Clinical Pathways
Clinical Pathways
Foreign Body Ingestion
Foreign Body Ingestion

Foreign Body Ingestion

Tags
Emerg. Med. Practice
Published
May 1, 2023
Author(s)
James C. Crosby, MD, FACEP

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Action

Patient presents with concern for foreign body ingestion

Decision

Does the patient have esophageal symptoms?

Drooling, Dysphagia, Odynophagia

Background

When symptoms are present, they may indicate where in the GI tract a foreign body may be located. Esophageal foreign bodies may present with drooling, dysphagia, wheezing, and chest pain. If patients are able to communicate, they may indicate a foreign-body sensation in the neck or chest. Abdominal pain, nausea, or vomiting can be present in the case of subdiaphragmatic foreign bodies, although gastric and intestinal foreign bodies are largely asymptomatic. A full history should include determination of the time of ingestion and as many details as possible about the object ingested, including size, shape, composition, and magnetic properties (if any).

Differential Diagnosis

An observed or reported ingestion of a foreign body is often how patients will present to the ED, but patients may not be able to recount an accurate history. Emergency clinicians must be careful to not assume that foreign bodies are in the GI tract, as aspirated foreign bodies occur at high rates as well. Differentiating aspiration versus ingestion can sometimes be difficult, as either may present in patients who are drooling, coughing, wheezing, and/or have stridor.

Inability to manage oral secretions can be seen in esophageal foreign body impactions, but other etiologies must be considered if the history does not point to ingestion. Epiglottitis and retropharyngeal abscesses can mimic a foreign body due to the mass effect that the inflammatory swelling causes on the larynx and upper esophagus. Esophageal or gastric malignancy can also cause symptoms similar to FBIs, but they are typically a more subacute or chronic presentation. It is also important to consider globus pharyngeus in those who present with a foreign-body sensation in the throat or esophagus. This is typically a diagnosis of exclusion, made after imaging and endoscopy fail to reveal a foreign body. Globus pharyngeus may represent up to 4% of new referrals to otolaryngology clinics.

Nausea, vomiting, and abdominal pain have a broad differential that certainly includes FBI in some clinical settings, but foreign bodies are often discovered incidentally on imaging, and clinicians should be careful not to anchor on an incidental foreign body as the cause of a patient’s GI complaints without considering other possibilities.

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References
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