Conservative management of ingested foreign bodies

Abstract

We reviewed the clinical benefits of hospitalization, esophagogastroduodenoscopy, and surgical intervention for ingested foreign bodies in adults. Patients with esophageal foreign bodies were not included in the study group. A 10-year experience is reported. Each patient’s physical examination findings at presentation, white blood cell count, length of hospital stay, number and types of foreign bodies ingested, endoscopic interventions, surgical interventions, and complications were reviewed. There were 75 separate hospitalizations, all occurring in 22 male prison inmates. A total of 256 foreign bodies were ingested. Patients incurred 281 hospitalization days (average 3.7 days per admission). One patient had signs of peritonitis. White blood cell count was less than 10 K/μL in 85%. Sixty-four endoscopies were performed with removal of 79 of 163 foreign bodies (48% success rate). Five patients required general anesthesia because of a lack of cooperation. Complications occurred in four of them, one requiring laparotomy. Eight additional laparotomies were performed. One was performed for an acute abdomen on admission and one for the development of an acute abdomen after conservative management. Two were performed to remove metal bezoars. Four additional laparotomies were performed because of surgeon preference. Among the 23 patients admitted and managed conservatively, 77 (97%) of 79 foreign bodies passed spontaneously. One patient required laparotomy. Of the 256 ingested foreign bodies, 79 were removed endoscopically, 71 were removed surgically, and 106 passed spontaneously. The size, shape, and number were not predictive of the ability to transit the gastrointestinal tract. Foreign body ingestion is problematic in prison inmates. With conservative management, most foreign bodies will pass spontaneously. Endoscopy has a high failure rate and is associated with significant complications. Surgical intervention should be reserved for those who have acute conditions in the abdomen or large bezoars.