Foreign body ingestion

Last reviewed: September 2018

Last updated: March 2018

Summary

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 non-operative intervention, and 1% or less of cases may develop complications (e.g., bowel obstruction, perforation, severe haemorrhage, abscess formation, or septicaemia) and require further surgical interventions.

Despite the technical challenge, fibre-optic endoscopy is considered the first line of intervention for removal of foreign bodies. It is also considered the safest and most reliable method of diagnosis and treatment of GI foreign bodies.

Other non-operative techniques for foreign body removal include: rigid endoscopy, Foley catheters, and oesophageal 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 into the mouth and through the gastrointestinal (GI) tract.

History and exam

Key diagnostic factors

presence of risk factors
dysphagia
non-specific abdominal pain
stridor and wheezing
drooling

Full details

Other diagnostic factors

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

Full details

Risk factors

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

Full details

Diagnostic investigations

1st investigations to order

x-rays of neck, chest, abdomen
FBC
urea and electrolytes
PT/INR
PTT
oxygen saturation
faecal occult blood testing
hand-held metal detector (HHMD)

Full details

Investigations to consider

cardiac biomarkers
ECG
CT neck, chest, and/or abdomen
magnetic resonance imaging (MRI)
laryngoscopy
endoscopy
barium or gastrografin oesophagogram

Full details

Treatment algorithm

INITIAL

Contributors

Authors VIEW ALL 

Juan Carlos Munoz, MD

Associate Professor of Medicine

Borland Groover Clinic

Jacksonville

Disclosures

JCM declares that he has no competing interests.

Acknowledgements

Professor Juan Carlos Munoz would like to gratefully acknowledge Professor Luis F. Laos, a previous contributor to this monograph. LFL declares that he has no competing interests.

Peer reviewers VIEW ALL 

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.

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Foreign body ingestion

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

unstable patients

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 VIEW ALL 

Juan Carlos Munoz, MD

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Prakash Adhikari, MBBS, MS

Disclosures

Jose Fernando Aycinena, MD

Disclosures

Richard V. Schaller, Jr, MD

Disclosures

David J. Hackam, MD, PhD

Disclosures

Differentials

Guidelines

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