Emergency Department Management of Gastrointestinal Foreign Body Ingestion -
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Publication Date: May 2023 (Volume 25, Number 5)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 05/01/2026.

Author

James C. Crosby, MD, FACEP

Assistant Professor of Emergency Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL

Peer Reviewers

Elizabeth Haines, DO, MSc, FACEP

Service Chief of Quality and Associate Professor of Pediatrics and Emergency Medicine, Hassenfeld Children’s Hospital at NYU Langone Health, New York, NY

Randy Sorge, MD, FACEP

Clinical Assistant Professor, Associate Program Director, Louisiana State University School of Medicine Emergency Medicine Residency Program, New Orleans, LA

Abstract

There are over 150,000 reports to American Poison Centers every year due to foreign body ingestions, and many patients will be directed to emergency departments for evaluation and management. This comprehensive review evaluates the current literature related to gastrointestinal foreign body diagnosis and management. A discussion of the utility of various imaging modalities is presented, along with a description of high-risk ingestions and the evidence behind society guidelines and management strategies. Finally, controversies in the management of esophageal impactions are reviewed, including the use of glucagon.

Case Presentations

CASE 1

A 42-year-old woman presents with discomfort after eating fish…

The patient states that the sensation of a foreign body in the mid-chest, just above the epigastric region began 2 hours ago while eating pan-seared halibut at a local seafood restaurant. She suspects a potential fish bone ingestion.
Chest and abdominal radiographs were obtained, and the radiologist’s impression is “no acute abnormality or foreign body identified.”
The patient continues to have some moderate discomfort when swallowing, but is able to drink juice and hold down crackers and a turkey sandwich in the ED.
You wonder whether the patient can be discharged with expectant management or if further testing is needed…

CASE 2

A mother brings in her 2-year-old son after witnessing him ingesting an object…

The mother states that she believes he ingested a coin, as he was playing with a toy electric cash register, and she saw him place a metallic circular object into his mouth. The child appears to be fussy, but his vital signs are normal. He is tolerating his secretions.
A chest radiograph reveals a disc-shaped object in the upper esophagus. It measures approximately 15 mm in diameter and has a halo-like appearance and a step-off edge on the lateral view.
The patient’s mother asks whether the coin will pass on its own or something more needs to be done…

CASE 3

A 22-year-old man presents with anorectal pain...

The patient reports 2 days of pain and difficulty with defecation. He denies any abdominal pain, nausea, or vomiting.
On examination, his abdomen is benign, and on visual genitourinary examination you do not see any external hemorrhoids or fissures. On digital rectal examination, you are easily able to palpate a smooth, hard object within the distal rectum.
On further inquiry, the patient reports that he inserted a television remote rectally, but he does not want to disclose additional details surrounding the incident. You wonder whether you should proceed with a removal attempt or if any additional testing is needed…

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