Foreign Body in the Digestive Tract

June 23, 2022

Ingestion of foreign bodies is common, the majority occurring in children. Fortunately, most ingested foreign bodies (80 % to 90 %) are likely to pass spontaneously. However, in about 10 % to 20 % of cases, endoscopic removal may be necessary, with 1 % or less requiring surgery for foreign body extraction or to treat complications such as intestinal obstruction or perforation.

In adults, esophageal food bolus impaction is a much more common. Non-food foreign body ingestion in adults, either intentional or unintentional, occurs more commonly in the elderly population; in those with psychiatric disorders, developmental delay and in alcohol intoxication. Some of the objects include:

  • Blunt/Round objects – coins buttons, toy batteries and magnets
  • Fine pointed objects – needles, toothpicks, bones, safety-pins and glass pieces
  • Sharp irregular objects – dentures and razor blades
  • Soft objects – string and cord
  • Hard objects – toothbrushes, cutlery, screwdrivers, pens, and pencils
  • Food bolus
  • Other objects – including packages of illegal drugs

Diagnostic Evaluation

Your gastroenterologist will take a thorough history of what happened and your symptoms. They will also perform a physical examination to assess for signs of any complications.

Radiological evaluation is not generally necessary for patients with non-bony food bolus impaction without complications. However, your gastroenterologist may order a plain X-ray to gain greater clarity on the location, size, configuration, and number of ingested foreign bodies, if radiopaque objects are suspected or the type of object ingested is uncertain. A computed tomography (CT) scan may be ordered if your gastroenterologist suspects perforation of your gastrointestinal tract or any other complication that may require surgery.

A conservative approach with close observation without the need for endoscopic removal may be all that is required in patients who have ingested of blunt and small objects (except batteries and magnets) without symptoms.

Foreign Bodies In The Oesophagus

Emergent therapeutic upper gastrointestinal endoscopy within 2 to 6hrs is necessary for foreign bodies causing complete esophageal obstruction, and sharp-pointed objects and batteries lodged in the esophagus. Urgent (within 24 hours) therapeutic upper gastrointestinal endoscopy is also required for other esophageal foreign bodies without complete obstruction.

Your gastroenterologist may manage the food bolus impaction in the esophagus by gently pushing the bolus into the stomach. However, should this procedure be unsuccessful, retrieval is an alternative.

In cases of food bolus impaction, your gastroenterologist may need to further assess for any potential underlying disease, including taking biopsies of the oesophageal lining for histological evaluation, in addition to therapeutic endoscopy.

Foreign Bodies In The Stomach

Your gastroenterologist may suggest an urgent (within 24 hours) therapeutic upper gastrointestinal endoscopy for foreign bodies in the stomach such as sharp objects, magnets, batteries or large objects that may cause obstruction.

If there is a high risk of aspiration of the foreign body into the lungs, endotracheal intubation may be necessary.

If you discover you or someone you know has ingested a foreign body or develops a food bolus obstruction, call us at GUTCARE in Singapore. One of our gastroenterologists will be able to assess your symptoms and advise on further management.