This document discusses the approach to foreign body ingestion. It begins with an introduction noting that foreign bodies in the gastrointestinal tract are generally not as dangerous as those in the airway. It then covers what types of objects are commonly ingested, who is most at risk, where in the GI tract objects typically lodge, clinical features, investigations like x-rays, and management approaches like endoscopic removal or conservative monitoring. Endoscopy is highlighted as the preferred minimally invasive method for removing ingested objects.

1. APPROACH TO FOREIGN
BODY INGESTION
Dr. Raman Ghimire

2. OVERVIEW
O Introduction
O What are FB ?
O Where FB are lodged?
O Who are at risk ?
O Clinical features
O Investigtions
O Management
O MCQs
O References
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3. INTRODUCTION
O FBs of GIT are not so dangerous as air
way foreign bodies.
O very common problem among children
and elderly
O 80-90 % pass harmlessly
O 10–20% will require endoscopic
intervention
O < 1% will require surgery
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4. WHAT ?
O Coin (45%)
O Fish bone (12%)
O Sharp (8%)
(nails, pins,blades )
O batteries. Keys, small toys
O Food bolus impactions
O Tooth brush : eating disorders
O Dentures partial , Teeth –artificial or natural
O Meat or chicken bone
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5. WHO?
O Pediatric patients (80%)
AGE: 6 months - 4 years.
O Psychiatric patients
O Patients with underlying GI disorders
(malignancy,strictures,achalasia)
O Edentulous elderly patients
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6. WHERE in GIT ?
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8. 70%
15%
15%
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9. HISTORY
O Did you witness the child ingesting a foreign
body?
O Did the child report to you that he/she ingested a
foreign body?
O Do you know what the foreign body is? (size,
shape, identity)
O Do you know when the child ingested the foreign
body?
O Have you found the foreign body in the
stool/vomitus already?
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10. O Does the child have any other medical
illnesses or have had previous surgery?
O Does the child have :
 Fever, abdominal pain, or vomiting?
 Stools? If so, how many times, what
color?
 Difficulty breathing ?
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11. CLINICAL FEATURES
Esophageal foreign body symptoms
O Dysphagia
O Food refusal, weight loss
O Drooling, gagging
O Emesis/hematemesis
O Foreign body sensation
O Chest pain, sore throat
O Noisey breathing, difficulty breathing, cough,
O Unexplained fever
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12. Stomach/lower GI tract foreign bodies
O Abdominal distention
O Abdominal pain
O vomiting
O Hematochezia
O Unexplained fever
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13. PHYSICAL EXAMINATION
O Usually unremarkable
O Oral cavity/oropharynx/Neck :
• Drooling or pooling of secretions
• Impacted FB : hypopharynx
• Crepitus ,swelling : neck
O Per Abdomen: tenderness, rigidity,distention
(perforation/ obstruction)
O Chest : wheeze , stridor
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14. INVESTIGATIONS
1. Lab investigations
• not necessary
• infections
• complications
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15. 2.Neck /Chest/Abdominal Radiography
O Initial Investigation of choice
O Most ingested foreign bodies are radiopaque
(60%)
Determines :
O Presence
O Type
O location of the foreign body.
O Identifying possible complications
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19. 3.Metal detectors:
• Identification of metallic FB
• Aluminum FB - often radiolucent.
• look for progresssion of metallic FB in
GIT
4.Endoscopy:
O diagnostic and therapeutic
O Radiolucent FB
5. CT- Scan :
• Non metallic ,radiolucent FB
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20. MANAGEMENT
O Site
O Size
O Type
O Duration
O Complications
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21. Removed immediately:
O Batteries in esophagus
O Length> 10cm
O Any object
Child: >1cm X 3cm
Adult: > 2cm X 5 cm
O Symptomatic, f/o perforation
O Esophageal FB (> 24 hrs at presentation)
O Sharp ,pointed FB
O Batteries remaining in the stomach (> 48 h )
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22. Conservative management
(wait and watch )
O Coins in the esophagus : 12–24 Hrs
O Any asymptomatic blunt object : 1week
Child: <1cm X 3cm
Adult: < 2cm X 5 cm
O Asymptomatic Disk batteries and
cylindrical batteries in stomach : upto 48
Hrs.
O Progression ; serial xrays , metal detector
O laxatives to increase GI motility
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23. Methods of removal
1.Endoscopy
O Procedure of choice
O Minimally invasive
O Success rate: 90-100%
O Can retrive FB up to 2nd part of duodenum
(FB beyond that often passes spontaneously)
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24. 2. Surgical
A. Cervical esophagostomy
B. Thoracotomy
C. laparotomy
INDICATIONS:
O Evidence of perforation, hemorrhage, fistula
formation, obstruction.
O FB fail to progress (lie beyond stomach)
O FB not retrieved endoscopically.
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25. MCQs
1.Which is the most common FB in
esophagus
A. Button batteries
B. Coin
C. Fish bone
D. chicken bone
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26. 2. Where is the FB ?
AP: sagittal (end on) Lat: coronal (face )
oesophagus
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27. REFERENCES
O Current opinion in pediatrics ;Foreign bodies in GIT
O African Journal of Emergency Medicine Volume 5,
Issue 4 December 2015, Pages 176-180;
Investigation and management of foreign body
ingestion in children at a major paediatric trauma unit
in South Africa
O Conners GP, Hadley JA. Esophageal coin with an
unusual radiographic appearance. Pediatric Emerg
Car. 2005;21:667-669.
O Raney LH, Losek JD. Child with esophageal coin and
atypical radiograph. J Emerg Med 2008;34:63-66
O Srilakshmi Narra, MD and Firas H. Al-Kawas MD;
The Importance of Preparation and Innovation in the
Endoscopic Management of Esophageal Foreign
Bodies
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28. OTHANK YOU
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