GI Foreign Bodies


Overview

Diagnosis

Pathophysiology

Treatment

  1. Treatment (Hypopharynx to Colon)
    1. Hypopharynx
      • Forceps removal under direct visualization
      • Local anesthesia
        • Benzocaine
        • Aerosolized lidocaine w/nebulizer
      • F/U X-ray
      • Consider referral to ENT for pharyngoscopy and/or (GI) barium swallow
         
    2. Esophageal
      • STAT GI referral for sharp objects, perf, severe symptoms, batteries, drugs; otherwise
        • Endoscopy urgently if food bolus still present (Tx of choice)
        • Foley technique (use caution to avoid aspiration/perforation)
        • Glucagon 0.5-2.0 mg IV VERY slowly for distal obst
        • Nitroglycerin SL low dose 0.15 mg after IV bolus if glucagon not effective
        • Maloney bougie to advance food bolus
        • Pt will need further GI W/U once bolus passed
           
    3. Stomach/Intestine
      • Most will pass w/no symptoms
      • Removal for large, multiple, or sharp objects
      • "Hang up" sites: Pylorus, duodenojejunal junction, ileocecal valve
      • Serial KUBs
      • Cocaine "stuffers & packers": Monitor, admit, tox screen, surg consult, poison control; avoid manual removal; see Toxicology, Cocaine section
         
    4. Batteries See Button Batteries

Disposition

  1. If FB removed, send home w/stool checks
  2. If object sharp, large, bulky and risk of perf, or if pt intoxicated, generally will need to remove or admit to hospital