Foreign body ingestion and rectal foreign body insertion: Diagnostic challenges

Abstract

Foreign body (FB) ingestions are common in children and mentally handicapped adults. Typical examples include children swallowing coins and mentally handicapped adults swallowing razor blades and silverware. A correlation has been found between age groups and specific types of ingested objects. Coins, toys, crayons, and ballpoint pen caps are most often ingested during childhood, while adults tend to have problem with meat and bones. Moreover, psychiatric patients and prison inmates may ingest such unlikely objects as spoons and razor blades. Fortunately, the vast majority of all swallowed objects pass through the gastrointestinal (GI) tract without problem [1]. The remainder may become lodged in the esophagus or other locations in the GI tract, placing the patient at risk for developing significant complications such as obstruction, aspiration, bleeding, perforation, fistulization, sepsis, and even death [1]. Elongated or sharp objects, such as needles, eating utensils, bobby pins, or razor blades, are more likely to lodge at areas of narrowing (from bowel adhesions or strictures) or to impinge at regions of anatomic acute angulation. The duodenal loop, duodenojejunal junction, appendix, and ileocecal valve region are predisposed to impaction from these types of objects. There is a greater than 90% chance that a FB will be passed spontaneously once it reaches the stomach. However, objects larger than 2 cm in diameter may lodge at the pylorus, whereas objects longer than 6 cm may become entrapped either at the pylorus or at the C-curve of the duodenum, between the first, second, and third parts of the duodenum, and rarely pass beyond that point [2, 3]. Otherwise, the only remaining obstacle hindering passage of the FB is the ileocecal valve. Rarely, a FB becomes entrapped in a Meckel’s diverticulum or at the sigmoid S-curve, which is more flexible than the duodenal Ccurve since it is not fixed in the retroperitoneum and hence more readily allows passage of the FB [4].