Intestinal foreign bodies

Various foreign bodies can enter the gastrointestinal tract. Many are evacuated spontaneously, but some become fixed, causing obstructive symptoms. Perforation may occur. Intestinal foreign bodies occur in 10-15% of cases in gastroenterological practice. Almost all obstructing foreign bodies can be removed endoscopically, but sometimes surgical treatment is required.

Foreign objects may be intentionally swallowed by children and adults with mental disorders. Elderly patients with dentures and intoxicated individuals are prone to accidentally swallowing insufficiently chewed food (especially meat), which may become lodged in the esophagus. Smugglers who swallow balloons, vials, or packets of illicit drugs may develop intestinal obstruction. The packaging may rupture, causing signs of drug overdose.

Foreign bodies migrate through the esophagus without symptoms unless obstruction or perforation occurs. Foreign bodies from the esophagus pass spontaneously into the stomach in 80% of cases, noninvasive interventions are required in 10-20% of cases, and surgical intervention is required in less than 1%. Thus, in most cases intragastric foreign bodies do not require specific treatment. However, objects larger than 5 x 2 cm are rarely evacuated from the stomach. Sharp foreign bodies should be removed from the stomach, since they cause intestinal perforation in 15-35% of cases, but patients with small round objects (e.g., coins and batteries) require observation only. The patient's stool should be examined, and if the object is not found, radiographic control is necessary at 48-hour intervals. Coins that remain in the stomach for more than 4 weeks or batteries that show signs of corrosion on radiography that remain in the stomach for more than 48 hours should be removed. A portable metal detector can locate metallic foreign bodies and provide information that can be correlated with radiographic findings.

Patients with signs of obstruction or perforation require laparotomy. Patients who have swallowed packets of medications require special attention because of the risk of packet rupture and subsequent overdose. Patients with symptoms of drug intoxication require urgent laparotomy. Patients without signs of intoxication should be hospitalized. Some clinicians recommend oral polyethylene glycol solution as a laxative to speed passage of the material; others suggest surgical removal. Overall, there is no consensus.

Most foreign bodies that migrate to the small intestine usually pass through the GI tract unimpeded, even if they are retained for weeks or months. They tend to be retained in front of the ileocecal valve or at any site of narrowing, such as that seen in Crohn's disease. Sometimes objects such as toothpicks can remain in the GI tract for many years, causing granuloma or abscess formation.

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