Foreign bodies of the intestine

Various foreign bodies can get into the digestive tract. Many are evacuated spontaneously, but some are fixed, causing symptoms of obstruction. Perforation may occur. Foreign bodies of the intestine are found in 10-15% of cases in gastroenterological practice. Almost all obturating foreign bodies can be removed endoscopically, but sometimes surgical treatment is required.

Foreign objects can be deliberately swallowed by children and adults with mental disorders. Elderly patients with dentures and persons in a state of intoxication are prone to accidentally ingesting insufficiently chewed food (especially meat), which can become stuck in the esophagus. Smugglers swallowing balloons, bubbles or packets with a prohibited drug may develop intestinal obstruction. Packaging can tear, leading to signs of drug overdose.

Migration of foreign bodies through the esophagus proceeds asymptomatically, if there is no obstruction or perforation. In 80% of cases, foreign bodies from the esophagus enter the stomach spontaneously, 10-20% of cases require non-invasive interventions and less than 1% require surgical care. Thus, in most cases, intragastric foreign bodies do not require special treatment. However, objects larger than 5 x 2 cm are rarely evacuated from the stomach. Sharp foreign bodies should be removed from the stomach, as in 15-35% they cause perforation of the intestine, but patients with small round objects (eg coins and batteries) require only observation. The patient's chair should be examined and, if the object is not detected, radiologic control is necessary at intervals of 48 hours. Coins that persist in the stomach for more than 4 weeks, or batteries with signs of corrosion during radiography, remaining in the stomach for more than 48 hours, should be removed. A portable metal detector can localize metallic foreign bodies and provide information that can be compared with radiographic data.

Patients with signs of obstruction or perforation require laparotomy. Patients who swallowed packets of drugs deserve special attention because of the risk of a burst of the package and subsequent overdose. Patients with symptoms of drug intoxication need urgent laparotomy. Patients without intoxication should be hospitalized. Some clinicians recommend oral administration of a solution of polyethylene glycol as a laxative to accelerate the passage of the material; others suggest its surgical removal. In general, there is no unequivocal opinion.

Most foreign bodies that have migrated into the small intestine usually pass through the digestive tract unimpeded, even if they are delayed for weeks or months. They tend to linger before the ileocecal valve or in any part of the constriction that are observed, for example, in Crohn's disease. Sometimes objects such as toothpicks can remain in the lumen of the digestive tract for many years, causing the formation of a granuloma or abscess.

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