Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- dysphagia
- non-specific abdominal pain
- stridor and wheezing
- drooling
Other diagnostic factors
- gagging, nausea/vomiting, neck/throat pain
- atypical chest pain or non-cardiac 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
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 oesophageal disease, surgery, or procedure
- seizure disorder
Diagnostic investigations
1st investigations to order
- x-rays of neck, chest, abdomen
- FBC
- basic metabolic panel
- prothrombin time (PT)/INR, PTT
- hand-held metal detector
Investigations to consider
- cardiac biomarkers and ECG
- CT of neck, chest, and/or abdomen
- MRI
- laryngoscopy
- endoscopy
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 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
AZ
Disclosures
BMF is the author of one reference cited in this topic.
James H. Tabibian, MD, PhD
Director of Endoscopy
Division of Gastroenterology
Department of Medicine
Olive View - UCLA Medical Center
Sylmar
Health Sciences Clinical Professor
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
JHT consults for Alpha lnsights, Atheneum, DeciBio, GLG, Guidepoint, Horizon, Ipsen, Olympus, and Techspert.
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
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.
Differentials
- Epiglottitis/supraglottitis (in children)
- Peritonsillar abscess (in children)
- Pyloric stenosis or hypertrophic pyloric stenosis (in children)
More DifferentialsGuidelines
- Foreign body ingestion
- Paediatric gastrointestinal endoscopy
More Guidelines
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer