Foreign body ingestion

Common clinical scenario which is intentional, not accidental, in the majority of cases.

Occurs more commonly in the elderly, the incarcerated, or who have alcoholism, dental abnormalities, developmental delay, or psychiatric disorders.

The most common foreign body ingrsted in the elderly include: dentures, fish bones, and chicken bones.

Coins and toys are more commonly ingested in the pediatric population.

Most ingested foreign objects are found in the esophagus.

Only 2.6-4.5% of foreign bodies are lodged in the duodenum.

Most foreign bodies pass uneventfully through the G.I. tract.

10-20% of patients require non-surgical interventions, and 1% need surgical removal.

Traversing the esophagus is the key determinant in the outcome of a foreign body ingestion.

Most foreign bodies will traverse the G.I. tract without complications after crossing the GE junction.

After passing the pylorus, the foreign body can obstruct at various locations in the bowel, usually at the junction of the second and third parts of the duodenum, the ileocecal junction, the appendiceal lumen, the cecal and asending colonic junction, and the large intestinal flexures and haustra.

Foreign bodies more than 2 cm wide tend the to remain in the stomach due to the narrowing at the pylorus.

Objects more than 5 cm long frequently impact in the duodenal.

Onset of symptoms is a variable from the time of ingestion,.

Imaging studies are used to detect foreign body location.

Imaging in localization by x-ray includes failure to identify fish or chicken bones, glass and thin metals, wood, and plastic.

CT is limited by its ability to detect radio lucent objects.

Initial management of foreign body ingestion depends on complication risks such as perforation or vascular penetration.

Patients at high risk for complications including those with history of G.I. tract surgeries or congenital gastrointestinal malformations.

Foreign bodies including multiple long and thin objects cause more complications.

In the majority of low risk individuals foreign bodies pass without complications, and observation is warranted.

Endoscopy is the initial approach where intervention is required, and find bodies can’t be retrieved using snares, baskets, nets or forceps.

Objects 6-10 cm in length may be grasped or snared by endoscopy.

Sharp objects should be retrieved due to a higher risk of complications and mortality.

Such objects can be retrieved with snare or forceps and an overtube.

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