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ingested foreign body (esophageal foreign body, coin ingestion)

Etiology: 1) dysphagia - most commonly due to stroke in the elderly - eosinophilic esophagitis in young patients 2) cancer 3) stricture 4) diverticulum 5) Schatzky's ring 6) experimential behavior in children a) coin ingestion b) magnet ingestion 7) grill brush bristle ingestion 8) fish bone (case report) [3] Epidemiology: 1) older persons, especially with dementia 2) children Clinical manifestations: 1) difficulty handling secretions 2) drooling 3) leaning forward 4) patients can often localize the level of the lesion by pointing to it 5) inability to swallow 6) regurgitation of food (no vomiting) Radiology: - serial abdominal radiographs to ensure multiple magnets are progressing through the intestines [5] Complications: - multiple magnets pose a unique risk when ingested together - they may attract one another through different loops of bowel & cause mural pressure necrosis resulting in - bowel perforation - intestinal fistula formation - volvulus - intestinal obstruction - intra-abdominal sepsis [5] Management: 1) patients with symptoms should always have obstructions removed as soon as possible 2) for asymptomatic individuals with identifiable object (i.e. coin) in esophagus, observation may be appropriate - 25% of asymptomatic patients with pass ingested coins spontaneously in the feces [2] 3) conservative management for ingestion of a single magnet [5,6,7] 3) for a child who has swallowed multiple magnets - endoscopic foreign body removal is indicated for magnets in the esophagus or stomach - if the magnets have moved beyond the stomach & are traveling together, & the patient is asymptomatic, the magnets may be followed with serial radiographs - if the magnets are not progressing, foreign body removal via intestinal endoscopy or abdominal surgery indicated - avoid stimulant laxatives - see complications [5,6,7]

Related

esophagus

Specific

grill brush bristle ingestion

General

gastroenterology (GI) foreign body

References

  1. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  2. Waltzman ML, Baskin M, Wypij D, Mooney D, Jones D, Fleisher G. A randomized clinical trial in the management of esophageal coins in children. Pediatrics 2005 Sep; 116:614-9. PMID: 16140701
  3. Gharib SD et al Case 21-2015 - A 37-Year-Old American Man Living in Vietnam, with Fever and Bacteremia. N Engl J Med 2015; 373:174-183. July 9, 2015 PMID: 26154791 http://www.nejm.org/doi/full/10.1056/NEJMcpc1411439
  4. Ahmadi MS, Ahmadi M. Missed Pharyngeal Foreign Body in an Infant that Persisted for 50 days:A Rare Case. Iran J Otorhinolaryngol. 2012 Summer;24(68):151. PMID: 24303402 Free PMC Article
  5. NEJM Knowledge+ Question of the Week. Nov 14, 2017 https://knowledgeplus.nejm.org/question-of-week/4148/
  6. Tavarez MM, Saladino RA, Gaines BA, Manole MD. Prevalence, clinical features and management of pediatric magnetic foreign body ingestions. J Emerg Med 2012 Jun 26; 44:261 PMID: 22727803
  7. Wright CC, Closson FT. Updates in pediatric gastrointestinal foreign bodies. Pediatr Clin North Am. 2013 Oct;60(5):1221-39. Review. PMID: 24093905