eMedicine Specialties > Emergency Medicine > Gastrointestinal

Foreign Bodies, Gastrointestinal: Follow-up

Author: David W Munter, MD, MBA, Assistant Clinical Professor of Emergency Medicine, Eastern Virginia Medical School; Medical Director, Emergency Medical Department, Sentara Obici Hospital; Partner, Emergency Physicians of Tidewater, LPC; President of the DESA Consulting Group
Contributor Information and Disclosures

Updated: Nov 3, 2009

Follow-up

Further Inpatient Care

  • Patients in an unstable condition including drooling, stridor, inability to handle secretions, signs of perforation or bleeding:
    • Manage airway and refer for urgent endoscopy.
    • Patients with button batteries in the esophagus are considered to be in an unstable condition.
  • Patients in a stable condition
    • Oropharyngeal foreign bodies: If ED evaluation is negative for a foreign body, discharge with follow-up, generally with an ear, nose, and throat (ENT) specialist in 24 hours. If ED evaluation is positive for a foreign body that cannot be removed under direct visualization, refer to an ENT specialist for endoscopy.
    • Esophageal foreign bodies: In cases that involve sharp, elongated, or multiple foreign bodies, refer the patient to a gastroenterologist for urgent removal. For patients with entrapped smooth foreign bodies, if treatment in the ED does not result in removal or passage into the stomach, refer to a gastroenterologist for endoscopy. In children with coins at the LES, watchful waiting may be used if the patient is stable, with follow-up and repeat radiography in 12-24 hours; if the coin has not advanced to the stomach by that time, refer for endoscopy.
    • Stomach or small intestine foreign bodies: Patients with smooth, blunt objects that are less than 2 cm in width or 6 cm in length should be discharged to home. Serial radiographs are generally not needed. Instruct patient to return if fever, vomiting, or abdominal pain occurs. Those with sharp or large foreign bodies in the stomach should be referred to a gastroenterologist for endoscopic removal. Serial radiographs are indicated for sharp or large foreign bodies in the duodenum or small intestine. In most cases, refer to a surgeon or gastroenterologist in 24 hours for follow-up examinations, radiographs, and intervention.
    • People who body pack should be admitted to a monitored setting and are typically treated with whole-bowel irrigation or observation alone. If they develop signs of drug toxicity, this indicates rupture of one of the drug-containing packages and mandates resuscitative measures and surgical consultation for possible surgical removal.

Further Outpatient Care

  • For adults with resolved esophageal foreign bodies, referral to a gastroenterologist in 24-72 hours is mandatory because a large percentage of these patients have underlying structural abnormalities, including malignancies, and follow-up endoscopy is needed.
  • In children with resolved esophageal foreign bodies, no follow-up is needed.

Complications

Miscellaneous

Medicolegal Pitfalls

  • Toothpicks, when ingested, have a high risk of complications, and persons with this foreign body should be treated with early endoscopy.
  • Patients with button batteries in the esophagus are at a high risk for esophageal necrosis. Urgent removal is mandatory.
  • Aluminum soda can tabs are not visualized on plain radiographs and are frequently entrapped in the esophagus. Early endoscopy is indicated if the ingestion is definitive; if unclear, localization of the soda can tab can be visualized via CT scanning.
  • Foley catheter removal of esophageal foreign bodies should be performed only in carefully selected patients and only by those who are experienced in its use who have emergency airway equipment immediately available.
  • Children with esophageal foreign bodies may present with minimal or no symptoms. Evaluate all children who may have swallowed an object.
  • Children with chronic esophageal foreign bodies may present with vague symptoms such as irritability, poor feeding, or pulmonary symptoms. Maintain a high index of suspicion for an esophageal foreign body.
 


More on Foreign Bodies, Gastrointestinal

Overview: Foreign Bodies, Gastrointestinal
Differential Diagnoses & Workup: Foreign Bodies, Gastrointestinal
Treatment & Medication: Foreign Bodies, Gastrointestinal
Follow-up: Foreign Bodies, Gastrointestinal
Multimedia: Foreign Bodies, Gastrointestinal
References
Further Reading
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Further Reading

Digoy GP: Diagnosis and management of upper aerodigestive tract foreign bodies. Otolaryngol Clin North Am. 2008 Jun; 41(3):485-96, vii-viii.

Munter DW, Heffner AC: Esophageal foreign bodies. Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine, 4th Ed. Saunders: Philadelphia, PA;  2004: 775-793.

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Keywords

gastrointestinal foreign bodies, GI foreign bodies, swallowed object, esophageal foreign bodies, swallowed foreign bodies, oropharyngeal foreign bodies, chalasia, button battery ingestion, foreign body sensation, dysphagia, small intestine foreign bodies, swallowed coin, swallowed toothpick, impacted esophageal foreign bodies, radiopaque foreign objects

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Contributor Information and Disclosures

Author

David W Munter, MD, MBA, Assistant Clinical Professor of Emergency Medicine, Eastern Virginia Medical School; Medical Director, Emergency Medical Department, Sentara Obici Hospital; Partner, Emergency Physicians of Tidewater, LPC; 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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

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, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier 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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