Swallowing a foreign object

As children explore and interact with the world, they will inevitably put foreign bodies into their mouths and swallow some of them.

Most swallowed foreign bodies pass harmlessly through the gastrointestinal (GI) tract. Foreign bodies that damage the GI tract, become lodged, or have associated toxicity must be identified and removed.

The ingestion of foreign bodies is most commonly a problem in young children aged 6 months to 5 years, but can affect children of all ages (those younger than 6 months can occasionally ingest materials with the aid of older siblings during play). It may be an event witnessed by parents. It usually occurs accidentally but can result from deliberate ingestion.

Virtually any object small enough to pass through the mouth may be swallowed. Items commonly ingested by children include coins, small toys, pencils, pens and their tops, batteries, safety pins, needles and hairpins – most of these objects can easily be seen on an X-Ray. Food-related items, such as fish and chicken bones, are more often swallowed by older children and adults and tend to be visible on an X-ray as well. In adults, dentures or parts from dentures may be accidentally swallowed.

The majority of ingested foreign bodies will pass safely through thedigetive tract (those that reach the stomach have an 80-90% chance of passage), but some will cause damage to the gastrointestinal (GI) tract and/or become stuck. Patients swallowing foreign bodies may not have any complaint but symptoms can result. It may even lead to life-threatening obstruction of the esophagus and respiratory tracts.

Foreign bodies will usually get lodged in the upper throat and cause a clear sensation of something being stuck or trapped. Commonly, small linear objects like fish bones or toothpicks get trapped in the tonsils, back of the tongue or the upper esophagus. The discomfort ranges from mild to quite severe and may include drooling and inability to swallow. Larger trapped objects may cause difficulty breathing.

If the foreign body lodges in the esophagus, a sudden sensation of something stuck in the middle of the chest will appear and because of the resulting difficulty swallowing for the remainder of the meal, the patient will begin drooling, gagging and vomiting.

Children with partial obstruction may present with a chronic course featuring inability to feed, failure to thrive, fever, recurrent lung infection or difficulty breathing.

Diagnosis
It is always important to figure out what was swallowed although in children that may be more easily said than done. Certain objects are more dangerous than others because of the possibility of rupturing or tearing the walls of the gastrointestinal tract. These objects include batteries that have corrosive acids that can literally melt down the esophageal or stomach lining, aluminum caps or can rings, sharp objects like pins and bones.

Blood tests are usually unhelpful. Where there is a history of a swallowed solid objects that may be located within the upper gastrointestinal (GI) tract, an X-ray should be carried out to ensure the item is not lodged. This need not be done urgently if occurring out-of-hours and the patient is well, but should be performed at the earliest opportunity possible. If there is a suspicion of swallowing a button battery, then X-rays and further treatment should be performed urgently.

Where there is a clear history of swallowing objects, such as toothpicks and/or aluminium bottle caps/can rings, endoscopy is the investigation/procedure of choice, because of the high rate of complications associated with waiting.

Endoscopy is a procedure that is performed under general anesthesia and involves the careful and gentle insertion of a slender metallic tube through the mouth into the esophagus. This allows direct visualization of the entire length of the esophagus into the stomach to extract any lodged foreign body.

Actual surgical removal of foreign objects is uncommonly performed.

Prevention
It is difficult to prevent toddlers from examining things with their mouths, but basic home-safety measures, such as cupboard catches, and vigilance about leaving objects within children’s reach, are helpful

Discussion with the parents of children who have swallowed foreign bodies is recommended to prevent repetition in the same child or siblings.