Predictors for operative intervention in adult patients with foreign body ingestion

The management of foreign body ingestion (FBI) in the adult population varies widely given the lack of evidence-based guidelines. This study aimed to identify risk factors associated with the need for operative intervention in these cases.

This was a retrospective cohort study between July 2015 and January 2021. All adult patients (age ≥18 years) presenting after FBI were included. We collected and analyzed demographics and clinical outcomes data. Multivariable regression was used to identify foreign body (FB) characteristics associated with operative interventions.

A total of 303 patient encounters were included. Ingested FBs were classified as sharp/pointed (64.7%), blunt (40.6%), magnetic (8.3%), or corrosive/battery (5.0%). Notably, 40% underwent endoscopic interventions, including esophagogastroduodenoscopy (35.3%) and colonoscopy (4.6%). Twelve patients (4.0%) underwent an operative intervention secondary to perforation or failure to progress. Patients with perforation or failure to progress had longer median FB lengths than patients without these complications (11.5 vs 3.0 cm; P <.001). On multivariate regression analysis, FB length was significantly associated with the need for operative intervention (odds ratio [OR], 1.67 for each centimeter increment; P <.001). The ingestion of sharp/pointed objects was associated with a lower risk of operative intervention (OR, 0.20; P =.04).

Adult patients who present after FBI can often be managed conservatively. The length of ingested objects seems to be more associated with the need for operative intervention rather than the shape. Early endoscopic removal of high-risk FBs should be considered when feasible.