Clinical approach to swallowing of foreign bodies

It is a well known fact that children often swallow things. Children aged 6 months to 6 years are most often affected, but even adults sometimes end up with a foreign body stuck in their throats-and not only there. Peter Ambe, D-sseldorf University Hospital, and his coauthors review this clinical problem in this issue of Deutsches -rzteblatt International (Dtsch Arztebl Int 2012; 109(50): 869−75).

Adults ingest foreign bodies mostly with their food. The most commonly swallowed objects are fish bones and chicken bones. The clinical approach depends on the characteristics of the ingested foreign body (size, length, chemical composition, etc), the patient's subjective symptoms, and the clinical findings. In 80% of cases, the ingested foreign body passes through the gastrointestinal tract without any problems. Endoscopic intervention is required in 20% of cases, and surgery in less than 1%. Emergency esophagogastroduodenoscopy is recommended in case of complete occlusion of the esophagus or if sharp or pointed objects or batteries have been swallowed. Magnets and foreign bodies longer than 6 cm should be removed within 24 hours.

The so-called body packers form a subgroup in this medical territory. Rule of thumb is that asymptomatic persons should be observed on the intensive care ward. No interventions should be undertaken. Symptomatic body packers with signs of intoxication, in whom a lethal dosis has to be assumed, should be medically stabilized and then immediately undergo laparotomy.