CII Foreign Bodies in the Gastrointestinal Tract

Abstract

When a patient with a swallowed foreign body which has become lodged in the esophagus presents himself for treatment, the problem confronting the physician is fundamentally that of the precise technic of endoscopic removal of the object from the patient's food passage; peroral removal is indicated in every instance. With the entrance of the swallowed foreign body into the gastrointestinal tract, however, the problem becomes more complex and its solution depends upon a variety of factors. In certain cases peroral endo-• scopy is the method of choice. In others the object may be removed . by laparotomy. In a large number conservative watchful waiting, in anticipation of spontaneous passage of the foreign body by bowel, is the wisest policy.Seeking to learn whether definite criteria might be established for the adoption of each of the' aforementioned procedures in the management of cases of foreign body in the gastrointestinal tract, we studied the records of 386 consecutive patients seen in the bronchoscopic clinic at Temple University Hospital. In each case the swallowed object was radiopaque and was present in the stomach (38 per cent) or in the intestines (62 per cent) at the time the patient was first seen. The most common foreign bodies, in the order of frequency, were as follows: straight pins, 49; coins, 40; open safety pins, 40; closed safety pins, 29; bobby pins, 29; and nails, 26. The greater number of the patients in the series were small children. The youngest was a baby 7 weeks old who swallowed an open safety pin and passed it in the stool two days later. The oldest was a 70-year-old woman who swallowed a denture. Of the 40 patients who had swallowed open safety pins, 19 (48 per cent) were infants less than 1 year of age. Of the 386 patients with foreign bodies in the gastrointestinal tract, 28 were less than 1 year old; 177 were be-*From the Chevalier Jackson Bronchoscopic Clinic, Temple University Hospital.at Harvard Libraries on July 15, 2015 aor.sagepub.com Downloaded from