Ingested Foreign Bodies of the Gastrointestinal Tract: Retrospective Analysis of 542 Cases

Abstract

Ingested foreign bodies (FBs) present a common clinical problem. As the incidence of FBs requiring operative removal varies from 1% to 14%, it was decided to perform this study and compare the data with those from the world literature, as well as to outline an algorithm for management, including indications for surgery. We reviewed all patients with FB ingestion from 1973 to 1993. There were 542 patients with 1203 ingestions, aged 15 to 82 years. Among them, 69. 9% (n = 379) were jail inmates at the time of ingestion, 22.9% (n = 124) had a history of psychosis, and 7.2% (n = 39) were alcoholics or denture-wearing elderly subjects. Most foreign bodies passed spontaneously (75.6%; n = 410). Endoscopic removal was possible in 19. 5% (n = 106) and was not associated with any morbidity. Only 4.8% (n = 26) required surgery. Of the latter, 30.8% (n = 8) had long gastric FBs with no tendency for distal passage and were removed via gastrotomy; 15.4% (n = 4) had thin, sharp FBs, causing perforation; and 53.8% (n = 14) had FBs impacted in the ileocecal region, which were removed via appendicostomy. Conservative approach to FB ingestion is justified, although early endoscopic removal from the stomach is recommended. In cases of failure, surgical removal for gastric FBs longer than 7.0 cm is wise. Thin, sharp FBs require a high index of suspicion because they carry a higher risk for perforation. The ileocecal region is the most common site of impaction. Removal of the FB via appendicostomy is the safest option and should not be delayed more than 48 hours.

Clinical Analysis and Proper Management of the Patients Visited ER Due to Ingested Foreign Body: Single Center Experience

“…Even if FB are less than 6 cm in size, surgical treatment should be considered if the retention time of the FB is longer than 12∼72 hours. 20 One case showed the ingestion of a toothbrush, which subsequently impacted the duodenum. A gastrostomy was required in that case.…”

An unusual cause of small bowel perforation: apricot pit

“…[5] In our case, the patient had dental plates and rapid eating habit. On questioning, she explained that she had a fruit garden and reported eating a lot of apricots rapidly during the week.…”

“…[5] The most common sites of intestinal perforation by a foreign body are the ileocecal and rectosigmoid regions. [6] Clinical presentations vary, depending on the site of perforation and the extent and duration of peritonitis.…”

Management of gastrointestinal tract perforations

“…[6][7][8] An ingested foreign body can also cause a GI tract perforation. In 1% of cases, an ingested sharp foreign body causes complications such as acute abdomen due to an intestinal perforation, 9,10 occasionally leading to serious complications and even death. The duration of an ingested foreign body in the GI tract and the risk of perforation or obstruction are associated with the anatomy and structure of the GI tract.…”