Gastrointestinal Foreign Bodies in Emergency Medicine Clinical Presentation

  • Author: David W Munter, MD, MBA; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: May 24, 2012
 

History

  • Oropharyngeal foreign bodies
    • Patients with oropharyngeal foreign bodies normally present with a foreign body sensation, especially after eating chicken or fish, although a variety of other objects, including toothpicks, may be involved.
    • They may have variable degrees of discomfort, from minor to more severe.
    • Patients may complain of inability to swallow or handle secretions.
    • Rarely, patients may have airway compromise, typically in delayed presentations with subsequent infection or perforation.
    • Patients can usually localize the foreign body sensation in the oropharynx.
  • Esophageal foreign bodies
    • Adults with esophageal foreign bodies usually present acutely, with a history of ingestion. A foreign body sensation or vague discomfort in the epigastrium suggests that the foreign body is entrapped at the LES.
    • Dysphagia is the norm in adults. If the obstruction is complete, an inability to handle secretions is common. The classic adult presentation is the person with dentures who has had some alcohol and is eating meat. Incomplete chewing leads to an impaction at the LES. Adults should be asked about the use of dentures, alcohol intake, and circumstances surrounding the ingestion.
    • In children with esophageal foreign bodies, the history may be less clear.[11, 9] As many as 35% of children with esophageal foreign bodies are asymptomatic; the history is given by a parent who has seen the child with an object in his or her mouth and suspects the child might have swallowed it. Such reports must be taken seriously and investigated.[12] Gagging, vomiting, and neck or throat pain are common presentations. Children with chronic esophageal foreign bodies may also present with poor feeding; irritability; failure to thrive; fever; stridor;[13] or pulmonary symptoms, such as repetitive pneumonias from aspiration.[14] Large esophageal foreign bodies at the UES can cause tracheal impingement in children, with resultant stridor or respiratory compromise.
  • Stomach/small intestine foreign bodies
    • Patients with foreign bodies in the stomach or small intestine may present with a history of swallowing an object, which has passed through the esophagus.
    • Patients may present with vague symptoms such as fever, abdominal pain, or vomiting.
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Physical

  • The physical examination typically is not helpful, but the oropharynx, neck, chest, lungs, heart, and abdomen should be carefully examined.
  • Occasionally, a foreign body in the oropharynx can be visualized and removed. In cooperative patients, indirect laryngoscopy or fiberoptic nasopharyngoscopy provides better information than a direct examination.
  • In children, tracheal compression and stridor suggest a large foreign body at the UES.
  • Complete obstructions can cause drooling and the inability to swallow.
  • Delayed presentations may be accompanied by signs of infection, including peritonitis.
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Causes

The most common causes of GI foreign bodies are food boluses and accidental swallowing of other objects.

  • Young children often put any object they find into their mouths and may accidentally swallow them.
  • Although less common, older children also put smooth objects, such as coins or marbles, in their mouths and swallow them. However, the larger diameter esophagus in this age group results in fewer entrapped foreign bodies compared to young children.
  • Children who are abused may present with GI foreign bodies after being forced to swallow objects; however, this is rare.
  • The most common cause of GI foreign bodies in adults involves food that does not pass through the esophagus because of underlying mechanical problems.
  • In adults, accidental swallowing often involves toothpicks and dentures.
  • Psychiatric patients may swallow a wide variety of objects, including multiple objects, large objects, and bizarre items.
  • Prisoners may swallow objects either to hide them from authorities or to seek medical care. In the case of razor blades, they often tape the sharp edge to avoid injury.
  • Drug smugglers may swallow multiple condoms (usually double wrapped) filled with cocaine or heroin. This is called "body packing," as opposed to "stuffing," which occurs when the patient attempts to elude arrest by swallowing packets of drugs in their possession.
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Contributor Information and Disclosures
Author

David W Munter, MD, MBA  Associate Clinical Professor of Emergency Medicine, Eastern Virginia Medical School; Associate Professor of Emergency Medicine, Edward Via Virginia College of Osteopathic Medicine; Partner, Emergency Physicians of Tidewater, PLC; President of the DESA Consulting Group

David W Munter, MD, MBA is a member of the following medical societies: American College of Emergency Physicians, American College of Physician Executives, Medical Society of Virginia, and Norfolk Academy of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerry Balentine, DO  Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St Barnabas Hospital

Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eugene Hardin, MD, FAAEM, FACEP  Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM  Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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Coin (quarter) lodged at the level of the cricopharyngeus muscle.
Coin lodged at the level of the aortic crossover.
Coin lodged at the lower esophageal sphincter.
A screw in the stomach; peristaltic action will carry the screw through the GI tract with the blunt end (head) leading and the sharp end trailing.
 
 
 
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