Foreign body ingestion

The patient should be instructed to return to the accident and emergency department if abdominal pain, fever, vomiting, or bleeding occurs.

Patients who have persistent symptoms but no physical evidence or radiological findings of a foreign body should be admitted to hospital for observation.

Patients with sharp or large foreign bodies in the duodenum or small intestine are usually admitted for observation and serial radiography. In most cases, surgery or gastroenterology should be consulted for possible intervention.

If the object has passed into the stomach and it is smooth, blunt, <2.5 cm in diameter, and <6 cm long, patients may be discharged. Serial radiographs are generally not needed; however, an abdominal x-ray 2 to 3 days after the event is recommended to observe progression.

Objects proximal to the rectum are more likely to require operative intervention for removal (>10 cm from anal verge).

All patients with rectal foreign body removal should be observed for 24 hours. Frequently, delays in presentation and multiple attempts at self-removal lead to mucosal oedema, laceration, obstruction, bleeding, and muscular spasms. Perforations may occur but are less common than other complications. Before discharge, all patients should be offered the opportunity for mental health support.

Body packers (people who transport illicit drugs by internal concealment) are considered high risk and should be admitted to hospital. Endoscopic removal of the foreign body is contraindicated. Whole bowel irrigation or observation for spontaneous passage is recommended. Surgical consultation is suggested for possible surgical extraction.