Foreign Bodies

(Gastrointest Endosc 2002;55:802-06)

DEFINITION:

EPIDEMIOLOGY:

Approximately 1500-3000 people die every year due to foreign body ingestion
Only 10-20% of foreign bodies require removal through some form of therapeutic intervention; the rest pass via the GI tract without incident
At risk:
- 80% of ingestions are children (coins)
- Adults: most common is food in pre-existing esophageal stricture/ring; almost all foreign bodies inserted into the rectum are in adults
- Others: psychiatric patients, inmates, smugglers, alcoholics, elderly (dementia, poorly fitting dentures, dysphagia post-stroke)

PATHOPHYSIOLOGY:

Several areas of anatomic or physiologic narrowing exist along the GI lumen and may compromise the spontaneous passage
- Esophagus compression from aortic arch, LES, pylorus, ileocecal valve, anal sphincters
Pathologic abnormalities can cause narrowing along the GI lumen
- Strictures, tumors
Sharp objects (pins, needles, nails, toothpicks): may perforate the intestine, but in 70-90% they pass through without complications
- Foreign bodies pass with axial flow down the lumen
- Reflex relaxation and slowing of peristalsis causes sharp objects to turn around so sharp end trails down intestine
- In colon, foreign objects are centered in the fecal bolus, which further protects bowel wall

Site	Anatomic Defect	Functional Defect
Esophagus	Stenosis, atresia, rings/webs, Zenker’s(tics), vascular anomalies	Scleroderma, Achalasia, Chagas
Stomach	Pyloric stenosis (congenital, malignancy, post-op, ulcer)	Gastroparesis (diabetes, uremia, thyroid)
Intestine	Malignancy, Adhesions, Meckel’s, Strictures (ischemic, surgical, IBD)	Idiopathic intestinal pseudoobstruction, Scleroderma
Colon	Strictures (ischemic, surgical, IBD, trauma, infection), Diverticula	Constipation, Megacolon, Pseudoobstruction
Anus	Stenosis (surgical, IBD, trauma, infection, radiation)	Hirschsprung’s disease
Reprinted with permission from McNally P: GI/Liver Secrets 3rd ed. Elsevier/Mosby, 2006:529.