History and exam
Key diagnostic factors
common
dysphagia
Inability to swallow solids, liquids, or both. Dysphagia may be classified as cricopharyngeal dysphagia (problem in initiating the swallowing process) or esophageal dysphagia (patient is able to swallow but the food bolus is unable to pass into the stomach lumen and is described as "food stuck in my chest").
nonspecific abdominal pain
Severe or nonspecific abdominal pain must be carefully evaluated, as it could be a symptom of esophageal tear/perforation, pyloric obstruction, or bowel strangulation and require immediate evaluation.
Rectal foreign bodies can also present with nonspecific abdominal complaints.
Special consideration should be taken in those people with previous abdominal surgery and unexplained abdominal pain.
stridor and wheezing
A large esophageal foreign body at the oropharynx or upper esophageal sphincter can cause tracheal obstruction with resultant stridor, wheezing, or respiratory compromise. Delayed presentation is commonly seen in children who may present primarily with respiratory symptoms and may not volunteer a history of foreign body ingestion/obstruction.[50]
drooling
The inability to handle secretions often indicates partial or complete oropharyngeal or esophageal obstruction and may increase the risk of aspiration pneumonia.
Other diagnostic factors
common
gagging, nausea/vomiting, neck/throat pain
Symptoms of a foreign body being stuck in the throat following ingestion.
atypical chest pain or noncardiac chest pain
Multiple etiologies such as esophageal tear or perforation, bolus obstruction, hiatus hernia strangulation, or esophageal malignancy can cause chest pain.
choking
Choking while consuming food, the "cafe coronary syndrome," is a type of upper airway obstruction caused by a food bolus at the level of the hypopharynx and can lead to death. The syndrome is more likely to occur in individuals who eat too fast or chew their food improperly, those with dentures, psychiatric patients, individuals who use drugs or consume alcohol, and those who are laughing or talking while eating.[29]
lower gastrointestinal bleeding
Nonspecific symptoms of an object in the colorectal area include hematochezia and mucus coming from the rectum.
uncommon
pain on swallowing
Pain with swallowing can sometimes be a symptom of a food impaction, and can occur with or without dysphagia.
fever, poor feeding, failure to thrive, and irritability (in children)
These symptoms are commonly seen in children with chronic foreign body obstruction.
acute or chronic asthma-like symptoms or recurrent pneumonia
Chronic foreign body obstruction should be part of the differential diagnosis of young children who present with acute or chronic symptoms resembling acute asthma attacks or unexplained recurrent pneumonia.
signs of sepsis
Patients presenting with tachycardia, hypotension, or fever may have a perforation of the gastrointestinal tract.
sign of acute drug intoxication
Rupture of a swallowed drug packet (e.g., condom filled with cocaine or heroin) can cause acute intoxication.
Risk factors
strong
age <15 years
Children <15 years old account for 70% to 80% of patients with foreign bodies in the upper gastrointestinal (GI) tract, with the highest incidence in children between 1 and 3 years old.
In Western countries, coins are the most common objects found in children.[9][10] In Asian countries, fish bones are the most common foreign bodies found in the upper GI tract of children (due to the early introduction of unfilleted fish into the diet).[12][13]
gastrointestinal tract narrowing
Congenital or acquired narrowing at any point within the gastrointestinal (GI) tract may serve as a barrier to the free passage of a foreign body.[24] This can include Schatzki ring, peptic strictures, fistula, eosinophilic esophagitis, other inflammatory processes, tumors, gastric outlet obstruction, and prior GI surgery.
chemical dependence
The use of alcohol/recreational drugs or other sedatives that can alter the mental status may increase the risk of foreign body ingestion.[25]
intellectual disability
Certain pathologies (e.g., Down syndrome) may increase the incidence of foreign body ingestion. These patients often have a repeated history of foreign body ingestion.[26]
mental illness
People who have schizophrenia or personality disorders have an increased risk of repeated ingestion of multiple, large, or unusual objects.[27]
inmates or people engaged in criminal activities
People who are incarcerated or engaged in criminal activities may swallow objects to seek some secondary gain with access to a medical facility or to hide them from authorities (e.g., multiple condoms filled with cocaine or heroin to transfer the drug from one country to another).[4]
dental disorders
Poor dentition and dental bridge work are associated with upper gastrointestinal tract obstruction.[28]
hurried eating
Associated with upper gastrointestinal tract obstruction.[29]
impaired gag reflex
Primary neurologic disorders involving gag reflex impairment (e.g., Parkinson disease, postictal states, history of stroke, and dementia) are associated with foreign body ingestion and food impaction.
weak
male sex (adults)
In adults, the incidence of accidentally or intentionally swallowing foreign bodies is higher in men than women. In children with swallowed foreign bodies, there is no sex predominance.
history of underlying esophageal disease, surgery, or procedure
History of surgery (e.g., Nissen fundoplication) or implants (e.g., esophageal stent) can increase the risk of foreign body impaction.
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