Swallowed foreign bodies in adults

Abstract

Background: Foreign-body ingestion is a common event most often seen in children from 6 months to 6 years of age. In adults, foreign bodies are usually ingested accidentally together with food. This happens more commonly in persons with certain pathological changes of the gastrointestinal tract.

Methods: We present a selective review of pertinent literature retrieved by a search in the PubMed database.

Results: The foreign bodies most commonly ingested by adults are fish bones and chicken bones. The clinical approach to the problem depends on the type of material ingested and on the patient's symptoms and physical findings. In about 80% of cases, the ingested material passes uneventfully through the gastrointestinal tract; endoscopy is performed in about 20% of cases, and surgery in less than 1%. Emergency esophagogastroduodenoscopy (EGD) is recommended when the esophagus is completely occluded (because of the risk of aspiration and/or pressure necrosis), when the ingested object has a sharp point or edge (because of the risk of perforation, with ensuing mediastinitis or peritonitis), and when a battery has been ingested (because of the risk of necrosis and fistula formation). For non-occluding esophageal foreign bodies, including magnets, an urgent but non-emergency EGD within 12 to 24 hours is recommended.

Conclusion: Most patients can be treated conservatively by observation alone, but there should be a low threshold for deciding to proceed to endoscopic retrieval. Surgery is reserved for complicated cases.

Figure 1

Abdominal x-ray with a foreign body (a spoon) in the left lower abdomen

Figure 2

Diagnostic and therapeutic algorithm in patients who have ingested foreign bodies; ^*cf. Table

Figure 3

Endoscopic and intraoperative confirmation of the diagnosis with simultaneous initiation of treatment after ingestion of a foreign body