Foreign Bodies in the Gastrointestinal Tract and Anorectal Emergencies

Foreign bodies in the gastrointestinal tract

In the United States, 1500 people die each year due to ingested foreign bodies (FBs).¹ Eighty percent of FB ingestions occur in young children who swallow small objects such as coins, toys, crayons, and ballpoint pen caps.2, 3 Accidental FBs in adults tend to be caused by meat and bones. The remaining cases are found primarily among edentulous adults, prisoners, and psychiatric patients, who often intentionally ingest objects such as toothbrushes, spoons, and razor blades; and who are also more

Oropharyngeal foreign bodies

Most ingested FBs do not become impacted in the oropharynx. The most common exceptions are fish or chicken bones (Fig. 1), although any sharp or irregular object may become impacted.13, 14, 15, 16 These objects most often lodge in the soft tissue at the base of the tongue, but may also be found in other areas such as the tonsil or piriform sinus.¹³ Minor lacerations and abrasions are common and self-limited. If the patient is drooling or is unable to tolerate oral intake of liquids, the

Stomach and duodenal foreign bodies

The vast majority of FBs that enter the stomach pass through the entire GI tract uneventfully. Objects longer than 5 cm may have difficulty negotiating the tight curve of the duodenum, and objects larger than 2 cm in diameter may have difficulty passing the pylorus or ileocecal valve.106, 107 Less than 1% of FBs that enter the stomach cause perforation of the bowel¹⁰⁸; however, some investigators describe an intestinal perforation rate of 35% with sharp objects (usually at the ileocecal valve)

Foreign bodies of the small and large intestine

Once in the small intestine, the most common impaction point is the ileocecal valve, followed by the hepatic and splenic flexures. Sharp objects tend to turn so that the blunt end leads and the sharp end trails.⁵ Management of sharp FBs in the intestine includes daily radiographs to document progression of the FB. If there is no distal progression over a 3-day period or if the patient becomes symptomatic, emergent surgical consultation should be obtained.⁵

Rectal foreign bodies

A wide variety of rectal FBs as well as complications from retained FBs have been reported. Anorectal FBs may infrequently be the result of an orally ingested sharp object that becomes impacted; however, the majority are the result of objects that are inserted through the anal canal.6, 129 Sharp ingested FBs usually present with symptoms of impaction such as bleeding, perforation, or abscess. The patient does not usually remember the ingestion and the object is identified during surgery.

Most

Anorectal emergencies

Anorectal disorders are commonly encountered in the ED setting. While the minority is life-threatening, there are many conditions that cause considerable discomfort. An understanding of anorectal anatomy is essential to understanding the disease processes that occur in this region. This section focuses on diseases that are commonly encountered or may require emergent management.

Summary

Ingested FBs are usually benign, but impacted FBs are potentially life-threatening. The ED management of FBs in the GI tract varies depending on the nature of the object, its anatomic location, and the symptoms experienced by the patient.

Anorectal disorders are frequently encountered in the ED. An understanding of anorectal anatomy and common disorders allows the emergency physician to provide relief and resolution in the majority of cases.