Gastrointestinal Foreign Bodies Follow-up

Updated: Feb 20, 2014
  • Author: David W Munter, MD, MBA; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Follow-up

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.

Next:

Further Inpatient Care

Patients in an unstable condition, including those with drooling, stridor, inability to handle secretions, and/or 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.

Body packers

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.

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