Table of contents
Foreign body ingestion
Background
Overview
Definition
Foreign body ingestion refers to the accidental or intentional swallowing of objects, which is a common issue in pediatrics and can involve a variety of objects, such as toys, batteries, magnets, and bones.
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Pathophysiology
Larger, sharper, or irregularly shaped objects can cause damage to the mucosal lining, leading to inflammation, bleeding, or perforation. In some cases, the foreign body can become lodged in certain areas of the gastrointestinal tract, such as the esophagus, stomach, or intestines, leading to impaction. Ingestion of multiple magnetic foreign bodies poses a particular risk for obstruction due to proximate attraction through the intestinal wall.
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Epidemiology
The annual incidence of foreign body ingestion in the US is estimated at 18 per 10,000 children aged < 6 years.
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Risk factors
Risk factors for foreign body ingestion include young age (especially under 6 years), certain behavioral habits, and conditions that may lead to decreased supervision or increased risk-taking behavior.
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Disease course
Clinical presentation can vary, with most cases being asymptomatic or presenting with only minor discomfort, while symptomatic cases may present with drooling, food refusal, unexplained crying, and dysphagia.
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Prognosis and risk of recurrence
While most foreign bodies pass spontaneously, up to 20% may require endoscopic removal. Potential complications can include gastrointestinal tract obstruction and perforation, airway obstruction, and infection.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of foreign body ingestion are prepared by our editorial team based on guidelines from the British Society of Gastroenterology (BSG 2024), the European Society of Gastrointestinal Endoscopy (ESGE 2023,2016), the World Society of Emergency Surgery (WSES 2019), the European Society of Gastrointestinal Endoscopy (ESGE/ESPGHAN 2017), and the American Society for Gastrointestinal ...
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Diagnostic investigations
History and physical examination: as per WSES 2019 guidelines, obtain initial evaluation based on the patient's history and physical examination.
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Plain X-ray
CT
Barium swallow
Laboratory tests
Medical management
Therapeutic procedures
Endoscopic removal, indications: as per WSES 2019 guidelines, perform therapeutic flexible endoscopy as first-line therapy of persistent esophageal foreign bodies, although 80-90% of ingested foreign bodies pass spontaneously through the gastrointestinal tract.
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Endoscopic removal (technical considerations)
Surgical interventions
Specific circumstances
Patients with food impaction, evaluation: as per WSES 2019 guidelines, obtain a diagnostic evaluation for potential underlying disease, including histological evaluation, in addition to therapeutic endoscopy.
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Patients with food impaction (management)
Individuals ingested drug-containing packets