Non-interventional outcomes of adult foreign body ingestions

Foreign body ingestions are a common problem in the emergency department. Patients often undergo invasive interventions that require significant resources. Current recommendations based on limited studies, are to attempt endoscopic removal of objects that are sharp or greater than 2.5 cm at or above the proximal duodenum. We hypothesized that many small and sharp objects will pass spontaneously without complication.

We performed a retrospective study of all foreign bodies ingested by adults that were not removed initially by endoscopy over five years. We recorded foreign body size, shape and location, radiographic results, interventions performed, and demographic data. Regression analysis was used to determine any significant associations with the outcome of late intervention.

117 patients with 171 encounters met inclusion criteria with an average age of 33 years. 74 % of patients had a known psychiatric history. The most common foreign body was a razorblade. Fifteen patients had late intervention with twelve endoscopies and three exploratory laparotomies. 87 % of these late interventions were for failure to progress determined by the treatment team. There were no small bowel obstructions. One patient had a recto-sigmoid perforation from a pencil. Analysis indicates that size and sharpness were not significant risk factors for later intervention.

Our study indicates that small objects, even sharp foreign bodies including razorblades, can pass spontaneously without intervention. If larger, future studies show the same conclusion, there should be a reconsideration of current guidelines.