Ingested foreign bodies in adults
Citation, DOI & article data
Ingested foreign bodies in adults, in contrast to in children, is often accidental. It usually occurs accidentally in association with food consumption and is most common in adults with underlying gastrointestinal tract pathology. Cases of intentional foreign body ingestion in adults are seen most frequently in people with psychiatric illnesses, drug smugglers (body-packing), and prisoners.
Around 80% of cases are asymptomatic 1.
The most common ingested foreign bodies in adults are chicken bones, fish bones and dentures 1. Ingestion of foreign bodies in adults is often associated with pre-existing pathologies including strictures, malignancy or esophageal rings 2.
Whilst certain cases may be investigated through clinical assessment alone, plain radiographs may be used as an initial screening method for the identification of ingested foreign bodies. However, this may be insufficient for very small or non-radiodense foreign bodies. Where radiographic examination is indicated, contrast studies are usually avoided as they may exacerbate complications and also inhibit clear visualization during potential subsequent endoscopy 3.
CT can be useful in the identification of foreign bodies that are not detected on plain radiograph, with a sensitivity of up to 100% 4. CT is also indicated in patients with suspected complications of foreign body ingestion, such as perforation 5.
Treatment and prognosis
In approximately 80% of cases, the ingested foreign body passes spontaneously without complication, whilst endoscopy is required in around 20% 1,6. Indications for emergency endoscopy include:
- complete esophageal occlusion
- sharp edges of the ingested object
- battery ingestion
Surgery may be required in <1% of patients 7.
- 1. Ambe P, Weber SA, Schauer M, Knoefel WT. Swallowed foreign bodies in adults. (2012) Deutsches Arzteblatt international. 109 (50): 869-75. doi:10.3238/arztebl.2012.0869 - Pubmed
- 2. Sung SH, Jeon SW, Son HS, Kim SK, Jung MK, Cho CM, Tak WY, Kweon YO. Factors predictive of risk for complications in patients with oesophageal foreign bodies. (2011) Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 43 (8): 632-5. doi:10.1016/j.dld.2011.02.018 - Pubmed
- 3. Ikenberry SO, Jue TL, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, Decker GA, Fanelli RD, Fisher LR, Fukami N, Harrison ME, Jain R, Khan KM, Krinsky ML, Maple JT, Sharaf R, Strohmeyer L, Dominitz JA. Management of ingested foreign bodies and food impactions. (2011) Gastrointestinal endoscopy. 73 (6): 1085-91. doi:10.1016/j.gie.2010.11.010 - Pubmed
- 4. Marco De Lucas E, Sádaba P, Lastra García-Barón P, Ruiz-Delgado ML, González Sánchez F, Ortiz A, Pagola MA. Value of helical computed tomography in the management of upper esophageal foreign bodies. (2004) Acta radiologica (Stockholm, Sweden : 1987). 45 (4): 369-74. doi:10.1080/02841850410005516 - Pubmed
- 5. Mosca S, Manes G, Martino R, Amitrano L, Bottino V, Bove A, Camera A, De Nucci C, Di Costanzo G, Guardascione M, Lampasi F, Picascia S, Picciotto FP, Riccio E, Rocco VP, Uomo G, Balzano A. Endoscopic management of foreign bodies in the upper gastrointestinal tract: report on a series of 414 adult patients. (2001) Endoscopy. 33 (8): 692-6. doi:10.1055/s-2001-16212 - Pubmed
- 6. Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF, Mallery JS, Raddawi HM, Vargo JJ, Waring JP, Fanelli RD, Wheeler-Harbough J. Guideline for the management of ingested foreign bodies. (2002) Gastrointestinal endoscopy. 55 (7): 802-6. doi:10.1016/s0016-5107(02)70407-0 - Pubmed
- 7. Webb WA. Management of foreign bodies of the upper gastrointestinal tract: update. (1995) Gastrointestinal endoscopy. 41 (1): 39-51. doi:10.1016/s0016-5107(95)70274-1 - Pubmed