Foreign body ingestion

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 5 Apr 2025

Last updated: 14 Feb 2023

Foreign body ingestion is a common clinical problem. Those at increased risk include children, older people, people who have an intellectual disability, patients with psychiatric pathologies, prisoners/inmates, and those with underlying gastrointestinal (GI) mechanical obstruction.

Most ingested foreign bodies will pass through the GI tract without symptoms and cause only minor mucosal injury. However, 10% to 20% of cases will require some kind of nonoperative intervention, and 1% or less of cases may develop complications (e.g., bowel obstruction, perforation, severe hemorrhage, abscess formation, or septicemia) and require further surgical interventions.

Endoscopy is considered the first-line intervention for removal of foreign bodies. It is also considered the safest and most reliable method of diagnosis and treatment of foreign bodies in the GI tract.

Other nonoperative techniques for foreign body removal include the use of laryngoscopy, Foley catheters, and esophageal bougienage. Laparoscopic or open surgery is the last resort when other techniques have failed.

Definition

An ingested foreign body is any object (including food) originating outside the body and ingested via the mouth into the GI tract.

History and exam

Key diagnostic factors

dysphagia
nonspecific abdominal pain
stridor and wheezing
drooling

Full details

Other diagnostic factors

gagging, nausea/vomiting, neck/throat pain
atypical chest pain or noncardiac chest pain
choking
lower gastrointestinal bleeding
pain on swallowing
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

Full details

Risk factors

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

Full details

Diagnostic tests

1st tests to order

x-rays of neck, chest, abdomen
CBC
basic metabolic panel
prothrombin time (PT)/INR, PTT
handheld metal detector

Full details

Tests to consider

cardiac biomarkers and ECG
CT of neck, chest and/or abdomen
MRI
laryngoscopy
endoscopy

Full details

Treatment algorithm

INITIAL

unstable patients

ACUTE

stable patients: oropharyngeal foreign body

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

stable patients: esophageal or rectal foreign body - multiple magnets

stable patients: esophageal or rectal foreign body - batteries

stable patients: foreign body in the stomach, proximal small bowel, or beyond reach of endoscope (excluding multiple magnets and batteries)

stable patients: foreign body in the stomach, proximal small bowel, or beyond reach of endoscope - multiple magnets

stable patients: foreign body in the stomach, proximal small bowel, or beyond reach of endoscope - batteries

Contributors

Authors

Brian M. Fung, MD

Gastroenterology Fellow

Division of Gastroenterology and Hepatology

Department of Internal Medicine

University of Arizona College of Medicine - Phoenix

Phoenix

Disclosures

BMF is the author of one reference cited in this topic.

Acknowledgements

Dr Brian M. Fung and Dr James H. Tabibian would like to gratefully acknowledge Dr Andrew C. Meltzer, Dr Juan Carlos Munoz, and Professor Luis F. Laos, previous contributors to this topic.

Disclosures

ACM, 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

Disclosures

JFA declares that he has no competing interests.

Richard V. Schaller, Jr, MD

Clinical Research Fellow

Cleveland Clinic Florida

Weston

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

Disclosures

DJH declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Kramer RE, Lerner DG, Lin T, et al. Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr. 2015 Apr;60(4):562-74.Full text Abstract

Gracia C, Frey CF, Bodai BI. Diagnosis and management of ingested foreign bodies: a ten-year experience. Ann Emerg Med. 1984 Jan;13(1):30-4. Abstract

Wai Pak M, Chung Lee W, Kwok Fung H, et al. A prospective study of foreign-body ingestion in 311 children. Int J Pediatr Otorhinolaryngol. 2001 Apr 6;58(1):37-45. Abstract

Thabet MH, Basha WM, Askar S. Button battery foreign bodies in children: hazards, management, and recommendations. Biomed Res Int. 2013;2013:846091.Full text Abstract

Ghahremani GG. Foreign bodies of the alimentary tract. In: Gore RM, Levine MS, Laufer I, eds. Textbook of gastrointestinal radiology. Philadelphia, PA: WB Saunders; 1994:2547-58.

Ikenberry SO, Jue TL, Anderson MA, et al; ASGE Standards of Practice Committee. Management of ingested foreign bodies and food impactions. Gastrointest Endosc. 2011 Jun;73(6):1085-91.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Epiglottitis/supraglottitis (in children)
- Peritonsillar abscess (in children)
- Pyloric stenosis or hypertrophic pyloric stenosis (in children)
More Differentials
Guidelines
- Foreign body ingestion
- Paediatric gastrointestinal endoscopy
More Guidelines
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Foreign body ingestion

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

unstable patients

stable patients: oropharyngeal foreign body

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

stable patients: esophageal or rectal foreign body - multiple magnets

stable patients: esophageal or rectal foreign body - batteries

stable patients: foreign body in the stomach, proximal small bowel, or beyond reach of endoscope (excluding multiple magnets and batteries)

stable patients: foreign body in the stomach, proximal small bowel, or beyond reach of endoscope - multiple magnets

stable patients: foreign body in the stomach, proximal small bowel, or beyond reach of endoscope - batteries

Contributors

Authors

Brian M. Fung, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Prakash Adhikari, MBBS, MS

Disclosures

Jose Fernando Aycinena, MD

Disclosures

Richard V. Schaller, Jr, MD

Disclosures

David J. Hackam, MD, PhD

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice