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Foreign body ingestion

Last reviewed: 16 Oct 2024
Last updated: 14 Feb 2023

Summary

Definition

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

AZ

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

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.

  • Foreign body ingestion images
  • 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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