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.
An ingested foreign body is any object (including food) originating outside the body and ingested into the mouth and through the gastrointestinal tract.
History and exam
Key diagnostic factors
- presence of risk factors
- non-specific abdominal pain
- stridor and wheezing
Other diagnostic factors
- gagging, nausea/vomiting, neck/throat pain
- atypical chest pain or non-cardiac chest pain
- signs of upper gastrointestinal obstruction
- lower gastrointestinal bleeding
- 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
- 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
1st investigations to order
- x-rays of neck, chest, abdomen
- urea and electrolytes
- prothrombin time/INR
- oxygen saturation
- faecal occult blood testing
- hand-held metal detector
Investigations to consider
- cardiac biomarkers
- CT of neck, chest, and/or abdomen
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
Andrew C. Meltzer, MD, MS
Department of Emergency Medicine
GW School of Medicine & Health Sciences
Center for Healthcare Innovation and Policy Research
ACM declares that he has no competing interests.
Dr Andrew C. Meltzer would like to gratefully acknowledge Dr Juan Carlos Munoz and Professor Luis F. Laos, previous contributors to this topic.
JCM and LFL declare that they have no competing interests.
Prakash Adhikari, MBBS, MS
Ganesh Man Singh Memorial Academy of ENT and Head and Neck Studies
TU Teaching Hospital
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
JFA declares that he has no competing interests.
Richard V. Schaller, Jr, MD
Clinical Research Fellow
Cleveland Clinic Florida
RVS declares that he has no competing interests.
David J. Hackam, MD, PhD
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
DJH declares that he has no competing interests.
- Epiglottitis/supraglottitis (in children)
- Peritonsillar abscess (in children)
- Pyloric stenosis or hypertrophic pyloric stenosis (in children)
- 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
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