Foreign-body ingestion: characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion

doi:10.1016/j.gie.2008.05.072

Gastrointestinal Endoscopy

Volume 69, Issue 3, Part 1, March 2009, Pages 426-433

https://doi.org/10.1016/j.gie.2008.05.072 Get rights and content

Background

Previous reports of foreign-body ingestions focused primarily on accidental ingestions.

Objective

To describe the characteristics and management of foreign-body ingestions, with predominantly intentional ingestion, in a lower socioeconomic status population.

Design

A retrospective case series.

Setting

An urban county hospital.

Patients

Patients ≥17 years old, with foreign-body ingestions between 2000 and 2006.

Main Outcome Measurements

Characteristics of ingestion cases, endoscopic extraction, need for surgery, and complications.

Results

Among 262 cases, 92% were intentional, 85% involved psychiatric patients, and 84% occurred in patients with prior ingestions. The time from ingestion to presentation was >48 hours in 168 cases (64%). The overall success rate for endoscopic extraction was 90% (165/183 cases). Surgery was performed in 30 cases (11%) and was more common for objects beyond the pylorus versus objects above the pylorus (16/43 [37%] vs 10/151 [7%], respectively) and in cases with a greater delay from ingestion to presentation (25/168 [15%] if >48 hours vs 4/77 [5%] if ≤48 hours) and from presentation to intervention (15/40 [38%] if >48 hours vs 14/165 [8%] if ≤48 hours). Perforation occurred in 16 cases (6%), with 6 perforations noted after endoscopy.

Limitation

A retrospective review of medical records.

Conclusions

Foreign-body ingestions in an urban county hospital occurred primarily in psychiatric patients who had repeated episodes of intentional ingestions. Endoscopic extraction was unsuccessful in 10% of cases. Long delays from ingestion to presentation and intervention may account for relatively high rates of surgery and perforation. Strategies to prevent ingestions and delays in endoscopic management are needed in this population.

Section snippets

Patients and methods

We retrospectively identified patients ≥17 years of age with foreign-body ingestions at the Los Angeles County + University of Southern California Medical Center between the years 2000 and 2006. Cases were identified through review of endoscopy reports, gastroenterology consultation requests, and medical record International Classification of Diseases codes (43215, 43247, 44363, 45332, 44390). A full medical record review, including review of endoscopy and radiology records, was performed

Baseline characteristics of foreign-body ingestions

Two hundred sixty-two incidents of foreign-body ingestion were identified in 60 patients (range 1–15 ingestions per patient). The mean age of the patients was 33 years (range 17-82; 95% CI, 32-34 years) compared with an average age of 45 years (95% CI, 45-45 years) in the overall population of the hospital (P <.001, t test). Eighty-five percent (N = 222) of the incidents involved patients with underlying psychiatric conditions (generally patients who were residing in inpatient psychiatric

Discussion

Published studies of foreign-body ingestion indicate that between 52% and 97% of foreign-body ingestions in the pediatric and adult population are accidental5, 7, 8, 9, 10 In contrast, our study, which focused on an adult population in an urban county hospital setting, found that the vast majority of foreign-body ingestions (92%) were intentional and occurred in patients with underlying psychiatric problems who repeated this behavior on multiple occasions. Most of the incidents were intentional

References (22)

W.A. Webb
Management of foreign bodies of the upper gastrointestinal tract
Gastroenterology
(1988)
G.M. Eisen et al.
Guidelines for the management of ingested foreign bodies
Gastrointest Endosc
(2002)
Z.S. Li et al.
Endoscopic management of foreign bodies in the upper-GI tract: experience with 1088 cases in China
Gastrointest Endosc
(2006)
F.J. Vizcarrondo et al.
Foreign bodies of the upper gastrointestinal tract
Gastrointest Endosc
(1983)
G.G. Ginsberg
Management of ingested foreign objects and food bolus impactions
Gastrointest Endosc
(1995)
J.E. MacManus
Perforations of the intestine by ingested foreign bodies
Am J Surg
(1941)
M.F. Lyons et al.
Foreign bodies of the gastrointestinal tract
Med Clin North Am
(1993)
M.T. Smith et al.
Esophageal foreign bodies: types and techniques for removal
Curr Treat Options Gastroenterol
(2006)
W.A. Webb
Management of foreign bodies of the upper gastrointestinal tract
Gastrointest Endosc
(1995)
D.M. Chaves et al.
Removal of a foreign body from the upper gastrointestinal tract with a flexible endoscope: a prospective study
Endoscopy
(2004)

J.K. Kim et al.

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

Endoscopy

(1999)

Cited by (163)

Adult Esophageal Foreign Bodies
2024, Otolaryngologic Clinics of North America
Endoscopic foreign body retrieval from the caecum – A case report and push for intervention guidelines
2022, International Journal of Surgery Case Reports
Endoscopic foreign body retrieval in the upper gastrointestinal tract is well established, however indications for endoscopy for retained foreign bodies in the lower gastrointestinal tract and specifically the right colon is still being navigated [3]. A PubMed and Google Scholar search discovered a variety of case reports detailing various methods and indications for endoscopic retrieval of right sided colonic foreign bodies. This case report endeavors to supplement the literature so that guidelines can one day be established for colonoscopic retrieval of right-sided foreign bodies.
36-year-old male prisoner swallowed 6.5 cm nail clippers with a long-standing history of intentional foreign body ingestion (FBI) including multiple laparotomies for foreign body retrievals. Computerized tomography (CT) was used initially to confirm the position of the nail clippers. After almost two weeks of failure of the foreign body (FB) to move beyond the caecum as demonstrated on plain abdominal X-rays, the patient had a colonoscopy with successful retrieval of the FB.
This case report hopes to encourage the consideration of colonoscopy for retrieval of right sided colonic foreign bodies that have failed to pass on their own and where an operation may come with increased risk (multiple laparotomies, multiple comorbidities, and higher anaesthetic risk for a general anaesthetic). Colonoscopy/endoscopy still has inherent risk and this patient did have an episode of temporary laryngospasm that required intubation and monitoring in the intensive care unit post operatively. Despite this the patient recovered and was discharged day one post procedure without further complication. The case report has been reported in line with the SCARE 2020 criteria (Agha et al., 2020 [2]).
Indications for consideration of endoscopic retrieval of foreign bodies in the right colon have not been entirely detailed as endoscopy is for upper gastrointestinal foreign bodies. This case report documents the indications for endoscopy in the clinical context of a recurrent FBI and a history of multiple laparotomies with failure of the FB to move beyond the caecum.
Endoscopist experience with pediatric recurrent and intentional foreign body ingestion (RIFBI): Management considerations and future directions
2024, Journal of Pediatric Gastroenterology and Nutrition
A unique operative approach to a retained gastrointestinal foreign body
2024, ANZ Journal of Surgery
Preputial advancement flap for delayed urethrocutaneous fistula of the glans following urethral insertion of an ‘AAA’ battery
2024, Urologia Journal
Factors Influencing the Fasting Time in Adult Patients After the Endoscopic Management of Sharp Esophageal Foreign Bodies
2024, Therapeutics and Clinical Risk Management

View all citing articles on Scopus

: DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

View full text

Original articleClinical endoscopyForeign-body ingestion: characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion

Background

Objective

Design

Setting

Patients

Main Outcome Measurements

Results

Limitation

Conclusions

Section snippets

Patients and methods

Baseline characteristics of foreign-body ingestions

Discussion

Gastroenterology

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Am J Surg

Foreign bodies of the gastrointestinal tract

Med Clin North Am

Esophageal foreign bodies: types and techniques for removal

Curr Treat Options Gastroenterol

Management of foreign bodies of the upper gastrointestinal tract

Gastrointest Endosc

Removal of a foreign body from the upper gastrointestinal tract with a flexible endoscope: a prospective study

Endoscopy

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

Endoscopy

Original article
Clinical endoscopy
Foreign-body ingestion: characteristics and outcomes in a lower socioeconomic population with predominantly intentional ingestion