Foreign body in the digestive tract

Disease Description (Causes and Symptoms)

A foreign body in the alimentary tract occurs when an object swallowed through the mouth or inserted through the anus becomes lodged or remains in the esophagus, stomach, small intestine, large intestine, or other part of the digestive tract.
Main causes: swallowing coins or toy parts in children; food impaction in adults (fibers of meat); and swallowing button batteries, magnets, or sharp objects (pins, needles, pointed bones), among others.
Pathophysiology summary: When a foreign body becomes lodged in the esophagus, it causes mechanical obstruction and mucosal injury; sharp objects pose a risk of perforation; button batteries can cause electrochemical or alkaline injury or poisoning; and multiple magnets can attract intestinal walls to each other, resulting in necrosis and perforation.
Main symptoms: foreign-body sensation in the throat, dysphagia (difficulty swallowing), increased salivation, vomiting, pain behind the sternum, coughing, difficulty breathing, and wheezing (when the airway is involved), and decreased appetite (in children). Fever, abdominal pain, bloody stool, and severe pain suggest complications.

Treatment Methods

• Initial principles
  • If there is airway obstruction or difficulty breathing, immediate emergency measures (airway maintenance and an emergency response team) are required.
  • Depending on the type and location of the foreign body and the patient's symptoms, a decision is made between watchful waiting and immediate removal.
• Management after imaging and endoscopic diagnosis
  • Foreign body lodged in the esophagus: In general, immediate removal is required regardless of the presence of symptoms or the type of material (endoscopic removal is recommended).
  • Foreign body in the stomach or small intestine: Most can be expected to pass spontaneously; however, endoscopic or surgical removal should be considered for sharp objects, large objects, multiple magnets, or harmful chemicals (such as button batteries).
  • Button battery: If located in the esophagus, it must be removed by emergency endoscopy as soon as possible (within several hours if possible). Even if it is in the stomach, early removal should be considered depending on the patient's age, battery size, and symptoms.
  • Multiple magnets or a magnet-plus-metal combination: If present in the intestinal tract, early removal is recommended because of the high risk of complications.
  • Coin: Endoscopic removal is performed if symptoms are present or if the coin remains in the esophagus; if asymptomatic and located in the stomach or small intestine, the course may be observed.
• Procedures and surgery
  • Endoscopic removal (upper endoscopy/colonoscopy for diagnosis and treatment) — first-line treatment for most indications.
  • If removal by endoscopy is not possible or if perforation, peritonitis, intestinal obstruction, or other conditions are present, surgical treatment (laparoscopy/open surgery) is required.
• Medication and supportive treatment
  • Pain and inflammation are controlled; antibiotics are administered when perforation or infection is suspected.
  • In cases of exposure to a battery or toxic substance, poisoning tests (such as blood heavy-metal testing) and appropriate treatment (such as detoxification) are performed.
• Lifestyle management and follow-up
  • Observe bowel movements and check the stool for the foreign body. If necessary, follow-up imaging is performed to confirm passage of the foreign body.
  • If mucosal injury or signs of perforation are present after endoscopic removal, fasting, antibiotics, and inpatient observation may be required.
• Precautions and complications
  • Prohibited: inducing vomiting without a doctor's instructions or attempting forceful removal with the fingers (risk of aspiration into the airway).
  • Complications: perforation, bleeding, infection (mediastinitis or peritonitis in severe cases), intestinal obstruction, electrochemical burns (button batteries), poisoning (lead, mercury, etc.), and thoracic complications (when esophageal perforation occurs).

Checklist Before an Outpatient Visit (Items to Bring, Patient Preparation, and Example Medical History Questions)

• Items to bring to the visit
  • The time of swallowing (the exact time if possible) and an explanation of the circumstances
  • A photo or packaging of the foreign body showing its shape and material (battery, magnet, coin, sharp object, etc.), if available
  • A record of current symptoms (difficulty swallowing, difficulty breathing, vomiting, drooling, etc.)
  • A list of medications currently being taken and a history of allergies
  • Important medical history, such as previous surgery, endoscopy, or heart disease
  • Food recently consumed (particularly when a large piece of meat or similar food may be the cause)
• Disease-related items to check at an outpatient clinic/emergency department
  • The time symptoms began and their course (whether they are worsening or improving)
  • Whether there is difficulty breathing, fever, bloody stool, or severe abdominal pain
  • In children, refusal of food, degree of fussiness, decreased vision, and other behavioral changes
• Preparation before examination
  • Fasting instructions in preparation for possible foreign-body removal (fasting is usually required if endoscopy is planned)
  • Possibility of radiographic examination (chest/abdominal X-ray)

Example questions (things for the patient to check personally)

• When and what object did you swallow?
• How has your condition been since the symptoms first appeared? (Are you able to swallow saliva? How is your breathing?)
• What medications are you currently taking, and do you have any allergies?

General Example Questions to Ask the Doctor

• How likely is this object to pass naturally?
• Does it need to be removed immediately? What are the risks and prognosis of the removal method (endoscopy/surgery)?
• How long will observation be needed after removal, and what restrictions (diet, activities) will apply?
• What symptoms should I watch for if complications occur?
• What are the side effects of the anesthesia and medications used during removal?

Examples of Condition-Specific Questions

• If a button battery (coin-type battery) was swallowed, within how many hours should it be removed? What risks are there if it is not removed?
• If several magnets were swallowed, or a magnet and metal were swallowed together, can this be treated with endoscopy alone, or is surgery necessary?