gastrointestinal disorders
Gastric and Intestinal Foreign Bodies
Treatment of Gastric and Intestinal Foreign Bodies
Observation Sometimes endoscopic removal Rarely surgery Management depends on several factors: Location of the object Nature of the object Symptoms and signs Sharp objects should be retrieved from the stomach because of the risk of perforation. Small round objects (eg, coins) can simply be observed for a period of time that varies depending on the nature of the object. Patients should observe their stools for spontaneous passage of the object. If the object does not appear in the stool, x-rays should be taken at 48- to 72-hour intervals and then at weekly intervals. The following objects should be removed endoscopically ( Treatment reference ): Batteries that cause symptoms or signs of GI tract injury Cylindrical batteries and disk batteries that remain in the stomach for > 48 hourswithoutcausing signs of GI injury Sharp-pointed objects in the stomach Objects > 2.5 cm diameter in the stomach Any objects that remain in the stomach after 3 to 4 weeks Any magnets within endoscopic reach Most foreign objects that have passed into the small intestine usually traverse the GI tract without problem, even if they take weeks to do so. They tend to be held up around the curvature of the first part of the duodenum (duodenal sweep) and by the area of physiologic narrowing before the ileocecal valve. Sometimes objects such as toothpicks or fish bones remain within the GI tract for many years, only to turn up in a granuloma or abscess. Ingestion of a single magnet is unlikely to cause GI complications, but multiple magnets are extremely hazardous because they can become attracted to each other across loops of bowel, which can lead to fistula formation, obstruction, necrosis, or perforation. Endoscopy can be used to access the small bowel and may have a role in the treatment of small-bowel foreign body ingestions in some patients. Surgical removal should be considered for short, blunt objects that are located in the small bowel, distal to the duodenum, but have not changed location for more than 1 week and cannot be managed endoscopically and for patients presenting with bowel obstruction. Patients who have ingested drug packages and who present with symptoms and signs of drug toxicity should receive medical treatment immediately. Prompt surgical evaluation should be obtained when sympathomimetic toxicity, bowel obstruction, perforation, or drug leakage is suspected. Asymptomatic patients should be admitted to the hospital and closely monitored in an intensive care setting. Endoscopic removal is not recommended for ingested drug packages because of the high risk of package perforation. Some clinicians advocate whole-body irrigation using oralpolyethylene glycolsolution as a cathartic to enhance passage of the material; others suggest surgical removal. The best practice is unclear. 1.ASGE Standards of Practice Committee, Ikenberry SO, Jue TL, Anderson MA, et al: Management of ingested foreign bodies and food impactions.Gastrointest Endosc73:1085–1091, 2011. doi: 10.1016/j.gie.2010.11.010 