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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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