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Foreign body ingestion

What's new

Added 2023 BSG, 2019 WSES, 2017 ESPGHAN, 2016 ESGE, and 2011 ASGE guidelines for the evaluation and management of foreign body ingestion.



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.
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.
The annual incidence of foreign body ingestion in the US is estimated at 18 per 10,000 children aged < 6 years.
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.
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.


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...
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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

Watchful waiting: as per ESGE/ESPGHAN 2017 guidelines, consider obtaining observation in patients with a single cylindrical battery in the stomach. Obtain outpatient monitoring followed by an X-ray 7-14 days after ingestion if the battery is not passed in the stool.
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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

Indications for surgery: as per WSES 2019 guidelines, perform surgery for irretrievable foreign body, perforation, foreign body close to vital structures (aortic arch), and other complications.
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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.

More topics in this section

  • Patients with food impaction (management)

  • Individuals ingested drug-containing packets