GI foreign bodies are objects ingested and stuck in the digestive tract.

Foreign bodies in upper GI tract swallowed to causes common emergency department presentation in patients.

Foreign bodies in GI tract such as food, objects, medical devices require management based on nature, location, and patient’s condition.

Foreign objects in upper GI tract swallowed accidentally or purposefully.

Common Types of GI Foreign Bodies are:

Food-related objects:

E.g. Bones

Non-food objects:

E.g. Coins, buttons, batteries, pins

Sharp objects:

E.g. Glass, needles, toothpicks

Medical devices:

E.g. Endoscopy caps, stents, piece of feeding tubes

Groups including children, patients with psychiatric conditions, and individuals with esophageal or GI motility disorders have more chances of foreign body ingestion.

Major locations for foreign bodies as follow:

Esophagus

Stomach

Small intestine

Colon
Complications such as perforation, obstruction, infection, and hemorrhage are seen in patient.

Unknown incidence of foreign body ingestions in all ages. Some study shows 1,671 magnet injuries cases yearly in USA.

Both race and nationality were not identified as factors in foreign body ingestion incidents. No distinctions based on race or nationality in children with swallowed foreign objects.

Men have higher incidence of accidentally swallowing foreign bodies than women.

75-85% of upper GI foreign body patients are children aged between 18 to 48 months.

Adults usually ingest food boluses, bones, fruit pits, dentures, or toothpicks. Prisoners and psychiatric patients may swallow bizarre objects.

GI tract may have foreign bodies, oropharynx well innervated for localizing them in patients.

Injuries to oropharynx mucosa cause foreign body sensation. Chronic foreign bodies or perforations lead to infections in throat tissues.

Objects over 2 cm may not pass the pylorus; those over 6 cm may get stuck at pylorus or duodenal sweep.

Sometimes bones or toothpicks can get stuck in the rectum to cause foreign body sensation.

Ingestion of small magnets at different times can cause bowel necrosis from adhesion.

GI tract may have foreign bodies, oropharynx well innervated for localizing them in patients.

Injuries to oropharynx mucosa cause foreign body sensation. Chronic foreign bodies or perforations lead to infections in throat tissues.

Objects over 2 cm may not pass the pylorus; those over 6 cm may get stuck at pylorus or duodenal sweep.

Sometimes bones or toothpicks can get stuck in the rectum to cause foreign body sensation.

Ingestion of small magnets at different times can cause bowel necrosis from adhesion.

The causes of GI foreign bodies:

Accidental Ingestion

Intentional Ingestion

Swallowing Disorders

Poor Mastication and Dentition

Eating Habits

Medical Devices and Procedures

Clinical History:

Collect details on GI foreign body ingestion including symptoms, risk factors, and circumstances to understand clinical history of patient.

Neck Examination

Respiratory Examination

Oropharyngeal Examination

Abdominal Examination

Severe symptoms are:

Acute chest or abdominal pain

Drooling or inability to swallow

Respiratory distress due to tracheal compression

Vomiting or bloody emesis

Abdominal distension

Sudden onset of severe pain

Moderate symptoms are:

Dysphagia

Odynophagia

Drooling and inability to manage oral secretions

Dysphagia or inability to swallow liquids or solids

Chest pain or pressure

Regurgitation of food or saliva

Nausea and vomiting

Epigastric pain or discomfort

Airway-compromised patients may require immediate airway management. Seated position may be preferred for patients unable to handle secretions.

Button batteries is an emergency case they it causes esophageal wall necrosis within 2 hours from ingestion.

Cases of button batteries in stomach should keep under monitoring using radiographs and follow-up scans in 24 to 48 hours.

Direct and indirect oropharyngeal examination for foreign body sensation patients.

Consider CT scan and endoscopy for patients with suspected ingestion of nonopaque foreign bodies such as plastic objects or toothpicks.

Most healthy children with coins stuck in their esophagus pass them into the stomach afterward.

People who ingest drugs via body packing should be observed their whole-bowel irrigation helps to pass the packets.

Emergency Medicine

Continuous monitoring of young children necessary due to their tendency to ingest objects.

But only age-appropriate toys without small detachable parts.

Secure button batteries with tape or keep in tool-locked battery compartments.

Regular dental check-ups and proper denture fittings is important in elderly patients.

Eating soft or pureed foods reduces choking risk for those prone to swallowing large objects.

Swallowing therapy with a speech-language pathologist helps patients with dysphagia reduce risk of foreign body ingestion.

Proper awareness about GI foreign bodies should be provided and its related causes with management strategies.

Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort.

Emergency Medicine

Glucagon:

It stimulates cAMP synthesis to increase hepatic glycogenolysis and gluconeogenesis in blood glucose levels.

Sodium bicarbonate, citric acid, and simethicone:

They neutralize acidity and relieves functional gastric bloating to improve peristaltic activity in the GI tract.

Emergency Medicine

The intervention for gastrointestinal (GI) foreign bodies involves procedures to remove the foreign body.

Key Interventions used for removal of GI Foreign Bodies are:

Endoscopy

Laparoscopy

Fluoroscopy-Assisted Removal

Bougie Dilation

Emergency Medicine

In initial treatment phase, evaluation of type of foreign body, triage, physical examination and diagnostic test to confirm diagnosis.

Pharmacologic therapy is effective in the treatment phase as it includes use of gastrointestinal agents.

In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies.

The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.