Foreign Body Ingestion

Overview

An ingested foreign body is any object (including food) originating outside the body and ingested into the mouth and through the gastrointestinal tract.

Key fact: Most ingested foreign bodies will pass through the GI tract without symptoms, but 10-20% require intervention and <1% develop serious complications.

Intervention Approaches

First Line

Fiberoptic endoscopy for foreign body removal

Other Techniques

Rigid endoscopy, Foley catheters, esophageal bougienage

Last Resort

Laparoscopic or open surgery when other techniques fail

Risk Factors

Age <15 years
Gastrointestinal tract narrowing
Mechanical disorders of the gastrointestinal tract
Intellectual disability
Mental illness
Impaired gag reflex

Clinical Features

Common Symptoms

Dysphagia
Nonspecific abdominal pain
Stridor and wheezing
Drooling

Other Features

Gagging, nausea/vomiting
Neck/throat pain
Atypical chest pain
Choking
Signs of upper GI obstruction
Lower GI bleeding

Investigations

X-rays of neck, chest, abdomen
Blood tests (FBC, U&E, PT/INR)
Consider CT of neck, chest and/or abdomen
Consider MRI
Consider laryngoscopy, endoscopy

Management

Unstable Patient Management

Patients are unstable if they present with airway compromise, drooling, inability to tolerate fluids, evidence of sepsis, perforation, or active bleeding.

Resuscitation: Follow ABCD protocol
Surgery: Emergency surgery mandatory for perforation due to obstruction
Consider NG/OG if trouble handling secretions
Consider IV antibiotics if signs of sepsis

Stable Patient Management

Management depends on type and location of foreign body, with endoscopic removal being primary approach.

Complications

Gastrointestinal obstruction, perforation, and fistula formation
Gastrointestinal bleeding
Esophageal perforation
Infection
Sepsis

Neodymium Magnets (Rare Earth Magnets)

Ingestion of multiple magnets or a magnet with metal object can cause significant injury. Magnet with button battery is a time-critical emergency.

Risk Factors for Complications

Co-ingestion with button battery
Multiple magnets or magnet with another metal object
Children with developmental/behavioral/psychiatric problems
Delayed presentation (>12 hours)

Investigations

Chest X-ray and abdominal X-ray (AP view)
Lateral abdominal X-ray if single magnet identified

Note: Neodymium magnets appear like ball-bearings on X-ray - be careful not to misdiagnose multiple magnets as single object.

Management

Suitable for discharge if:

Single magnet ingestion
Accidental ingestion
No comorbidities
Tolerating oral intake
Presents within 24hr of ingestion
Caregiver can provide close observation

All discharged patients require follow-up imaging after 6-12 hours.

Patients with multiple magnets or symptoms require specialist pediatric surgical consultation.

Foreign Body Ingestion

Overview

An ingested foreign body is any object (including food) originating outside the body and ingested into the mouth and through the gastrointestinal tract.

Key fact: Most ingested foreign bodies will pass through the GI tract without symptoms, but 10-20% require intervention and <1% develop serious complications.

Intervention Approaches

First Line

Fiberoptic endoscopy for foreign body removal

Other Techniques

Rigid endoscopy, Foley catheters, esophageal bougienage

Last Resort

Laparoscopic or open surgery when other techniques fail

Risk Factors

Age <15 years
Gastrointestinal tract narrowing
Mechanical disorders of the gastrointestinal tract
Intellectual disability
Mental illness
Impaired gag reflex

Clinical Features

Common Symptoms

Dysphagia
Nonspecific abdominal pain
Stridor and wheezing
Drooling

Other Features

Gagging, nausea/vomiting
Neck/throat pain
Atypical chest pain
Choking
Signs of upper GI obstruction
Lower GI bleeding

Investigations

X-rays of neck, chest, abdomen
Blood tests (FBC, U&E, PT/INR)
Consider CT of neck, chest and/or abdomen
Consider MRI
Consider laryngoscopy, endoscopy

Management

Unstable Patient Management

Patients are unstable if they present with airway compromise, drooling, inability to tolerate fluids, evidence of sepsis, perforation, or active bleeding.

Resuscitation: Follow ABCD protocol
Surgery: Emergency surgery mandatory for perforation due to obstruction
Consider NG/OG if trouble handling secretions
Consider IV antibiotics if signs of sepsis

Stable Patient Management

Management depends on type and location of foreign body, with endoscopic removal being primary approach.

Complications

Gastrointestinal obstruction, perforation, and fistula formation
Gastrointestinal bleeding
Esophageal perforation
Infection
Sepsis

Neodymium Magnets (Rare Earth Magnets)

Ingestion of multiple magnets or a magnet with metal object can cause significant injury. Magnet with button battery is a time-critical emergency.

Risk Factors for Complications

Co-ingestion with button battery
Multiple magnets or magnet with another metal object
Children with developmental/behavioral/psychiatric problems
Delayed presentation (>12 hours)

Investigations

Chest X-ray and abdominal X-ray (AP view)
Lateral abdominal X-ray if single magnet identified

Note: Neodymium magnets appear like ball-bearings on X-ray - be careful not to misdiagnose multiple magnets as single object.

Management

Suitable for discharge if:

Single magnet ingestion
Accidental ingestion
No comorbidities
Tolerating oral intake
Presents within 24hr of ingestion
Caregiver can provide close observation

All discharged patients require follow-up imaging after 6-12 hours.

Patients with multiple magnets or symptoms require specialist pediatric surgical consultation.