Sharp Foreign Body Ingestion in Adult

Dr. Julia Moon

Clinical Context

The patient will be an adult that may or may not appear well, depending on time of ingestion and if bowel has perforated

-Usually patient ingested bones during meal (i.e. chicken or fish bones)

-May have history of suicidal ideation, pica or psychiatric illness causing intentional ingestion

What next?

-Determine if stable or unstable

-ABC’s

-IV, O2 

-Monitored bed

-Portable XR of Chest, Abdomen, Pelvis

-Immediate surgical or GI consult, depending on facility

Important history

-Timing of ingestion - when did they swallow the foreign bodies? What did they swallow?

            -Consider chicken bones, fish bones, sharp inanimate objects, button batteries, caustic objects that could be co-ingested

-Airway compromise?

            -Ask about lacerations or trauma to oral cavity, nares, face

-Chest pain?

            -Consider esophageal perforation, mediastinitis, subcutaneous emphysema, bleeding

-Shortness of breath?

            -Consider possible aspiration of objects, perforation of trachea, airway obstruciton

-Abdominal pain?

            -Consider bowel perforation, peritonitis, obstruction

Disposition

-All patients are admitted

            - Surgical vs observation

References:

Birk, Michael et al. “Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.” Endoscopy vol. 48,5 (2016): 489-96. doi:10.1055/s-0042-100456

Evans, David C et al. “Intentional ingestions of foreign objects among prisoners: A review.” World journal of gastrointestinal endoscopy vol. 7,3 (2015): 162-8. doi:10.4253/wjge.v7.i3.162