| Abstract|| |
A retrospective study of 20 cases diagnosed as "swallowed foreign body" seen over a five-year period (July 1993-June 1998) at Asir Central Hospital was performed. Six (30%) were children and 14 (70%) adults. In the children, five were boys and one was a girl. Objects swallowed included metal nails. coins, hair pins and a chain pendant. In the adult group, eight (57%) were males and six (43%) females. Objects swallowed included sewing needles, sharp blades, pieces of glass, paper clips and gravel. The swallowed foreign body in all the patients passed innocuously through the gastrointestinal tract in two to ten (average 4.7) days. Our method of treatment consisted of giving high fiber diet, Metamucil or lactulose and liquid paraffin. There was no mortality.
Keywords: Swallowed foreign body, conservative treatment.
|How to cite this article:|
Al Shehri GY, Al Malki TA, Al Shehri MY, Ajao OG, Jastaniah SA, Haroon KS, Mahfouz MM, Al Shraim MM. Swallowed foreign body: Is interventional management always required?. Saudi J Gastroenterol 2000;6:84-6
|How to cite this URL:|
Al Shehri GY, Al Malki TA, Al Shehri MY, Ajao OG, Jastaniah SA, Haroon KS, Mahfouz MM, Al Shraim MM. Swallowed foreign body: Is interventional management always required?. Saudi J Gastroenterol [serial online] 2000 [cited 2018 Dec 11];6:84-6. Available from: http://www.saudijgastro.com/text.asp?2000/6/2/84/33484
Swallowed foreign body may lodge in the esophagus or other parts of gastrointestinal tract with a considerable degree of morbidity and mortality. It may also pass innocuously through the entire length of gastrointestinal tract. Because of serious complications that may occur when a pointed or a sharp object is trapped, endoscopic or surgical intervention may be required. It has been shown that in experienced hands, the removal of swallowed foreign body through upper gastrointestinal endoscopy is safe, even in paediatric age group, and reduces hospital admission,, . This paper highlights the evolution of 20 cases of foreign body ingestions seen at Asir Central Hospital that were eliminated without any intervention. The purpose of this study is to report our results of non invasive approach to swallowed foreign bodies.
| Patients and Methods|| |
All the case notes of patients diagnosed as "swallowed foreign body" seen at Asir Central Hospital, Abha in a 5-year period from July 1993 to June 1998 were reviewed. There were 20 cases recorded during this period. On presentation five patients had foreign body in the stomach. In the others the foreign bodies had passed through the pylorus and lodged in the upper small intestines. The sex, the age and the nationality of the patients were recorded. The clinical presentation, the treatments administered and the outcome of the treatment noted. All the patients presented between 12 and 36 hours of swallowing the foreign body.
| Results|| |
Six patients (30%) were children aged between 9 months and 11 years (average 4.3 years). For administrative and admission purposes, the upper limit of the pediatric age group is 12 years. This age was therefore adopted for this study. Of the six children, five were boys and only one was a girl. All were Saudi Nationals except one Egyptian. Objects swallowed were chain pendant, metal screw, metal nail, coin, hair pin and small metal pins [Figure - 1]. All these objects were swallowed accidentally. They were treated successfully by conservative means since they were totally asymptomatic. None of these children had subnormal mentality. Foreign bodies passed within four to five days (average 4.3 days). There was no mortality.
The remaining 14 patients (70%) were adults. Eight (57%) were males and six (43) were females. The age ranged between 14 and 34 (average 20.5) years. Only one patient, a 17-year-old girl was Syrian and the others were Saudi nationals. Objects swallowed included a . gold ring, pins, blade fragments, metallic nails, pieces of glass, metal paper clips, sewing needles, hair pins, gravel and pieces of metal. Only two patients admitted to deliberately swallowing the objects. One patient, who had multiple admissions for "non-specific" abdominal pain, swallowed pieces of glass. The others claimed that the swallowing of the objects was accidental, although the histories did not support their claims. One patient, who swallowed blade fragments, had been under psychiatric treatment. Two patients, who swallowed pieces of glass and metal clips respectively, were in jail. None of the patients was symptomatic on presentation. Eleven of the adult patients (78.6%) were single and three (21.4%) were married. The foreign bodies passed in 2 to 10 (average 4.7) days.
| Discussion|| |
Even though this series consists of only 20 cases, these cases were seen over a period of 5 years in this institution. In a previous report on the findings of esophagogastroduodenoscopy in pediatric patients, Al-Mofleh et ah found ten cases of swallowed foreign body and successfully extracted nine endoscopically. In another series of 166 upper gastrointestinal endoscopy by Lardhi et al, foreign bodies were removed endoscopically in nine patients. The largest series of endoscopic extraction of foreign bodies from the upper gastrointestinal tract in Saudi Arabia was reported by Al-Moagel et al. Sixty-one patients had foreign bodies and endoscopic extraction was successful in (91%). Despite the small number of cases in our report, we feel that useful deductions can still be made. When swallowed foreign bodies lodge in the esophagus it may induce life-threatening condition such as aortoesophageal fistula, with fatal outcome. The objects tend to lodge at the level of the aortic arch and produce a fistula between the thoracic descending aorta and esophagus. Such complication has been reported in association with ingested fish and chicken bones,, . Fish and chicken are commonly eaten in our community but none of our patients swallowed bones. The average latent period between the time of swallowing the foreign body and the signal of hemorrhage has been estimated to be 8 days. The Chiari's triad, that is chest pain, the symptom-free interval and the signal mostly represent the characteristic clinical features. The prognosis of this condition is very poor.
Swallowed foreign bodies that have safely passed through the esophagus may be held up in the stomach if there has been previous surgery on the pylorus causing scarring, or in any part of the intestines if there has been a pre-existing abdominal adhesions. This was not encountered in any of our patients. Swallowed and inhaled foreign bodies in children under five years of age are common and have been considered as serious causes of morbidity and mortality. This series shows that practically all these objects, regardless of how dangerous they may appear, may pass innocuously, if they are not trapped in the esophagus, in the absence of abdominal adhesions and if they are properly managed. Our practice in managing these patients is conservative, consisting of high fiber diet, bulking agents or lactulose, banana fruit and liquid paraffin. The elimination of the foreign body can be confirmed by its identification in the stool and/or negative abdominal radiography. The progress of the foreign body is usually monitored by plain abdominal radiographs. However, children with a history of a suspected swallowed radio-opaque foreign body may also need radiographic examination of the nasopharynx even in the absence of symptoms and signs, because an object in this area can be fatal.
Even though endoscopic extraction is well accepted and recommended as a form of treatment for swallowed foreign body in upper gastrointestinal tract, a conservative approach with proper management is also effective and is preferable when foreign bodies have passed the esophagus.
| References|| |
|1.||Al Motleh IA, Klaus Jessen, AL Hmaid RSA, At Samarai AYI, AI Aska At, Jawad A.1, AI Faleh FZ. Ann Saudi Med 1989;9:32-5. |
|2.||Lardhi A, Al Sutan M, AI Fadel Saleh M, Al Quorain A, Adel A, Al Baradie R. The Saudi J Gastroenterol 1996;2:15-8. |
|3.||Al Moagel MA, Al Mofarreh M, Mohsen A, Rawashda A, Fakunle Y, Tikku N. 3 rd Saudi Symposium on Gastroenterology and Hepatology and first meeting of the Saudi Gastroenterology Association. College of Medicine, Riyadh, Saudi Arabia Feb. 26-28, 1989. |
|4.||Talal AI Malki. Personal Communication. |
|5.||Fukunag T, Yamamoto K, Mizoi Y, Nakagawa K, Yamamoto Y, Yamada M, Tatsuno Y. Aortoesophageal fistula by swallowed foreign body - A case report and a review of the literature. Nippon Hoigaku Zasshi 1989;43:337-47. |
|6.||Li S. Aorto-esophageal fistula caused by swallowed foreign body (report of 17 cases). Chung Hua Erh Pi Yen Hou Ko Tsa Chih 1992;27:91-2 & 125-6. [PUBMED] |
|7.||Umeki S, Nakajima M, Tsukiyama K, Okimoto N, Yagi S, Soejima R. Foreign body-induced bronchial actinomycosis with severe stenosis that must be distinguished lung cancer. Nippon Kyobu Shikkan Gakkai Zasshi 1990;28:481-6. [PUBMED] |
|8.||Suita S, Iwanaga M, Sumitomo K, Ogami H. Prolonged retention of a swallowed foreign body in the stomach following pyloromyotomy. Aust Paediatr J 1988;24:373-4. [PUBMED] |
|9.||Imaizumi H, Yamauchi M, Namiki A, Takahashi H, Hatakeyama K. Obstructive ileus caused by a swallowed foreign body-A "press-through" package and preexisting adhesions. Am J Emerg Med 1997;15:52-3. [PUBMED] |
|10.||Halit V, Gunaydin S. An unusual foreign body swallowed by a newborn causing respiratory distress (Letter). Acta Gastroenterol Belg 1993;56:359-60. |
|11.||Parker AJ, Bin.-ham BJ, Osbome JE. The swallowed foreign body: Is it in the nasopharynx? Postgrad Med J 1988,64:201-3. |
Gharamah Yahya Al Shehri
Department of Surgery, College of Medicine, King Khalid University, P.O. Box 641, Abha
Source of Support: None, Conflict of Interest: None
[Figure - 1]