Intestinal foreign bodies - Causes of ingestion

Foreign bodies enter the intestines either through accidental ingestion (for example, fruit pits, meat or chicken bones, etc.), or for suicidal purposes (needles, nails, shards of glass, etc.).

There are various reasons why foreign bodies enter the digestive tract.

1. Intentional presence of foreign bodies in the mouth; the habit of keeping inedible objects in the mouth. This is usually observed in small children, as well as shoemakers, craftsmen, tailors, carpenters, who have a common habit of keeping needles, nails and other small objects necessary for work in their mouths during work. Naturally, when coughing, talking to others or trying to swallow saliva, a foreign body can be swallowed.
2. The need to constantly use dentures, which, if not sufficiently fixed in the mouth or if there are additional circumstances (severe coughing fits, laughter, food, serious general illness, various degrees of impaired consciousness), can be swallowed. Dental crowns pose a lesser danger due to their smaller size, but if not sufficiently fixed and if there are a number of the above circumstances, they are often swallowed or enter the respiratory tract.
3. Carelessness in food preparation, as a result of which the finished dish may contain pieces of glass when opening glass cans, some small objects, such as needles, buttons, if the housewife is busy with other housework at the same time as preparing food, etc. In some cases, due to the carelessness of the people preparing the food, it may contain small pieces of crushed bone (beef, chicken, fish), not removed during the preliminary processing of meat, poultry, fish.
4. Not taking the process of eating seriously enough: talking while eating, laughing, eating hastily, smoking, reading a newspaper or book at the table - all can lead to swallowing foreign bodies that accidentally end up in food (meat, fish or chicken bones, fruit pits).
5. Eating while heavily intoxicated.
6. Decreased sensitivity of the oral mucosa, for example in patients with dentures, in whom the plastic plate of the denture covers a significant part of the hard palate, as well as in certain diseases, taking a number of medications that can cause anesthesia of the oral cavity (anesthesin, almagel A, etc.).
7. Insufficient assessment of the danger of swallowing foreign bodies, which is observed in early childhood, in debilitated patients and in senile dementia.
8. Intentional swallowing of foreign objects by mentally ill individuals, during suicide attempts, and also in some cases during deliberate attempts at self-harm.

Often there is a combined effect of a number of the above factors, for example, swallowing poorly fixed dentures by a patient in a state of severe alcohol intoxication, during a meal, a cheerful conversation that causes laughter, etc.

It should be noted that when a foreign body with sharp edges is retained in the esophagus, it most often injures its wall. Relatively large foreign bodies can be retained in the stomach for a long time, since its passage through the pylorus is somewhat of an obstacle for them. However, further passage of foreign bodies through the small intestine usually occurs without hindrance. Foreign bodies with sharp edges, such as fish bones, sharp metal objects and even sewing needles, in most cases pass through the intestines without hindrance and exit naturally during defecation. Naturally, such an outcome is the most favorable for the patient.

The literature contains descriptions of casuistic cases that are of particular interest. H. Bamberger (1858) describes the following observation: a young girl swallowed a pack of needles wrapped in paper with suicidal intent. Over the course of several weeks, 408 needles came out with her feces without damaging the digestive tract. Similar cases have been repeatedly described in the literature since then.

Upon entering the intestine, the further fate of a foreign body may be as follows: it passes through the intestine unhindered and after a certain period of time, corresponding to the passage time of the contents through the intestine, as indicated above, it comes out naturally during defecation (which is observed most often); it lingers for a long time in some part of the intestine, without causing clinical symptoms; a foreign body (or multiple foreign bodies) in the intestine causes complications that significantly affect the patient's condition (perforation of the intestinal wall and peritonitis, abscess, necrotic changes in the intestinal wall due to pressure of the foreign body, intestinal bleeding, intestinal obstruction).

The main reasons for the retention of foreign bodies in the large intestine can be conditionally classified.

1. Reasons related to the foreign body itself: large size, features of the shape of the foreign body that contribute to its fixation in the digestive tract (for example, dentures), sharp ends that can injure the intestinal wall and become fixed in it (sewing needles, sharp fish and chicken bones).
2. Local causes directly related to the condition of the intestine or its part:
   1. functional disorders: intestinal dyskinesia, hypertonicity, spastic contractions of the intestinal wall, intestinal atony;
   2. organic changes that contribute to the fixation of a foreign body: diverticula, tumors, polyps, inflammatory-ulcerative, granulomatous lesions due to various diseases (Crohn's disease, nonspecific ulcerative colitis, tuberculous lesions).

Often, the retention of a foreign body in the intestine is facilitated by the simultaneous action of a number of the above factors (spastic dyskinesia of the colon and the presence of an organic obstruction in the form of a tumor, polyp). It should be taken into account that various local processes (inflammation, tumor damage) themselves can reflexively cause functional disorders of the intestine.

[ 1 ]