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Foreign Bodies in the Digestive Tract

By Raghav Bansal, MBBS, Assistant Professor, Ichan School of Medicine at Mount Sinai, NY ; Aaron E. Walfish, MD, Clinical Assistant Professor, Mount Sinai Medical Center

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Foreign bodies are ingested objects that can get stuck in the digestive tract and sometimes perforate (pierce) it.

  • Foreign bodies can get stuck in various parts of the digestive tract.

  • Foreign bodies may cause no symptoms or may cause symptoms depending on where they become stuck.

  • The diagnosis is based on x-rays and endoscopy and sometimes computed tomography.

  • Most foreign bodies pass without treatment, but some need to be removed endoscopically, surgically, or manually.

Foreign bodies can get stuck in various parts of the digestive tract such as the

Foreign bodies may be accidentally swallowed. Children may swallow small, round foods (such as grapes, peanuts, or candies), which may become stuck. In addition, infants and toddlers often swallow a wide variety of inedible objects (such as coins and disk or button batteries), some of which become stuck in the esophagus. People who wear dentures, older people, and intoxicated adults are at risk of accidentally swallowing inadequately chewed food (particularly meat such as steak or hot dogs), which may become stuck in the esophagus.

Sometimes foreign bodies are swallowed purposely, as when smugglers (body packers) or body stuffers swallow balloons, packages, or vials filled with illegal drugs to evade detection. Prison inmates and people who have mental health disorders may also purposely and repeatedly swallow foreign bodies.

If undigestible objects are small, they pass through the digestive system until they are passed with stool. However, larger objects or sharp ones, such as toothpicks and chicken or fish bones, may get stuck in the esophagus or stomach or at areas of the intestine that have sharp turns or are narrow. Objects that pass all the way through the intestines may still become stuck in the rectum.

Foreign bodies may be inserted in the rectum intentionally (such as during sexual play) but may become stuck unintentionally (see Foreign Objects in the Rectum).

Symptoms

Foreign bodies cause symptoms depending on the nature of the foreign body and where it becomes stuck.

Foreign bodies in the esophagus

A small blunt object that is swallowed may cause the sensation of something being stuck in the esophagus and difficulty swallowing (dysphagia). This feeling may persist for a short time even after the object has passed into the stomach. A small sharp object that is swallowed may become lodged in the esophagus and cause pain, even though the person is able to swallow normally. When the esophagus is completely blocked, the person is unable to swallow anything, even saliva, and drools and spits constantly. The saliva may be stained with blood, and the person may gag and choke. The person may try to vomit, but nothing comes up.

Foreign bodies in the stomach and intestines

If a foreign body is partially or completely obstructing the stomach, the small intestine, or, rarely, the large intestine, it may cause cramps, bloating, loss of appetite, nausea, and vomiting (see Intestinal Obstruction).

Foreign bodies in the rectum

Sudden, excruciating pain during bowel movements suggests that a foreign object is piercing the lining of the anus or rectum. The stool may be bloody.

Complications of foreign bodies in the digestive tract

If a sharp object pierces the esophagus, consequences may be serious. Food can leak into the chest cavity (mediastinum) and cause life-threatening inflammation (mediastinitis). People who have swallowed button batteries, which can eat away at the lining of the esophagus, may have burns of the esophagus.

Sharp objects can cause a perforation of the digestive tract. A perforation allows food, digestive juices, or intestinal contents including stool to leak into the abdomen. Such leakage is a medical emergency because it can cause peritonitis (inflammation of the peritoneal [abdominal] cavity).

Sometimes foreign bodies lead to blood in the stool.

If a person has swallowed an object filled with drugs, the object may rupture, which can then lead to an overdose of the drug.

Diagnosis

  • Imaging tests (typically x-rays)

  • Endoscopy

Often, a foreign body can be seen on x-rays of the abdomen and sometimes of the chest. Usually, endoscopy (a visual examination of the digestive tract using a flexible tube called an endoscope) is done to determine the nature of the foreign body and to rule out a tumor. Other imaging tests, such as computed tomography (CT), may be done to help identify the foreign body.

Foreign bodies that are stuck in the rectum can often be felt by a doctor during a digital examination, in which the doctor inserts a gloved finger in the person's rectum.

Doctors may use a hand-held metal detector to detect metallic foreign bodies (such as coins and batteries). However, these metallic objects are usually detected with x-rays.

Treatment

  • For foreign bodies in the esophagus, glucagon or endoscopy

  • For foreign bodies in the stomach, endoscopy

  • For foreign bodies in the intestines, occasionally endoscopic or surgical removal

  • For foreign bodies in the rectum, endoscopic or manual removal

Some foreign bodies pass spontaneously and require no treatment. Sometimes a doctor recommends that the person consume a liquid diet to help excrete the object. Some small objects, such as toothpicks and fish bones, may remain in the gastrointestinal tract for many years without causing symptoms.

Foreign bodies in the esophagus

People who do not have symptoms of obstruction and who have not ingested a sharp object or disk or button batteries are observed by a doctor for up to 24 hours to see whether the object passes on its own. When a doctor suspects that a piece of food is stuck in the esophagus, the drug glucagon may be given by vein (intravenously) to relax the esophagus and allow the food to pass spontaneously through the digestive tract.

A doctor typically removes a foreign body that has not passed out of the esophagus within 24 hours because a delay in removal increases the risk of complications, including perforation, and decreases the likelihood of a successful removal.

Doctors can remove some objects that are stuck in the esophagus with forceps or a basket passed through an endoscope.

Because sharp objects may pierce the wall of the esophagus, they must be removed urgently by endoscopy. Batteries must also be removed urgently from the esophagus because they can cause internal burns.

Foreign bodies in the stomach and intestines

Doctors typically do endoscopy to remove sharp objects from the stomach because they can cause perforation. Doctors also do endoscopy to remove

  • Small, round objects that have been in the stomach longer than 3 to 4 weeks

  • Batteries that have been in the stomach for more than 48 hours but have not caused injury

  • Objects that are larger than 1 inch (about 2.5 centimeters) in diameter in the stomach

  • Any magnets that can be reached with the endoscope

Small, round objects, such as coins, may pass on their own. Doctors advise people to check their stool to see if the object has passed. If the object does not appear in the stool, doctors do repeated x-rays to check whether the object has passed.

Foreign bodies that exit the stomach and pass into the small intestine usually pass the digestive tract with no problems. However, if a short, blunt object is stuck in the small intestine for more than 1 week and cannot be removed with endoscopy, doctors may remove it surgically.

When an object suspected of being filled with drugs is detected in a person who does not have symptoms, the person is hospitalized and closely monitored in an intensive care unit (ICU). Doctors do surgery if the person has

  • Symptoms of intestinal obstruction

  • Symptoms of drug overdose (suggesting the object is leaking drugs)

  • Not passed the object after a considerable time

Doctors usually do not do endoscopy to remove a drug-filled object because there is a high risk it may break open during removal and cause a serious overdose.

Foreign bodies in the rectum

A foreign body in the rectum may be removed endoscopically or manually depending on the type of object. Sometimes manual removal will require the person's anus to be numbed with injections of a local anesthetic and held open with a special instrument. Doctors are then able to use forceps to grasp and remove the object. This procedure may require heavy sedation.

After removal of a foreign body, doctors may look in the rectum and in the lower part of the colon using a flexible tube called a sigmoidoscope to rule out injury or perforation. See also treatment of foreign objects in the rectum.

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