Foreign Bodies in the Gastrointestinal Tract

Foreign bodies may be deliberately or accidentally swallowed or introduced into the lower gastrointestinal tract from the rectum. The most frequent victims are young children, persons with dentures, and individuals who are inebriated or mentally impaired.

There are no controlled studies for the management of foreign bodies in the gastrointestinal tract. Each situation needs to be evaluated depending on the nature of the foreign body, the symptoms, the condition of the patient, and the organs involved. Most ingested foreign bodies pass safely through the intestinal tract between 48 hours and 1 month after ingestion. Some objects may result in obstruction or perforation and may require endoscopic or surgical intervention. Sharp objects such as pins, toothpicks, and bones may cause perforation, especially in the esophagus and the ileocecal area. Patients may have pain, sepsis, mediastinitis, peritonitis, hemorrhage, abscess, or abdominal mass.

I. ESOPHAGUS.

Foreign bodies may cause obstruction above the upper esophageal sphincter and may compromise the airway. These patients should be urgently handled by ear, nose, and throat specialists.

Most obstructions from foreign body ingestions involve the esophagus; many occur above a benign or malignant stricture, web, or ring. The four areas of physiologic narrowing in the esophagus—the cricopharyngeal muscle, the aortic arch, the left main-stem bronchus, and the gastroesophageal junction—are also common sites for obstruction. Sharp objects such as fish or poultry bones, pins, or toothpicks may perforate the esophagus, resulting in sepsis or hemorrhage. Button (miniature, 7.9-11.6 mm) battery ingestions are not uncommon in children. Most of these spontaneously pass; however, those with larger diameters (15.6-23.0 mm) may impact in the esophagus, causing tissue necrosis, perforation, or hemorrhage.

A. Clinical findings

1. Signs and symptoms.

Acute esophageal obstruction may result in substernal pain at the level of obstruction or be referred to the sternal notch. The pain may be mild or severe or may mimic a myocardial infarction. There may be profuse salivation and regurgitation. In patients who have ingested a sharp object like a fish bone, odynophagia and a sensation of the object lodged in the esophagus may be present.

2. Physical examination

is usually unrewarding. When perforation is suspected, subcutaneous air in the soft tissues should be sought by looking for crepitus by palpation of the upper thorax and neck.

B. Diagnostic tests

1. Radiographic techniques

a. Photographic densities. Plain x-rays are frequently used in the detection of foreign bodies. However, not all foreign bodies are radiopaque due to differences in their densities.

i. Foreign bodies of high density are highly radiopaque and have low photographic density on a radiograph. If the object is of adequate size, it is easily differentiated from the surrounding tissues. Common examples include objects made of iron, steel, and some alloys, as in nails, screws, chips, bullets, and many coins.

ii. Foreign bodies with physical densities somewhat higher than body tissues (e.g., glass, aluminum, chicken bones, plastics) have photographic densities slightly less than body tissues and form more subtle images.

iii. Body-density foreign bodies possess the same photographic density as the surrounding body tissues and are virtually impossible to detect in radiographs. Thorns, cactus needles, sea- and freshwater animal spines, some plastics, and wood that has been in the body for more than 48 hours are common examples.

iv. When the density of the object is less than the density of surrounding body tissues, it appears darker. Some examples of this type of foreign body are wood immediately after introduction into the body, materials containing air, and some plastics.

v. Glass,

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