Intestinal foreign bodies: causes of entry

Foreign bodies enter the intestines or if they are accidentally ingested (for example, fruit bones, meat or chicken bones, etc.), or with a suicidal purpose (needles, nails, glass fragments, etc.).

The reasons that contribute to the ingress of foreign bodies into the digestive tract are different.

1. Intentional detection of foreign bodies in the mouth; habit of keeping inedible objects in the mouth. Usually this is observed in young children, as well as shoemakers, handicraftsmen, tailors, carpenters, who have a habit of keeping needles, nails and other small items necessary for work during work. Naturally, when you cough, talk with others, or when you try to swallow saliva, the foreign body can be swallowed.
2. The need to constantly use dental prostheses, which with insufficient fixation in the mouth or the presence of additional circumstances (bouts of severe coughing, laughter, eating, serious general disease, various degrees of impairment of consciousness) can be swallowed. Smaller danger due to smaller sizes is represented by dental crowns, which, however, with insufficient fixation and the presence of a number of the above-mentioned circumstances, are often swallowed or enter the respiratory tract.
3. Negligence in the preparation of food, so that in the finished dish may be pieces of glass when opening glass cans, some small items, such as needles, buttons, if the hostess is simultaneously busy with cooking and other domestic work, etc. In some cases, due to negligence people preparing food, it may be small pieces of crushed bone (beef, chicken, fish), not removed when pre-processing meat, poultry, fish.
4. Insufficiently serious attitude to the very process of food intake: talking with food, laughing, hasty food, smoking, reading a newspaper or a book at a table - everything can lead to ingestion of foreign bodies (meat, fish or chicken bones, fruit bones) .
5. Eating in a state of heavy alcohol intoxication.
6. Reducing the sensitivity of the oral mucosa, for example in patients with dentures, in which the plastic plate of the prosthesis covers a significant part of the hard palate, as well as in certain diseases, the administration of a number of drugs capable of causing anesthesia of the oral cavity (anesthesin, diamond A, etc.).
7. Insufficient estimation of the danger of ingestion of foreign bodies, which is observed in early childhood, in morbid patients and in senile dementia.
8. Intentional ingestion of foreign objects by the mentally ill, with suicidal attempts, and also in certain cases with conscious attempts at self-mutilation.

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 heavy alcohol intoxication, while eating, having a gay conversation, causing laughter, etc.

It should be noted that when a foreign body is delayed with sharp edges in the esophagus, it most often hurts its wall. Relatively large foreign bodies can stay in the stomach for a long time, because its passage through the gatekeeper presents for them some obstacle. However, further passage of foreign bodies through the small intestine usually occurs without hindrance. Foreign bodies with sharp edges, for example fish bones, sharp metal objects and even sewing needles, in most cases pass unobstructed through the intestine and exit outward naturally during defecation. Naturally, such an outcome for the patient is most favorable.

In the literature, descriptions of casuistic cases of some interest are given. N. Bamberger (1858) describes the following observation: a young girl with a suicidal purpose swallowed a bundle of needles wrapped in a piece of paper. For several weeks, 408 needles left her with feces, which did not damage the digestive canal. Such cases have been repeatedly described in the literature and in the following.

When entering the intestine, the further fate of the foreign body can be as follows: it passes unimpeded through the intestine and after a certain period of time, corresponding to the passage time of the contents along the intestine, as indicated above, goes outward naturally in the act of defecation (which is most often observed); it lingers in a part of the intestine for a long time without causing clinical symptoms; 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 foreign body pressure, intestinal bleeding, intestinal obstruction).

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

1. Causes associated with the foreign body itself: large size, peculiarities of the shape of the foreign body, promoting its fixation in the digestive tract (for example, dentures), sharp ends that can injure the intestinal wall and be fixed in it (sewing needles, sharp fish and chicken bones) .
2. Causes of a local nature, directly related to the state of the intestine or its site:
   1. functional disorders: dyskinesia of the intestine, hypertonus, spastic contractions of the intestinal wall, intestinal atony;
   2. organic changes that contribute to the fixation of a foreign body: diverticula, tumors, polyps, inflammatory-ulcer, granulomatous lesions due to various diseases (Crohn's disease, ulcerative colitis, tuberculous lesion).

Often, the delay in the foreign body in the intestines is facilitated by the simultaneous action of a number of these factors (spastic dyskinesia of the colon and the presence of an organic obstruction in the form of a tumor, polyp). It should be borne in mind that various local processes (inflammation, tumor damage) themselves can reflexively cause functional bowel disorders.

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