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Foreign Body Ingestion

  1. What is foreign body ingestion?
  2. Symptoms
  3. Causes
  4. Risks
  5. Diagnosis
  6. Treatment
  7. Prevention
  8. Complications
  9. FAQs
  10. Other names for foreign body ingestion

What is foreign body ingestion?

Foreign body ingestion most often occurs when a non-edible object is swallowed and enters the digestive tract. However, the condition can also refer to edible items that become lodged before reaching the stomach. It can be a medical emergency, depending on the object swallowed.

Around 80 percent of foreign body ingestions pass through the gastrointestinal tract without causing any symptoms or complications at all.[1] Items that are small and rounded, such as coins, buttons and marbles, are the least likely to cause complications when swallowed. However, if the foreign body that has been swallowed is large, sharp or toxic, urgent medical intervention can be required.[2]

Objects, which are more likely to cause complications when ingested, include:

  • Batteries
  • Magnets
  • Toothpicks
  • Other sharp objects

Symptoms relating to foreign body ingestion tend to vary, depending on the object swallowed and exactly where in the digestive tract it is. Signs that a foreign body has been swallowed and is causing a problem may include pain in the throat or chest, a lump in the throat or chest, and difficulty swallowing.[3]

Treatment depends on the object swallowed, where in the digestive tract it is and whether or not the object is likely to pass through the body of its own accord. Although some objects can cause severe consequences, the majority of people who swallow a foreign body will recover without complications.

Symptoms of foreign body ingestion

If the foreign body that has been ingested is small, blunt and non-toxic, it may pass through the entire digestive tract without causing any health problems or symptoms. Such objects generally pass through the gastrointestinal system within four to six days, although the precise time frame can depend on additional factors, such as the person’s metabolism, as well as the item swallowed.[1]

If the object is large or sharp, it might get stuck in a specific area of the digestive tract, such as the:[2]

  • Esophagus, the muscular tube that carries food and drink from the throat down to the stomach
  • Stomach, the internal organ that uses enzymes and acids to help break food down into smaller pieces
  • Small and large intestines, the long tubes that absorb the nutrients and water from food, before turning all remaining waste material into stool
  • Rectum, the final section of the large intestine where the body stores stool before defecation

Good to know: The digestive tract covers a large area of the human body. Therefore, symptoms of a foreign body ingestion depend not only on what has been ingested, but also where the foreign object is currently located. If you are concerned you or a loved one may have ingested a foreign object, you can use the Ada app to carry out a free symptom assessment.

Symptoms of a foreign body in the esophagus

When the foreign body that has been ingested does become stuck, it most often lodges in the esophagus. In approximately 75 percent of pediatric cases, the foreign object becomes lodged in the upper esophageal sphincter (UES), which is the muscular barrier at the top of the esophagus that opens and closes to allow food to pass from the throat into the digestive tract. In adults, 70 percent of obstructions occur in the lower esophageal sphincter (LES), which is the muscular barrier that prevents the stomach contents from travelling back up the esophagus.[3]

When a foreign body ingestion affects the esophagus, symptoms commonly include:[1][2][3][4]

  • Difficulty swallowing, also known as dysphagia
  • Sensation of a lump in the throat, neck or chest, if the object is blunt
  • Pain in the throat, neck or chest, if the object is sharp
  • Gagging, retching and vomiting
  • Wheezing and coughing
  • Drooling or spitting due to excess saliva in the mouth
  • Blood-stained saliva
  • Loss of appetite

Symptoms of a foreign body in the stomach or intestines

If the foreign body passes through the esophagus, but then gets stuck in the stomach or intestines, the following symptoms may be present:[2][4][5]

  • Pain or cramping in the abdomen
  • Abdominal swelling or bloating
  • Loss of appetite
  • Nausea
  • Vomiting
  • Fever
  • Blood in the stool
  • Diarrhea or constipation

Symptoms of a foreign body in the rectum

If a small, blunt foreign body reaches the rectum without issue, it will often be passed out in the stool without complication. However, if it is sharp and pierces the rectum, symptoms may include:[2][3]

  • Sharp pain during bowel movements
  • Blood in the stool

Worried you may be experiencing symptoms of a foreign body ingestion? You can use the free Ada app to carry out a symptom assessment.

Causes of foreign body ingestion

The most common cause of a foreign body ingestion is when a person unintentionally or unknowingly swallows an object which is either too large, sharp or toxic to pass through the digestive tract without causing potential harm.

Because they often use their mouth to explore the world around them and aren’t aware of the related risks, children are more likely to experience this condition than adults. Foreign body ingestion can occur at any age, but is most often seen in children aged between six months and four years old.[6] Repeated foreign body ingestion in children can be an indication of neglect or a disruptive home environment.[4]

On occasion, foreign bodies are ingested deliberately. Such behavior is often the result of a mental health issue, learning impairment, a means of protest or to hide an object, e.g. drug smuggling.[2][3]

Edible foreign body ingestion

Edible, as well as non-edible, objects can be classed as a foreign body. A food-related obstruction typically occurs in the esophagus and can be caused by a number of factors, such as:[7]

  • Accidentally swallowing food before it has been sufficiently chewed
  • Underestimating the size of the food
  • Pre-existing medical conditions that may narrow the esophagus, such as esophageal cancer and laryngeal cancer

Once an edible object reaches the stomach, it will usually be broken down into smaller pieces through the body’s normal digestive processes. Therefore, edible obstructions most often affect the esophagus, whereas swallowing a non-edible item can affect any area of the digestive tract.

Good to know: It is more typical for adults to experience obstructions due to food ingestion, whereas children are more likely to experience problems due to ingesting non-edible objects.[6]

Non-edible foreign body ingestion

Non-edible foreign bodies often seen ingested by children include:[2][3][6]

  • Coins
  • Small toy parts
  • Pen lids
  • Pins
  • Screws
  • Hair clips
  • Button batteries

In adults, non-edible foreign bodies are more commonly ingested by accident, and include:[3]

  • Food-related items such as bones from meat, toothpicks and fruit pits
  • Dentures

Risk factors for foreign body ingestion

Age is a primary risk factor for foreign body ingestion, with around 80 percent of reported incidents each year in the United States occurring in children.[8] Foreign body ingestion is also more prevalent in the elderly. Other risk factors include:[1][2][9][10]

  • Mental health or psychiatric issues
  • Learning difficulties
  • Pre-existing digestive tract abnormalities, usually resulting from certain surgeries or existing medical conditions such as esophageal cancer
  • Adolescent boys are more likely to ingest a foreign body than adolescent girls, although gender does not appear to be a risk factor in either young children or adults
  • Intoxication. People under the influence of alcohol are more likely to accidentally swallow inadequately chewed food

Good to know: Although there is no evidence to suggest that foreign body ingestion is more common in specific parts of the world, geographic location can affect which objects are most commonly swallowed. In the United States, coins are the foreign body most often ingested. In other countries, fish bones are more common.[9]

Diagnosing a foreign body ingestion

If the affected person is believed to have swallowed a foreign body, diagnosis is usually based on their personal account of the ingestion, the type of object swallowed, symptoms experienced and a physical examination. A physical examination may include the following procedures:[1][3][9]

  • Visually checking the throat and pharynx, the passageway at the back of the throat that connects the mouth and esophagus
  • Manually examining the neck to feel for any obstruction or abnormality
  • Manually examining the abdomen to feel for any obstruction or abnormality
  • Listening to the lungs and checking breathing function
  • Checking vital signs such as blood pressure, temperature and heart rate

People who are known to have swallowed a non-toxic, small, blunt object and are experiencing minimal or no symptoms, may not require any further tests and can simply be observed until the object passes in the stool and symptoms subside.[7] However, if the affected person is displaying significant symptoms or the object is likely to cause complications, further tests may be required.

Imaging tests

Imaging tests, if necessary, usually begin with an X-ray of the neck, chest and abdominal regions.[11] This non-invasive test uses electromagnetic waves and can usually detect the presence and location of objects such as glass, meat bones, dentures, stone and certain metals including coins and batteries. These types of objects are referred to as radiopaque, meaning they are visible on radiograph tests such as X-rays.[3]

Radiolucent objects, i.e. objects which do not always show up on an X-ray, include certain plastics, wood, fish bones and food.[12] Small or fine objects, made of any substance, may also avoid detection.

If the foreign body is understood to be radiolucent, doctors might suggest a procedure called an esophagram.[13] This involves the affected person swallowing a small amount of dye called barium sulphate. The non-toxic powder coats the inside of the esophagus, allowing radiolucent objects to show-up during X-ray.

Good to know: CT scans or MRI scans are less frequently used as an initial diagnostic tool for foreign body ingestion. However, they might be recommended as a further test to help confirm diagnosis or identify complications.[1][11]

Diagnostic endoscopy

An endoscopy is a medical procedure where a long, thin tube ending in a light and camera is inserted into a person’s body in order to gain an internal view. The tube itself, known as an endoscope, is usually inserted through the mouth to access the throat and esophagus.[14]

In the case of foreign body ingestion, an endoscopy can either be used:[9]

  • Diagnostically, to confirm the presence and location of a foreign body,
  • As a treatment method to physically remove the foreign body

Diagnostic endoscopy is often suggested for people who have symptoms of a foreign body ingestion, but for whom imaging tests have been inconclusive.[7]

Metal detectors

Hand-held metal detectors are occasionally used and can be helpful in identifying the presence of commonly swallowed metal objects such as coins and batteries.[2] As this diagnostic method is quick and non-invasive, it is most often used in pediatric cases.

However, although the use of a metal detector is fast, cheap and simple, it does not provide as much detailed information on the precise nature and location of the object as imaging tests do. Therefore, imaging tests are generally considered preferable when diagnosing a foreign body ingestion.[1]

Good to know: Laboratory testing, such as blood tests or urine tests are rarely required during foreign body ingestion diagnosis. If they are suggested, it is usually to check for any associated complications, such as an infection.[11]

Treatment of foreign body ingestions

Around 80 percent of foreign objects will pass through the gastrointestinal tract without causing any complications or requiring medical intervention.[1] However, foreign objects that have become stuck, that can damage the digestive tract or that have toxic properties, generally need to be removed.[2]

Good to know: It is important to get specific advice from a doctor if a foreign body ingestion is suspected, even if the affected person is not currently displaying any symptoms.

Endoscopic treatment

Removal of the foreign body during an endoscopy is the most common treatment method for a foreign body ingestion.[15] An endoscope is a long, thin tube with a camera and light source on one end, which can be inserted into the human body to access and look into the digestive tract.

As well as helping to locate the foreign body, certain surgical instruments such as forceps can be attached to the endoscope to enable removal of the object. Endoscopes are typically inserted through the mouth to access the esophagus and stomach, or through the anus to access the rectum and large intestine.

An emergency endoscopy may be performed immediately if:[2][7]

  • The foreign body is causing a significant obstruction of the airways
  • The object is sharp enough to pierce internal walls
  • The object is a battery or other item which could cause additional complications

An endoscopy may also be recommended to remove the object under the following circumstances:[2][16]

  • The object has been stuck in the esophagus for more than 24 hours
  • The object has been stuck in the stomach for longer than three to four weeks
  • The object is larger than 1 inch in diameter
  • The object is awkwardly shaped and likely to become lodged
  • The object is a magnet that can be successfully reached with the endoscope

Good to know: Endoscopic removal of a foreign body very rarely results in complications, and is therefore typically considered a low-risk treatment method for foreign body ingestion.[17]

Medication

The drug glucagon may be recommended for people who are suspected to have a piece of food stuck in their esophagus. This type of obstruction is often referred to as a food bolus impaction.[18] Glucagon is administered intravenously and relaxes the esophagus, allowing the food to naturally move down and enter the rest of the digestive tract.[2]

Surgery

Surgery is typically only required in the most complicated of cases and less than 1 percent of foreign body ingestions result in surgical treatment.[1] Surgical removal of the foreign body may be necessary in the following instances:[1][2]

  • Endoscopic removal has been unsuccessful
  • The object has been lodged in the small intestine for longer than a week
  • Certain complications have occurred such as peritonitis, an inflammation of the tissue that lines the abdomen
  • The object is filled with drugs and has become lodged, or the affected person is displaying symptoms of a drug overdose

Good to know: Surgery is preferred over endoscopy to remove drug-filled packages from the body. This is due to the risk of an endoscope breaking open the package during retrieval and causing a serious overdose.[2]

Other treatment methods

Although the above treatments are widely used in cases of foreign body ingestion, there are a number of other possible treatment methods such as:

Foley catheter method

This method involves passing an un-inflated Foley catheter down the esophagus until it passes the foreign body. The catheter is then gently inflated and withdrawn, drawing the object away with it. This method should only be attempted by experienced medical staff and is only suitable for blunt esophageal obstructions that have been in place for less than 24 hours.[15][19]

Bougienage method

This method can be used with blunt foreign objects in the esophagus. It involves using a thin, cylindrical instrument known as a bougie to gently push on the object, dislodging it so it passes into the rest of the digestive tract. Again, this method should only be attempted by experienced medical staff and is only suitable for esophageal obstructions that have been in place for less than 24 hours.[15][19]

Manual removal

Manual removal is rarely attempted in the upper digestive tract due to difficulties of access and the gag reflex.[20] However, if the object has passed all the way down to the rectum, manual removal via the anus might be possible.[2]

Flushing techniques

Flushing techniques may be recommended for non-complicated foreign bodies lodged around the lower esophageal sphincter (LES). This involves the affected person eating and/or drinking in order to encourage the object to pass through the LES and into the stomach. Carbonated drinks are thought to be helpful in certain cases, as they can increase gas pressure in the esophagus.[19]

Good to know: Treatment options for foreign body ingestion are often different from person to person and dependent on individual circumstances. Always contact a doctor if a foreign body ingestion is suspected to confirm diagnosis and discuss appropriate treatment methods. You can also download the free Ada app and carry out a personalized symptom assessment.

Preventing a foreign body ingestion

Educating caregivers about foreign body ingestion can help prevent the children in their care swallowing non-edible items. Preventive suggestions include:[21][22]

  • Keeping small objects like coins, buttons and marbles away from children
  • Being aware of battery-operated devices and supervising children’s play with them
  • Home-safety procedures such as safety latches on cupboards and lockable drawers
  • Taking special care around unusual times such as parties or vacations, when there may be extra visitors to the home and new objects within arms’ reach

Foreign body ingestion can occur to anyone at any age. Avoid putting small objects which can accidentally be swallowed into your own mouth e.g. pen lids, screws, toothpicks. Always take care to eat slowly and chew food down into small, easily digestible chunks.

Complications of foreign body ingestion

A foreign body ingestion does not always result in medical complications. In 80 percent of cases, the object that has been swallowed will simply pass through the digestive tract as normal, exiting the body in the feces.[1]

However, in some cases, the ingested object may cause complications. Around 1,500 deaths are reported each year in the United States due to foreign body ingestion.[1] Three primary causes of complications in foreign body ingestion are:

Impaction

The term impaction is the state of something becoming lodged or stuck in a bodily passage. In foreign body ingestion the affected passage is usually the esophagus, but objects can also become stuck in the stomach, intestines or rectum. Impaction is most likely to occur with objects that are particularly large, sharp or unusually shaped.

Impaction is the most common cause of complications in pediatric foreign body ingestions.[9] Typical symptoms of an object becoming stuck in the digestive tract have already been covered in the Symptoms section above. However, more severe complications of foreign body impaction include:[1][10][23][24]

  • Difficulty breathing, particularly when the object is blocking the esophagus
  • Deterioration of the soft tissues around the impacted object, known as necrosis
  • Abscesses forming in the throat, esophagus or any soft tissue
  • Narrowing of the esophagus, known as esophageal stricture, which can lead to choking or difficulty breathing

Perforation

The term perforation refers to a hole made in a part of the body. This can occur in a foreign body ingestion when the swallowed object is sharp and pierces the internal walls of the digestive tract. Possible complications include:[1][2][23][25][26]

  • Soft tissue infection, potentially leading to sepsis
  • Mediastinitis, an inflammation in the chest cavity
  • Peritonitis, an inflammation in the abdominal cavity
  • Pneumothorax, a collapsed lung
  • Internal bleeding

Toxic substances

Complications may also occur when the swallowed foreign body contains toxic chemicals or substances that can be dangerous when consumed. Generally, such complications are associated with objects such as batteries, coins or drugs. Possible complications include:[1][6][7][23][27]

  • Deterioration of the soft tissues around the object, known as necrosis
  • Internal burns
  • Formation of a fistula, which is an abnormal connection between two hollow spaces in the body. In foreign body ingestion, a tracheoesophageal fistula is most likely, in which the trachea and esophagus tubes, which are not usually joined, become connected
  • Metal poisoning
  • Allergic reaction to the ingested object, such as a nickel allergy

Good to know: Severe complications due to a foreign body ingestion are rare, but can occur. Although impaction, perforation and toxic substances are known causes of medical complications, the precise symptoms displayed can be extremely variable. Always contact a doctor immediately if a foreign body ingestion is suspected.

Foreign body ingestion FAQs

Q: Can a foreign body ingestion be caused by food?
A: Yes. Medical issues arising from a foreign body ingestion can be caused by swallowing both non-edible and edible objects. Whereas children are more likely to swallow non-food objects, adults are more likely to experience health problems due to food ingestion.

Q: What foreign objects are most commonly swallowed?
A: In the United States, the object most commonly swallowed is a coin. In other countries, fish bones are the most frequently swallowed foreign body. Other foreign bodies often swallowed include:

  • Small toy parts
  • Pen lids
  • Pins and screws
  • Hair clips
  • Button batteries
  • Needles
  • Magnets
  • Buttons
  • Food-related items such as bones from meat, toothpicks and fruit pits – most often seen in adults
  • Dentures – most often seen in adults

Q: Should I contact a doctor if I or a loved one has swallowed a foreign object?
A: Yes. Even though the majority of foreign body ingestions do not result in complications and sometimes do not even cause symptoms, it is still important to visit a doctor for a proper examination. In some cases, foreign body ingestion can result in serious complications and may even become life-threatening, so always seek medical help if it is suspected.

Q: What is the treatment for a foreign body ingestions?
A: Treatment for a foreign body ingestion depends on the object that has been swallowed, as well as where in the digestive tract it is. In many cases, a non-complicated foreign body will simply pass through the gastrointestinal tract without the need for any medical treatment at all. However, if treatment is required, an endoscopy is the most common method. This procedure involves passing a long, thin tube into the digestive tract in order to locate and remove the foreign object.

Other, less common, treatment methods include medication and surgery.

Q: Why is foreign body ingestion more common in children than adults?
A: Foreign body ingestions are much more common in childhood than in adulthood. This is because young children often use their mouths to explore new objects, leading to a greater chance of accidentally swallowing a foreign body. Children are also less aware of the associated risks, and are therefore more likely to ingest potentially harmful objects such as batteries, magnets or sharp items.

Other names for foreign body ingestion

  • swallowed foreign body
  • foreign body in alimentary tract

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