investigations

1st investigations to order

  • x-rays of neck, chest, abdomen
  • FBC
  • urea and electrolytes
  • prothrombin time/INR
  • PTT
  • oxygen saturation
  • faecal occult blood testing
  • hand-held metal detector
More 1st investigations to order

Investigations to consider

  • cardiac biomarkers
  • ECG
  • CT of neck, chest, and/or abdomen
  • MRI
  • laryngoscopy
  • endoscopy
More investigations to consider

Treatment algorithm

INITIAL

unstable patients

ACUTE

stable patients: oropharyngeal foreign body

stable patients: oesophageal or rectal foreign body (excluding multiple magnets and batteries)

stable patients: oesophageal or rectal foreign body - multiple magnets

stable patients: oesophageal or rectal foreign body - batteries

stable patients: foreign body beyond reach of endoscope (excluding multiple magnets and batteries)

stable patients: foreign body beyond reach of endoscope - multiple magnets

stable patients: foreign body beyond reach of endoscope - batteries

Contributors

Authors

Andrew C. Meltzer, MD, MS

Associate Professor

Department of Emergency Medicine

GW School of Medicine & Health Sciences

Center for Healthcare Innovation and Policy Research

Washington

DC

Disclosures

ACM declares that he has no competing interests.

Acknowledgements

Dr Andrew C. Meltzer would like to gratefully acknowledge Dr Juan Carlos Munoz and Professor Luis F. Laos, previous contributors to this topic.

Disclosures

JCM and LFL declare that they have no competing interests.

Peer reviewers

Prakash Adhikari, MBBS, MS

Consultant

Ganesh Man Singh Memorial Academy of ENT and Head and Neck Studies

TU Teaching Hospital

Maharajgunj

Kathmandu

Nepal

Disclosures

PA declares that he has no competing interests.

Jose Fernando Aycinena, MD

General Surgery Chief Resident

Department of General Surgery

University of Tennessee Medical Center

Knoxville

TN

Disclosures

JFA declares that he has no competing interests.

Richard V. Schaller, Jr, MD

Clinical Research Fellow

Cleveland Clinic Florida

Weston

FL

Disclosures

RVS declares that he has no competing interests.

David J. Hackam, MD, PhD

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

DJH declares that he has no competing interests.

  • Foreign body ingestion images
  • Differentials

    • Epiglottitis/supraglottitis (in children)
    • Peritonsillar abscess (in children)
    • Pyloric stenosis or hypertrophic pyloric stenosis (in children)
    More Differentials
  • Guidelines

    • Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guideline executive summary
    • Foreign body ingestion
    More Guidelines
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