Guideline for the management of ingested foreign bodies

doi:10.1016/S0016-5107(02)70407-0

Gastrointestinal Endoscopy

Volume 55, Issue 7, June 2002, Pages 802-806

https://doi.org/10.1016/S0016-5107(02)70407-0 Get rights and content

Abstract

This is one of a series of statements discussing the utilization of gastrointestinal endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts.

Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations.

Section snippets

Diagnosis

Older children and fully conscious, communicative adults may be able to identify the material swallowed and point to the location of discomfort. Localization of the level of impaction, however, is often not reliable.²⁶ In many instances the ingestion goes unrecognized or unreported until the onset of symptoms, which may be remote from the time of ingestion.27, 28, 29, 30 Young children, the mentally impaired, or the psychiatrically deranged may present with choking, refusal to eat, vomiting,

General

Once foreign body ingestion is diagnosed, the physician must decide whether or not intervention is necessary, what degree of urgency is called for, and by what means. Management is influenced by the patient's age and clinical condition; the size, shape, and classification of the ingested material; the anatomic location in which the object is lodged; and the technical abilities of the endoscopist.19, 38

The timing of endoscopic intervention in foreign body ingestion is dictated by the perceived

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Self-harm, suicide and brain death: the role of the radiologist
2024, Clinical Radiology
Suicide is a leading cause of death worldwide and takes many forms, which include hanging, jumping from a height, sharp force trauma, ingestion/poisoning, drowning, and firearm injuries. Self-harm and suicide are associated with particular injuries and patterns of injury. Many of these patterns are apparent on imaging. Self-harm or suicidal intent may be overlooked initially in such cases, particularly when the patient is unconscious or uncooperative. Correct identification of these findings by the radiologist will allow a patient's management to be tailored accordingly and may prevent future suicide attempts. The initial role of the radiologists in these cases is to identify life-threatening injuries that require urgent medical attention. The radiologist can add value by drawing attention to associated injuries, which may have been missed on initial clinical assessment. In many cases of self-harm and suicide, imaging is more reliable than clinical assessment. The radiologist may be able to provide important prognostic information that allows clinicians to manage expectations and plan appropriately. Furthermore, some imaging studies will provide essential forensic information. Unfortunately, many cases of attempted suicide will end in brain death. The radiologist may have a role in these cases in identifying evidence of hypoxic–ischaemic brain injury, confirming a diagnosis of brain death through judicious use of ancillary tests and, finally, in donor screening for organ transplantation. A review is presented to illustrate the imaging features of self-harm, suicide, and brain death, and to highlight the important role of the radiologist in these cases.
Life-threatening esophageal perforation due to blister pack ingestion
2023, American Journal of Emergency Medicine
Citation Excerpt :
Most FBs that reach the GI tract pass through spontaneously. However, 10–20% of patients with FB ingestion require non-operative intervention and ≤1% require a surgical procedure [10]. Dangerous esophageal FBs such as fishbones, animal bones, metal, and dental prosthesis result in endoscopic treatment or serious damage [11-13].
Most ingested foreign bodies do not cause serious complications. In rare cases, elderly people with cognitive decline may unintentionally swallow a blister pack while trying to take medicine. When a blister pack is separated into individual parts, the separated parts have sharp edges that can cause serious damage if ingested. We report a case of an elderly patient who unintentionally ingested a blister pack, which led to esophageal perforation and ultimately his death.
Reprint of: Ingestion and insertion of foreign bodies
2022, Disease-a-Month
Gastrointestinal perforations by ingested foreign bodies: A preoperative diagnostic flowchart-based experience. A case series report
2022, International Journal of Surgery Case Reports
Gastrointestinal tract perforation is the most harmful complication of Foreign Body (FB) ingestion, besides diagnostic delay adversely affects the outcome. This paper aims to present our preoperative diagnostic flowchart and describe the surgical management in a Tunisian center.
A retrospective review of 48 patients with gastrointestinal perforation by ingested FB treated in the surgery department of Jendouba Hospital. January 2010–December 2020.
48 patients were treated for gastrointestinal tract perforation induced by FB ingestion. The mean age was 56.6 years. The sex ratio was 2/1. Acute abdominal pain was reported in all the patients. 35 patients had abdominal X-ray that showed a FB in 12 cases. CT scan was performed in 38 patients and identified the FB in 28 cases. Postoperative proofreading has identified a preoperative missed diagnosis of FB perforation in 5 cases, all before applying the diagnostic flowchart. All patients underwent open surgery after a median time of 7.12 h. This duration decreased after applying the flowchart (8.21 h versus 5.6 h). 33 patients had a terminal ileum perforation. Enterectomy was performed in 33 patients. Postoperatively, there was one abdominal abscess, one pulmonary embolism, one refractory septic choc, and one wound abscess. The median hospital stay was 6.35 days. The mortality rate was 6.25%. All patients managed with enterostomy had their stoma closed after 3–5 months.
The challenge of gastrointestinal perforation due to FB ingestion is accurate diagnosis and early management. A standardized initial assessment based on a diagnostic flowchart is helpful to achieve this goal and improve outcomes.
Enteroenteric fistulae after ingestion of multiple magnets in children
2022, Journal of Pediatric Surgery Case Reports
Infants and young children explore objects by putting them in the mouth. Although most swallowed foreign bodies pass spontaneously through the gastrointestinal tract without causing harm, some of them are potentially dangerous and may be lethal.
Five children (3boys and 2girls) have swallowed multiple high strength and powerful rare earth element Neodymium magnets. Their ages ranged between (nine months to six-year-old). Three cases were subjected to open and two for laparoscopic exploration (one of them converted to open).
multiple complicated enteroenteric fistulae in three cases and multiple perforation of small intestine in two cases. Resection anastomosis was done for one case and simple closure of small bowel perforations for other four cases. Post operative course was uneventful for all patients and discharged in a good general condition.
General practitioners should be aware of the danger and complications of Neodymium magnetic beads ingestion by children. Early endoscopic removal is recommended if the patient presents immediately after ingestion. Parents awareness through media is required to abandon magnet balls in houses and where children can ingest those dangerous balls.
Upper gastrointestinal foreign bodies in adults: A systematic review
2021, American Journal of Emergency Medicine
Foreign body(FB) ingestion in the upper digestive tract is a common emergency that lacks sufficient attention in adult population. Improper management may bring additional injuries and financial burdens to patients. This review was performed to determine the clinical characteristics of upper gastrointestinal FBs, including the demographic of adult patients, the type and location of FBs, underlying diseases of patients and other risk factors, and outcomes.
We searched PubMed, MEDLINE, EMBASE and Cochrane databases with the terms “foreign body AND upper gastrointestinal NOT child”. Finally, we got 7 articles between 2001 and 2020 and extracted the information.
A total of 1391 patients were included. 736 (52.9%) patients were males and 655 (47.1%) were females. Fish bone was the most common type of FBs. Esophagus accounts for the most location in the upper digestive tract. 18.2% (235/1291) patients had the underlying diseases, and 11.7% (58/494) had other risk factors. The overall complication rate was 4.5% (63/1391).

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GuidelinesGuideline for the management of ingested foreign bodies

Abstract

Section snippets

Diagnosis

General

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

J Pediatr Surg

J Pediatr Surg

J Emerg Med

Gastrointest Endosc

JAMA

Gastrointest Endosc

Ann Thorac Surg

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Am J Emerg Med

Am J Emerg Med

Am J Emerg Med

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Foreign body in the esophagus: review of 2394 cases

Br J Surg

Fatal upper esophageal hemorrhage caused by a previously ingested chicken bone: case report

Am J Forensic Med Pathol

Zinc toxicity following massive coin ingestion

Am J Forensic Med Pathol

Ingested foreign bodies of the gastrointestinal tract: retrospective analysis of 542 cases

World J Surg

Management of foreign bodies in the gastrointestinal tract: an analysis of 104 cases in children

Endoscopy

Management of ingested foreign bodies in childhood: our experience and review of the literature

Eur J Emerg Med

The management of ingested foreign bodies in children-a review of 663 cases

Eur J Emerg Med

Guidelines
Guideline for the management of ingested foreign bodies