Common, curious, and often challenging, foreign bodies in the GI and GU tracts carry a unique set of presentations, risks, and treatment options. MedTwitter
Gastrointestinal Tract Foreign Bodies
Foreign bodies identified within the esophagus should generally be considered impacted and should be removed via endoscopy. Rigid endoscopy is recommended for sharp objects because it enables the use of optical forceps with strong grasping capacity.However, blunt foreign bodies ingested within the preceding 24 hours can usually be monitored. These objects typically pass through the GI tract spontaneously.
Adapted image from Kelly J, Corrigan M, Cahill RA, Redmond HP. World J Emerg Surg. 2007;2:9. PMID: 17448234, PMCID: PMC1868019. [Creative Commons Attribution License 2.0 Generic .]Body Packing/Body Stuffing of DrugsBody packers and body stuffers ingest packets filled with drugs, most commonly heroin or cocaine, to avoid detection.
A rectal examination should initially be deferred until the location and type of foreign body can be determined so as to reduce the chances that a fragile object might be broken, the examiner might be injured if the object is sharp, or the object might be accidentally pushed deeper within the body. Plain radiography of the abdomen or pelvis is typically sufficient to identify most objects. Upright chest radiography may be indicated if perforation is suspected.
Gentle traction with forceps can remove most objects. If a strong amount of negative suction is created, passage of a Foley catheter beyond the object will equalize the pressure. Very low–lying objects may be removed via digital manipulation while the patient performs a Valsalva maneuver. Vaginal foreign bodies may result in chronic vaginal discharge, bleeding, or a foul-smelling odor due to inflammation and infection. Retained highly absorbent tampons may lead to the development of toxic shock syndrome.
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