Citation, DOI and article data
Foreign bodies are objects lying partially or wholly within the body that originated in the external environment. Foreign body placement is voluntary or involuntary. Although implanted medical devices represent foreign bodies in the broad sense of the term, these have their own set of articles (see below).
There are many ways in which a foreign body can be introduced into various parts of the human body.
Aspirated foreign bodies will have a clear clinical correspondence: choking, coughing, neck pain or struggling to breathe. Risk factors for foreign body aspiration include intubation, neurological deficit, facial trauma, and dental instrumentation. The right main bronchus is the most common site of obstruction due to the anatomy of the bronchial tree favoring the right side (larger diameter, more vertical orientation). Often two orthogonal plain radiographs are the primary investigation of choice 12.
Many surgical procedures deliberately introduce foreign bodies either in the form of hemostatic clips (most common), stents, valve replacements, pacing boxes, catheters, etc. or accidentally when a surgical instrument or surgical pack is inadvertently left in situ.
Ingested foreign bodies range from pediatric patients placing objects in their mouths, to mental-health-related self-harm, to bones stuck in the pharynx or gastrointestinal tract. Coins account for 70% of pediatric ingested foreign bodies and will typically become ‘stuck’ at the level of the cricopharyngeus muscle 8,14.
Sharp ingested foreign bodies can be potentially problematic when lodged in the esophagus; patients will often require emergency endoscopy; more often than not, if the sharp object is within reach of endoscopy, it will be removed before it progresses further 12.
Plastic bread clips are diagnostically challenging. The limited literature on this foreign body suggests they are invisible on both plain radiography and CT. The rigid shape can cause bowel perforations or gastrointestinal hemorrhage 15,16.
Drug packing is a well-documented form of foreign body. Often drugs are placed within condoms, or wrapped in foil, latex or cellophane, then swallowed or inserted anally or vaginally. These should be considered hazardous to the patient until evacuated due to the possibility of the containment method rupturing.
Most rectal foreign bodies are inserted via the anus, although occasionally the foreign body has been ingested and has passed through to lie in the rectum. Commonly, rectal foreign bodies are used for sexual purposes 1-3. Rectal foreign will vary from case to case. The main problem with this is the often delayed presentation due to the reluctance of patients to present to emergency departments. Patients may suffer from extraperitoneal mucosal injuries or suffer from a more severe complication such as perforation 1-5.
Two plain radiographs are recommended to accurately demonstrate the size, shape, and location of the rectal foreign body. This should be performed before a digital examination to prevent staff-related injuries from sharper foreign bodies.
Most soft tissue foreign bodies are involuntary, resulting from accidental injury 18. The most commonly reported soft-tissue foreign bodies are glass, metal, and splinters from wood 5 and the most common location is the wrist/hand/finger 18.
It is imperative to locate foreign bodies before they become infected or worse, such as damage close-by organs, ideally within 24 hours of injury 18. ~40% are missed on clinical examination 18. Patients may have a delayed presentation with a foreign body granuloma.
The investigation of foreign bodies relies heavily on radiology and every foreign body will have an optimal modality for investigation 17. Metal, glass, and stone can be visualized very well using conventional plain film radiography, whereas more organic structures, such as wood, may require further imaging such as ultrasonography 5-7.
The radiological appearance in plain radiography of foreign bodies is dependent on three factors: the x-ray attenuation of the foreign body, the surrounding structures and any overlying structures that may veil the object.
The anatomical location will affect the radiopacity of the suspected foreign body and the rate of magnification as the object is placed further or closer to the detector; lateral cervical radiographs can have a magnification rate of up to 21.6% 9-11.
Most foreign bodies are hyperechoic.
The density of the foreign material in the body can range markedly, so the use of multiple window settings is crucial in identifying the presence of the objects. Routinely soft tissue, lung, and bone windows should be assessed. Certain plastics may be occult on CT.
The signal intensity of the foreign material in the body can range markedly, but most objects cause artifacts of some sort. Particular objects may be occult on MRI, such as those made of wood or plastic.
- 1. Coskun A, Erkan N, Yakan S et-al. Management of rectal foreign bodies. World J Emerg Surg. 2013;8 (1): 11. doi:10.1186/1749-7922-8-11 - Free text at pubmed - Pubmed citation
- 2. Nivatvongs S, Metcalf DR, Sawyer MD. A simple technique to remove a large object from the rectum. J. Am. Coll. Surg. 2006;203 (1): 132-3. doi:10.1016/j.jamcollsurg.2006.03.012 - Pubmed citation
- 3. Akhtar MA, Arora PK. Case of unusual foreign body in the rectum. Saudi J Gastroenterol. 2009;15 (2): 131-2. doi:10.4103/1319-3767.48973 - Free text at pubmed - Pubmed citation
- 4. Cohen JS, Sackier JM. Management of colorectal foreign bodies. J R Coll Surg Edinb. 1996;41 (5): 312-5. Pubmed citation
- 5. Aras MH, Miloglu O, Barutcugil C et-al. Comparison of the sensitivity for detecting foreign bodies among conventional plain radiography, computed tomography and ultrasonography. Dentomaxillofac Radiol. 2010;39 (2): 72-8. doi:10.1259/dmfr/68589458 - Free text at pubmed - Pubmed citation
- 6. Hunter TB, Taljanovic MS. Foreign bodies. Radiographics. 2003;23 (3): 731-57. doi:10.1148/rg.233025137 - Pubmed citation
- 7. Eggers G, Welzel T, Mukhamadiev D et-al. X-ray-based volumetric imaging of foreign bodies: a comparison of computed tomography and digital volume tomography. J. Oral Maxillofac. Surg. 2007;65 (9): 1880-5. doi:10.1016/j.joms.2006.09.029 - Pubmed citation
- 8.Jayachandra S, Eslick GD. A systematic review of paediatric foreign body ingestion: presentation, complications, and management. (2013) International journal of pediatric otorhinolaryngology. 77 (3): 311-7. doi:10.1016/j.ijporl.2012.11.025 - Pubmed
- 9. Mark Halverson, Sabah Servaes. Foreign bodies: radiopaque compared to what?. (2013) Pediatric Radiology. 43 (9): 1103. doi:10.1007/s00247-013-2660-y - Pubmed
- 10. Shigematsu H, Koizumi M, Yoneda M et-al. Magnification error in digital radiographs of the cervical spine against magnetic resonance imaging measurements. Asian Spine J. 2013;7 (4): 267-72. doi:10.4184/asj.2013.7.4.267 - Free text at pubmed - Pubmed ci
- 11.Shigematsu H, Koizumi M, Yoneda M, Iida J, Oshima T, Tanaka Y. Magnification error in digital radiographs of the cervical spine against magnetic resonance imaging measurements. (2013) Asian spine journal. 7 (4): 267-72. doi:10.4184/asj.2013.7.4.267 - Pubmed
- 12. Weiland ST, Schurr MJ. Conservative management of ingested foreign bodies. (2002) Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 6 (3): 496-500. Pubmed
- 13. Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging battery-ingestion hazard: clinical implications. (2010) Pediatrics. 125 (6): 1168-77. doi:10.1542/peds.2009-3037 - Pubmed
- 14. Sahn B, Mamula P, Ford CA. Review of foreign body ingestion and esophageal food impaction management in adolescents. (2014) The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 55 (2): 260-6. doi:10.1016/j.jadohealth.2014.01.022 - Pubmed
- 15. Anthony P. H. Tang, Andrew B. Kong, David Walsh, Ratan Verma. SMALL BOWEL PERFORATION DUE TO A PLASTIC BREAD BAG CLIP: THE CASE FOR CLIP REDESIGN. (2005) ANZ Journal of Surgery. 75 (5): 360. doi:10.1111/j.1445-2197.2005.03356.x - Pubmed
- 16. Newell KJ, Taylor B, Walton JC, Tweedie EJ. Plastic bread-bag clips in the gastrointestinal tract: report of 5 cases and review of the literature. (2000) CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 162 (4): 527-9. Pubmed
- 17. Martin L. Gunn. Pearls and Pitfalls in Emergency Radiology. ISBN: 9781139619899
- 18. Bruno C. Carneiro, Isabela A. N. Cruz, Renan N. Chemin, Thiago A. Rizzetto, Júlio B. Guimarães, Flávio D. Silva, Ciro Yoshida Junior, Daniel Pastore, Alípio G. Ormond Filho, Marcelo A. C. Nico. Multimodality Imaging of Foreign Bodies: New Insights into Old Challenges. (2020) RadioGraphics. doi:10.1148/rg.2020200061