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.
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
- nonspecific abdominal pain
- stridor and wheezing
Other diagnostic factors
- gagging, nausea/vomiting, neck/throat pain
- atypical chest pain or noncardiac chest pain
- 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
- 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
1st investigations to order
- x-rays of neck, chest, abdomen
- basic metabolic panel
- prothrombin time (PT)/INR, PTT
- handheld metal detector
Investigations to consider
- cardiac biomarkers and ECG
- CT of neck, chest and/or abdomen
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
Brian M. Fung, MD
Division of Gastroenterology and Hepatology
Department of Internal Medicine
University of Arizona College of Medicine - Phoenix
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
Health Sciences Clinical Professor
David Geffen School of Medicine at UCLA
JHT consults for Alpha lnsights, Atheneum, DeciBio, GLG, Guidepoint, Horizon, Ipsen, Olympus, and Techspert.
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.
ACM, 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.
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