Advertisement

Approach to Foreign Body Ingestion, Food Impaction, and Caustic Injury

  • Emmanuel C. GorospeEmail author
  • Louis M. Wong Kee Song
  • Prasad G. Iyer

Abstract

Foreign body ingestion and food impaction are conditions that may require prompt endoscopic therapy. Although the majority of ingested foreign bodies will eventually pass through the gastrointestinal tract, early intervention is necessary in some cases to prevent complications and alleviate symptoms. Although complications from ingested foreign bodies and impacted food boluses are rare, they can be severe, including aspiration, perforation, obstruction, and fistula and stricture formation. In addition, caustic injury from ingestion of acid or alkali is a cause of significant morbidity and mortality, especially in children. Early recognition, timely endoscopic evaluation of the degree of injury, and prevention of life-threatening complications are critical in triaging patients for either supportive or more invasive surgical intervention. Herein, the prevalence, predisposing factors, clinical presentation, and initial management of these gastrointestinal emergencies are highlighted. Specific endoscopic tools and techniques in managing ingested foreign bodies and food impaction are reviewed in a separate chapter. Suggested algorithms for the management of foreign body ingestion and food impaction are outlined.

This chapter includes supplementary videos.

Keywords

Caustic injury Endoscopy Esophageal perforation Food impaction Foreign body ingestion Foreign body removal 

Supplementary material

Video 7.1

Retained capsule endoscope in the ileum removed via double-balloon enteroscopy (MP4 16177 kb)

Video 7.2

Endoscopic removal of food bolus impaction (MP4 12332 kb)

Video 7.3

Endoscopic appearance of severe esophageal caustic (lye) injury (MP4 7435 kb)

References

  1. 1.
    Ikenberry SO, Jue TL, Anderson MA, Appalaneni V, Banerjee S, Ben-Menachem T, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc. 2011;73:1085–91.CrossRefPubMedGoogle Scholar
  2. 2.
    Mosca S, Manes G, Martino R, Amitrano L, Bottino V, Bove A, et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract: report on a series of 414 adult patients. Endoscopy. 2001;33:692–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF, et al. Guideline for the management of ingested foreign bodies. Gastrointest Endosc. 2002;55:802–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Nandi P, Ong GB. Foreign body in the oesophagus: review of 2394 cases. Br J Surg. 1978;65:5–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Cheng W, Tam PK. Foreign-body ingestion in children: experience with 1,265 cases. J Pediatr Surg. 1999;34:1472–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Gundling F, Seidl H, Stark T, Schneider A, Schepp W. Management of impacted foreign bodies in the upper gastrointestinal tract in adult patients - results of a retrospective case series. Z Gastroent. 2012;50:1287–91.CrossRefGoogle Scholar
  7. 7.
    Conway WC, Sugawa C, Ono H, Lucas CE. Upper GI foreign body: an adult urban emergency hospital experience. Surg Endosc. 2007;21:455–60.CrossRefPubMedGoogle Scholar
  8. 8.
    Vijaysadan V, Perez M, Kuo D. Revisiting swallowed troubles: intestinal complications caused by two magnets--a case report, review and proposed revision to the algorithm for the management of foreign body ingestion. J Am Board Fam Med. 2006;19:511–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Henderson CT, Engel J, Schlesinger P. Foreign body ingestion: review and suggested guidelines for management. Endoscopy. 1987;19:68–71.CrossRefPubMedGoogle Scholar
  10. 10.
    Selivanov V, Sheldon GF, Cello JP, Crass RA. Management of foreign body ingestion. Ann Surg. 1984;199:187–91.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Faigel DO, Stotland BR, Kochman ML, Hoops T, Judge T, Kroser J, et al. Device choice and experience level in endoscopic foreign object retrieval: an in vivo study. Gastrointest Endosc. 1997;45:490–2.CrossRefPubMedGoogle Scholar
  12. 12.
    Jayachandra S, Eslick GD. A systematic review of paediatric foreign body ingestion: presentation, complications, and management. Int J Pediatr Otorhinolaryngol. 2013;77:311–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Chinitz MA, Bertrand G. Endoscopic removal of toothbrushes. Gastrointest Endosc. 1990;36:527–30.CrossRefPubMedGoogle Scholar
  14. 14.
    Chauvin A, Viala J, Marteau P, Hermann P. Dray X. Management and endoscopic techniques for digestive foreign body and food bolus impaction. 2013;45:529–42.Google Scholar
  15. 15.
    Frei-Lanter CM, Vavricka SR, Kruger TH, Tutuian R, Geier A, Bauerfeind P, et al. Endoscopy for repeatedly ingested sharp foreign bodies in patients with borderline personality disorder: an international survey. Eur J Gastroenterol Hepatol. 2012;24:793–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Centers for Disease Control and Prevention (CDC). Injuries from batteries among children aged <13 years--United States, 1995–2010. MMWR Morb Mortal Wkly Rep. 2012;61:661–6.Google Scholar
  17. 17.
    Litovitz T, Schmitz BF. Ingestion of cylindrical and button batteries: an analysis of 2382 cases. Pediatrics. 1992;89:747–57.PubMedGoogle Scholar
  18. 18.
    Nagaraj HS, Sunil I. Multiple foreign body ingestion and ileal perforation. Pediatr Surg Int. 2005;21:718–20.CrossRefPubMedGoogle Scholar
  19. 19.
    Haraguchi M, Matsuo S, Tokail H, Azuma T, Yamaguchi S, Dateki S, et al. Surgical intervention for the ingestion of multiple magnets by children. J Clin Gastroenterol. 2004;38:915–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Wildhaber BE, Le Coultre C, Genin B. Ingestion of magnets: innocent in solitude, harmful in groups. J Pediatr Surg. 2005;40:e33–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Butterworth J, Feltis B. Toy magnet ingestion in children: revising the algorithm. J Pediatr Surg. 2007;42:e3–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Liu S, de Blacam C, Lim FY, Mattei P, Mamula P. Magnetic foreign body ingestions leading to duodenocolonic fistula. J Pediatr Gastroenterol Nutr. 2005;41:670–2.CrossRefPubMedGoogle Scholar
  23. 23.
    Tsai J, Shaul DB, Sydorak RM, Lau ST, Akmal Y, Rodriguez K. Ingestion of magnetic toys: report of serious complications requiring surgical intervention and a proposed management algorithm. Perm J. 2013;17:11–4.PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Beckley I, Ansari NA, Khwaja HA, Mohsen Y. Clinical management of cocaine body packers: the Hillingdon experience. Can J Surg. 2009;52:417–21.PubMedCentralPubMedGoogle Scholar
  25. 25.
    Mandava N, Chang RS, Wang JH, Bertocchi M, Yrad J, Allamaneni S, et al. Establishment of a definitive protocol for the diagnosis and management of body packers (drug mules). Emerg Med J. 2011;28:98–101.CrossRefPubMedGoogle Scholar
  26. 26.
    Traub SJ, Hoffman RS, Nelson LS. Body packing--the internal concealment of illicit drugs. N Engl J Med. 2003;349:2519–26.CrossRefPubMedGoogle Scholar
  27. 27.
    Lancashire MJ, Legg PK, Lowe M, Davidson SM, Ellis BW. Surgical aspects of international drug smuggling. Br Med J (Clin Res Ed). 1988;296:1035–7.CrossRefGoogle Scholar
  28. 28.
    Needleman H. Lead poisoning. Annu Rev Med. 2004;55:209–22.CrossRefPubMedGoogle Scholar
  29. 29.
    Needleman HL, Landrigan PJ. What level of lead in blood is toxic for a child? Am J Public Health. 2004;94:8. author reply 9.PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Gorospe EC, Gerstenberger SL. Atypical sources of childhood lead poisoning in the United States: a systematic review from 1966–2006. Clin Toxicol. 2008;46:728–37.Google Scholar
  31. 31.
    Cabb EE, Gorospe EC, Rothweiler AM, Gerstenberger SL. Toxic remedy: a case of a 3-year-old child with lead colic treated with lead monoxide (greta). Clin Pediatr. 2008;47:77–9.Google Scholar
  32. 32.
    Gerstenberger SL, Savage G, Sellers C, Zupnik K, Gorospe EC. Lead-contaminated candies in Southern Nevada. Public Health Rep. 2007;122:572.PubMedCentralPubMedGoogle Scholar
  33. 33.
    McKinney PE. Acute elevation of blood lead levels within hours of ingestion of large quantities of lead shot. J Toxicol Clin Toxicol. 2000;38:435–40.CrossRefPubMedGoogle Scholar
  34. 34.
    Mowad E, Haddad I, Gemmel DJ. Management of lead poisoning from ingested fishing sinkers. Arch Pediatr Adolesc Med. 1998;152:485–8.PubMedGoogle Scholar
  35. 35.
    Fry LC, Akbar Q, von Gruchalla C, Monkemuller K. Endoscopic removal of a partial denture lodged in the jejunum, using single balloon enteroscopy. Endoscopy. 2012;44(Suppl 2 UCTN):E236–7.PubMedGoogle Scholar
  36. 36.
    Chang CW, Wang HY, Chen MJ, Lin SC, Chang WH, Lee JJ. Intermittent small-bowel obstruction due to a mobile bezoar diagnosed with single-balloon enteroscopy. Endoscopy. 2011;43(Suppl 2 UCTN):E297.CrossRefPubMedGoogle Scholar
  37. 37.
    Hendrickson RG, Horowitz BZ, Norton RL, Notenboom H. “Parachuting” meth: a novel delivery method for methamphetamine and delayed-onset toxicity from “body stuffing”. Clin Toxicol. 2006;44:379–82.Google Scholar
  38. 38.
    Cave D, Legnani P, de Franchis R, Lewis BS. ICCE consensus for capsule retention. Endoscopy. 2005;37:1065–7.CrossRefPubMedGoogle Scholar
  39. 39.
    Li F, Gurudu SR, De Petris G, Sharma VK, Shiff AD, Heigh RI, et al. Retention of the capsule endoscope: a single-center experience of 1000 capsule endoscopy procedures. Gastrointest Endosc. 2008;68:174–80.CrossRefPubMedGoogle Scholar
  40. 40.
    Sears DM, Avots-Avotins A, Culp K, Gavin MW. Frequency and clinical outcome of capsule retention during capsule endoscopy for GI bleeding of obscure origin. Gastrointest Endosc. 2004;60:822–7.CrossRefPubMedGoogle Scholar
  41. 41.
    Cheon JH, Kim YS, Lee IS, Chang DK, Ryu JK, Lee KJ, et al. Can we predict spontaneous capsule passage after retention? A nationwide study to evaluate the incidence and clinical outcomes of capsule retention. Endoscopy. 2007;39:1046–52.CrossRefPubMedGoogle Scholar
  42. 42.
    Baichi MM, Arifuddin RM, Mantry PS. What we have learned from 5 cases of permanent capsule retention. Gastrointest Endosc. 2006;64:283–7.CrossRefPubMedGoogle Scholar
  43. 43.
    Rogers AM, Kuperman E, Puleo FJ, Shope TR. Intestinal obstruction by capsule endoscopy in a patient with radiation enteritis. JSLS. 2008;12:85–7.PubMedCentralPubMedGoogle Scholar
  44. 44.
    Van Weyenberg SJ, Van Turenhout ST, Bouma G, Van Waesberghe JH, Van der Peet DL, Mulder CJ, et al. Double-balloon endoscopy as the primary method for small-bowel video capsule endoscope retrieval. Gastrointest Endosc. 2010;71:535–41.CrossRefPubMedGoogle Scholar
  45. 45.
    Longstreth GF, Longstreth KJ, Yao JF. Esophageal food impaction: epidemiology and therapy. A retrospective, observational study. Gastrointest Endosc. 2001;53:193–8.CrossRefPubMedGoogle Scholar
  46. 46.
    Webb WA. Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc. 1995;41:39–51.CrossRefPubMedGoogle Scholar
  47. 47.
    Dellon ES. Eosinophilic esophagitis. Gastroenterol Clin North Am. 2013;42:133–53.PubMedCentralCrossRefPubMedGoogle Scholar
  48. 48.
    Stadler J, Holscher AH, Feussner H, Dittler J, Siewert JR. The “steakhouse syndrome”. Primary and definitive diagnosis and therapy. Surg Endosc. 1989;3:195–8.CrossRefPubMedGoogle Scholar
  49. 49.
    Ferrucci Jr JT, Long Jr JA. Radiologic treatment of esophageal food impaction using intravenous glucagon. Radiology. 1977;125:25–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Trenkner SW, Maglinte DD, Lehman GA, Chernish SM, Miller RE, Johnson CW. Esophageal food impaction: treatment with glucagon. Radiology. 1983;149:401–3.CrossRefPubMedGoogle Scholar
  51. 51.
    Sodeman TC, Harewood GC, Baron TH. Assessment of the predictors of response to glucagon in the setting of acute esophageal food bolus impaction. Dysphagia. 2004;19:18–21.CrossRefPubMedGoogle Scholar
  52. 52.
    Alaradi O, Bartholomew M, Barkin JS. Upper endoscopy and glucagon: a new technique in the management of acute esophageal food impaction. Am J Gastroenterol. 2001;96:912–3.CrossRefPubMedGoogle Scholar
  53. 53.
    Weinstock LB, Shatz BA, Thyssen SE. Esophageal food bolus obstruction: evaluation of extraction and modified push techniques in 75 cases. Endoscopy. 1999;31:421–5.CrossRefPubMedGoogle Scholar
  54. 54.
    Vicari JJ, Johanson JF, Frakes JT. Outcomes of acute esophageal food impaction: success of the push technique. Gastrointest Endosc. 2001;53:178–81.CrossRefPubMedGoogle Scholar
  55. 55.
    Mamel JJ, Weiss D, Pouagare M, Nord HJ. Endoscopic suction removal of food boluses from the upper gastrointestinal tract using Stiegmann-Goff friction-fit adaptor: an improved method for removal of food impactions. Gastrointest Endosc. 1995;41:593–6.CrossRefPubMedGoogle Scholar
  56. 56.
    Gorospe EC, Arora AS. New diagnostic and therapeutic frontiers in eosinophilic esophagitis. Minerva Gastroenterol Dietol. 2013;59:59–68.PubMedGoogle Scholar
  57. 57.
    Ally MR, Dias J, Veerappan GR, Maydonovitch CL, Wong RK, Moawad FJ. Safety of dilation in adults with eosinophilic esophagitis. Dis Esophagus. 2013;26:241–5.CrossRefPubMedGoogle Scholar
  58. 58.
    Goldman LP, Weigert JM. Corrosive substance ingestion: a review. Am J Gastroenterol. 1984;79:85–90.PubMedGoogle Scholar
  59. 59.
    Celerier M. Management of caustic esophagitis in adults. Ann Chir. 1996;50:449–55.PubMedGoogle Scholar
  60. 60.
    Johnson CM, Brigger MT. The public health impact of pediatric caustic ingestion injuries. Arch Otolaryngol Head Neck Surg. 2012;138:1111–5.CrossRefPubMedGoogle Scholar
  61. 61.
    Einhorn A, Horton L, Altieri M, Ochsenschlager D, Klein B. Serious respiratory consequences of detergent ingestions in children. Pediatrics. 1989;84:472–4.PubMedGoogle Scholar
  62. 62.
    Hawkins DB, Demeter MJ, Barnett TE. Caustic ingestion: controversies in management. A review of 214 cases. Laryngoscope. 1980;90:98–109.CrossRefPubMedGoogle Scholar
  63. 63.
    Friedman EM. Caustic ingestions and foreign bodies in the aerodigestive tract of children. Pediatr Clin North Am. 1989;36:1403–10.PubMedGoogle Scholar
  64. 64.
    Gaudreault P, Parent M, McGuigan MA, Chicoine L, Lovejoy Jr FH. Predictability of esophageal injury from signs and symptoms: a study of caustic ingestion in 378 children. Pediatrics. 1983;71:767–70.PubMedGoogle Scholar
  65. 65.
    Moulin D, Bertrand JM, Buts JP, Nyakabasa M, Otte JB. Upper airway lesions in children after accidental ingestion of caustic substances. J Pediatr. 1985;106:408–10.CrossRefPubMedGoogle Scholar
  66. 66.
    Sarfati E, Gossot D, Assens P, Celerier M. Management of caustic ingestion in adults. Br J Surg. 1987;74:146–8.CrossRefPubMedGoogle Scholar
  67. 67.
    Previtera C, Giusti F, Guglielmi M. Predictive value of visible lesions (cheeks, lips, oropharynx) in suspected caustic ingestion: may endoscopy reasonably be omitted in completely negative pediatric patients? Pediatr Emerg Care. 1990;6:176–8.CrossRefPubMedGoogle Scholar
  68. 68.
    Holinger PH. Management of esophageal lesions caused by chemical burns. Ann Otol Rhinol Laryngol. 1968;77:819–29.CrossRefPubMedGoogle Scholar
  69. 69.
    Zargar SA, Kochhar R, Mehta S, Mehta SK. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc. 1991;37:165–9.CrossRefPubMedGoogle Scholar
  70. 70.
    Christesen HB. Prediction of complications following unintentional caustic ingestion in children. Is endoscopy always necessary? Acta Paediatr. 1995;84:1177–82.CrossRefPubMedGoogle Scholar
  71. 71.
    Ferguson MK, Migliore M, Staszak VM, Little AG. Early evaluation and therapy for caustic esophageal injury. Am J Surg. 1989;157:116–20.CrossRefPubMedGoogle Scholar
  72. 72.
    Karagiozoglou-Lampoudi T, Agakidis CH, Chryssostomidou S, Arvanitidis K, Tsepis K. Conservative management of caustic substance ingestion in a pediatric department setting, short-term and long-term outcome. Dis Esophagus. 2011;24:86–91.CrossRefPubMedGoogle Scholar
  73. 73.
    Penner GE. Acid ingestion: toxicology and treatment. Ann Emerg Med. 1980;9:374–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Emmanuel C. Gorospe
    • 1
    • 2
    Email author
  • Louis M. Wong Kee Song
    • 1
  • Prasad G. Iyer
    • 1
  1. 1.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA
  2. 2.Center for Digestive Health, Prevea Health & Hospital Sisters Health SystemGreen BayUSA

Personalised recommendations