Foreign body ingestion (ICD-10-GM T18-: Foreign body in the digestive tract) occurs when a foreign body is swallowed and passes through the gastrointestinal tract (digestive tract) – hypopharynx (mouth part of the pharynx and lower pharynx), esophagus (esophagus), stomach, small intestine, and colon (large intestine). Foreign body ingestion is among the more common suspected diagnoses in pediatric medicine (pediatric patients). However, foreign body ingestion can also occur in adults, for example in drunk people, unconsciousness, psychiatric diseases or neurological deficits in which the swallowing act is disturbed. Commonly ingested foreign bodies in infants and preschool-aged children include:
- Batteries, button cells (are becoming more common).
- Coins (> 80% of cases)
- Toys / parts, marbles
- Magnets
- Buttons
- Food
Older children also sometimes swallow a ballpoint pen cap out of carelessness, which they “temporarily store” in the mouth.Adults swallow foreign bodies mostly in the course of food intake (fish cakes, chicken bones, pieces of meat not chewed small enough). Likewise, dentures are among the ingested foreign bodies in adults. Foreign bodies can be classified according to the following criteria:
- Size:
- Longer or shorter than 6 cm?
- Diameter larger or smaller than 2.5 cm?
- Surface texture:
- Pointed or blunt?
- Flattened or sharp-edged?
- Material or content:
- Food?
- Drugs?
- Battery?
- Magnet/s?
- Features:
- Radiopaque?
- Metallic?
- Chemically inert? (uninvolved in chemical processes)
Frequency peak: foreign body ingestion occurs predominantly in children, that is, between 6 months and 6 years of age. However, children between the 2nd and 3rd year of life are particularly affected. The prevalence (disease incidence) for bolus impaction (getting a food bolus (swallowable morsel) stuck in the esophagus (food pipe)) is 13 per 100,000 population per year. If foreign body ingestion is suspected, the pediatrician should always be consulted. If necessary, the pediatrician will refer the patient to a clinic. Both diagnosis and therapy should be interdisciplinary. The course and prognosis are significantly influenced by the size of the foreign body, shape and material. In the case of a blunt, short and narrow foreign body that has passed the pylorus (stomach gate), it is possible to wait and observe. Quick action is required if the foreign body is sharp-edged or toxic, if it is a battery, button cell or several magnets, or if the swallowed foreign body is stuck in the cricopharyngeal region (throat area at the level of the cervical vertebrae C5/C6) or in the esophagus (esophagus), as there is then a risk of aspiration (choking) (emergency!). This also exists if swallowed coins are choked up. If larger foreign bodies have passed the esophagus, they usually remain in the stomach. The further procedure then depends on whether the foreign body is classified as dangerous, non-toxic or mechanically harmless. If the foreign body is dangerous, the affected person should be admitted to a hospital for inpatient monitoring. Likewise, if symptoms occur. If it is a non-dangerous foreign body in the stomach and the patient is symptom-free, it is possible to wait until the foreign body is eliminated naturally (outpatient monitoring). X-ray monitoring should be performed after 7-10 days. Complications are rarely expected in this case. If the foreign body is large and pyloric passage is unlikely, extraction (removal) must be performed.Marbles and thumbtacks often come off spontaneously.Swallowed button cells can cause severe local health damage due to the discharge current of the battery. In addition, toxic substances may leak from the battery and cause local burns.Lead-containing items swallowed, such as lead pellets from curtain cord, may cause poisoning. Children’s toys may only contain enough lead to release a maximum of 0.7 micrograms of lead per day if accidentally swallowed.Metallic foreign bodies could be transported out by means of magnets under X-ray fluoroscopy.However, there is a risk of aspiration, because the foreign body could lose contact with the magnet on its way out. Approximately 80-90% of ingested foreign bodies are excreted naturally (via naturalis), 10-20% are recovered endoscopically (“by reflection”), and only 1-2% require surgical removal. In adults, about 60 % of ingested foreign bodies leave the gastrointestinal tract spontaneously. The mean passage time is 5 days. Whether a foreign body ingestion is lethal (fatal) depends on the mechanical and physical properties of the foreign body. Mortality (number of deaths in a given period of time, based on the number of the population in question) is less than 0.05%. Most ingested foreign bodies pass without health consequences.