Foreign Body in Stomach and Intestine: Signs and Treatment

Introduction:

Foreign body ingestion is commonly seen in pediatric patients and can also be seen in adult patients. This leads to its challenges and management. The foreign objects can get lodged in various upper or lower gastrointestinal tract areas. The primary objective of healthcare professionals is to identify these patients as they have a high risk for complications that require immediate medical intervention.

What Is Foreign Body Ingestion?

Foreign body ingestion usually occurs when a non-edible object is swallowed and gets stuck in the digestive tract. However, it can also occur due to edible items that may get lodged before reaching the stomach. Sometimes, it can be a medical emergency that must be dealt with immediately. However, 80 % of the foreign objects passed through the gastrointestinal tract without causing complications.

What Is the Etiology of Foreign Body Ingestion?

The majority of foreign body ingestion is usually unnoticed and goes without causing any problems. Adults usually are symptomatic as they can tell the problems they are experiencing. However, the diagnosis may be difficult in the case of children. The complications and the severity of the ingestion depend upon three factors which include

• The type of object.

• Location of ingestion.

• The time of ingestion.

The most common complication of impaction is usually seen within the esophagus (food pipe). There are three locations in the esophagus where there are high chances of food impaction due to narrowing, which include the following:

• The first is the most common thoracic inlet.

• The second section is an aortic arch.

• The third section is at the gastroesophageal junction.

What Are the Commonly Ingested Foreign Objects?

The most commonly ingested foreign objects in children and adults include -

• In Children:

  1. Coins.

  2. Button batteries.

  3. Crayons.

  4. Toys.

• In Adults:

  1. Food boluses.

  2. Fish bones.

  3. Chicken bones.

  4. Dentures.

  5. Crab shells.

  6. Wires.

  7. Pins.

What Are the Symptoms of Foreign Body Ingestion?

A foreign object that is small, blunt, and non-toxic to the body does not cause any problems and may pass through the digestive tract without causing any complications. These objects usually pass through the gastrointestinal system within four to six days depending upon the metabolism of the patient. If the object is sharp, it might get stuck in specific areas of the digestive tract, such as:

• Esophagus (food pipe).

• Stomach.

• Small and large intestines.

• Rectum.

Symptoms of a Foreign Body in the Esophagus:

The most common location of foreign body ingestion is the esophagus. In around 75 percent of pediatric cases, the foreign object usually gets lodged in the upper esophageal sphincter (UES), which opens and closes to allow the food to pass through. In adults, 70 percent of foreign objects get lodged in the lower esophageal sphincter (LES), a muscular barrier preventing the food particles from traveling back to the esophagus. The symptoms commonly include affecting the esophagus are as follows:

• Difficulty in swallowing (dysphagia).

• A feeling of swelling or lump in the throat, neck, or chest area.

• Gagging or vomiting.

• Coughing.

• Wheezing.

• Pain in the throat, neck, or chest if the object is sharp.

• Drooling of saliva.

• Loss of appetite.

• Blood in saliva.

Symptoms of a Foreign Body in the Stomach or Intestines:

In cases where a foreign body passes through the esophagus, it can then get stuck in the stomach or intestines, and it can lead to some of the following symptoms:

• Pain or cramps in the abdomen.

• Loss of appetite.

• Vomiting

• Abdominal swelling or bloating.

• Nausea.

• Fever.

• Blood in the stool.

• Diarrhea or constipation.

Symptoms of a Foreign Body in the Rectum:

A small and blunt foreign body goes to the rectum and will often be passed out in the stool without causing any problem, but in some cases, if the object is sharp, and can harm the rectum. The symptoms may include:

• Blood in the stool.

• Sharp pain during bowel movements.

What Are the Complications of Foreign Body Ingestion?

Foreign body ingestion does not always cause complications, and in the majority of cases, the object that gets swallowed simply passes through the digestive tract normally.

However, in some cases, it can still cause complications, and around 1500 deaths have been reported annually in the United States. The three primary reasons causing complications in foreign body ingestion include the following:

1. Impaction - This means when an object gets stuck in the digestive tract. This is the most common complication involved in the case of foreign body ingestion, and the object can get stuck anywhere in the esophagus (food pipe), stomach, intestines, or rectum. The impaction can lead to severe complications, which include -

• Difficulty breathing or choking due to impaction in the esophagus can be fatal.

• Abscess or pus formation in the throat, esophagus, or soft tissue.

• Necrosis of the tissues where impaction occurs.

2. Perforation - A sharp foreign object can make a hole in the wall of the digestive tract, which can lead to complications like:

• Soft tissue infection leading to sepsis.

• Internal bleeding.

• Peritonitis (inflammation of the abdominal cavity).

• Pneumothorax (collapsed lung).

• Mediastinitis (swelling of the chest cavity).

3. Toxic Substances - Ingestion of toxic substances like batteries or chemicals may lead to some of the following complications such as:

• Internal burns.

• Necrosis of soft tissues.

• Formation of the fistula, an abnormal opening connecting two hollow spaces.

• Metal poisoning.

• Allergic reaction.

How to Diagnose Foreign Body Ingestion?

The diagnosis of foreign body ingestion is made based on factors like the type of object swallowed, symptoms appearing, and physical examination.

1. Physical Examination - During the physical examination, some of the following things are checked such as:

• Manually examining the neck and abdomen to feel any object causing the obstruction.

• Checking the throat.

• Listening to the lungs and checking breathing function.

• Checking blood pressure, heart rate, and temperature.

2. Imaging Tests - The chest, neck, or abdominal X-rays may help view the region and notice the foreign object's location. In some cases, where the object does not appear on the X-ray, an esophagram may be done in which a dye called barium sulfate is swallowed and helps in viewing the radiolucent objects in the X-ray.

3. Endoscopy - In this procedure, a long thin tube with a camera is inserted into the patient's mouth and throat, and the esophagus is examined for any foreign object causing an obstruction.

4. Metal Detectors - Metal detectors can also be used in some cases in case of ingestion of metal objects. This is a non-invasive, simple, and fast method to know the location of impaction.

What Is the Treatment for Foreign Body Ingestion?

Foreign objects that get stuck in the body require treatment to remove them from the body before they cause any complications. Some of the methods by which these can be removed are as follows:

1. Endoscopy - This is the most common treatment to remove foreign objects. A long, thin tube with a camera and light is inserted from the patient's mouth into the digestive tract to locate the object. The timing of endoscopy depends upon the type of object ingested, such as -

• Immediate:

  1. Esophageal obstruction.

  2. Disk battery in the esophagus.

  3. Sharp pointed objects in the esophagus.

• Urgent Within 24 Hours:

  1. Esophageal objects that are not sharp.

  2. Esophageal food impaction without any obstruction.

  3. Objects greater than six centimeters or located above the duodenum.

  4. Magnets within endoscopic reach.

• Nonurgent:

  1. Coins.

  2. Objects in the stomach of less than three centimeters in diameter.

  3. Disk batteries and cylindrical batteries in the stomach are asymptomatic.

2. Medication - Glucagon can be administered intravenously, which helps in relaxing the esophagus and allowing the impacted food to naturally move down from the esophagus and enter the digestive tract.

3. Surgery - Surgery is rarely required in food impaction cases. It is usually done in complicated cases where endoscopic treatment has been unsuccessful, and objects are stuck for too long in the body.

Conclusion:

Most foreign body ingestion does not cause any problems and gets removed from the body through normal processes. Parents should be educated about leaving harmful objects near their children, such as batteries or magnets. If the object is ingested, they should immediately get medical assistance as soon as possible.