Foreign Body in the Gastrointestinal Tract (Swallowed Objects)

What to do right now

1. Check breathing. If the person cannot breathe, speak or cough, start choking first aid (back blows and abdominal thrusts) and call 911. See choking.
2. Find out what was swallowed. Keep the packaging, a matching item, or the device the battery came from.
3. Button battery in a child over 12 months: if it happened within the last 12 hours, give 2 teaspoons (10 ml) of honey every 10 minutes, up to 6 doses, on the way to the ER. This can coat the battery and reduce burns. Do not delay going to the hospital to do this. Do not give honey to babies under 12 months.
4. Do not make the person vomit. Vomiting can push the object into the airway or injure the esophagus again.
5. Do not give food or drink if the object may be stuck, a battery or magnet is involved, or surgery may be needed.
6. Call Poison Control at 1-800-222-1222 (US) for advice about batteries, magnets or toxic items.

Where swallowed objects get stuck

The gut has natural narrow points. An object that passes them usually leaves the body:

• Upper esophagus at the level of the collarbones, the most common site in children.
• Middle esophagus where the aorta crosses it.
• Lower esophagus just above the stomach, where food boluses often stick in adults.
• The stomach outlet (pylorus), which may hold objects wider than about 2.5 cm.
• The duodenal loop, which may trap objects longer than about 5 to 6 cm.
• The ileocecal valve at the end of the small intestine, and the appendix.

Anything that reaches the stomach and is small and blunt usually passes in 4 to 7 days.

Types of foreign bodies and why they matter

Symptoms

Many swallowed objects cause no symptoms at all, especially once they are in the stomach. Symptoms depend on where the object is:

• In the esophagus: pain or a sense of something stuck in the chest or throat, painful or difficult swallowing, drooling, gagging, refusal to eat in children, vomiting.
• In the stomach or intestines: usually none. Abdominal pain, vomiting, swelling or blood in the stool suggest blockage or perforation.
• Signs of perforation: fever, severe pain, swelling or crackling under the skin of the neck, or a rigid belly.

In young children, the only clue may be drooling, poor feeding, irritability or new noisy breathing.

Food bolus impaction in adults

Meat stuck in the lower esophagus is the most common adult problem. It often points to an underlying condition such as eosinophilic esophagitis, an esophageal stricture or a ring, so a doctor will usually take biopsies during removal. A food bolus that does not pass needs endoscopic removal, ideally within 6 to 24 hours, sooner if you cannot swallow saliva. Do not try meat tenderizer or carbonated drinks without medical advice.

Diagnosis

• X-rays of the neck, chest and abdomen find metal objects and most batteries. A button battery shows a "double ring" or halo outline, which distinguishes it from a coin.
• CT scan finds bones, glass and plastic that X-rays miss, and looks for perforation.
• Endoscopy confirms and removes objects in the esophagus, stomach and first part of the small intestine.
• Barium swallows are avoided because they coat the object and make endoscopy harder.

Treatment

• Watchful waiting: for small blunt objects in the stomach or beyond. You eat normally and check the stool. A repeat X-ray may be arranged if the object has not passed in 1 to 2 weeks or for certain items like batteries in the stomach.
• Endoscopic removal: under sedation or general anesthesia, using nets, baskets, graspers and protective hoods for sharp objects. Most objects in reach can be removed this way.
• Surgery: for perforation, blockage, objects that will not move past a point, magnets that have linked through bowel walls, or leaking drug packets.

Laxatives do not speed up passage and are not usually advised.

Complications

Most swallowed objects cause no lasting harm. Serious complications include burns and holes in the esophagus from batteries, narrowing (stricture) after a battery burn, perforation and infection of the chest or abdomen, bowel obstruction, and bleeding. Button battery injuries can cause problems up to several weeks after removal, so follow-up is important.

Prevention

• Keep button batteries, magnets, water beads and small items out of reach, and choose toys with screw-secured battery compartments.
• Supervise young children and anyone with dementia or developmental disability.
• Cut meat into small pieces, chew well, and limit alcohol at meals, particularly with dentures.
• A child or adult who repeatedly eats non-food items may have pica, which deserves assessment.

Frequently asked questions

How long does it take a swallowed object to pass?

Most small, blunt objects that reach the stomach pass in the stool within 4 to 7 days, sometimes up to 2 weeks. If the object has not appeared after that, or there is pain or vomiting, see a doctor for an X-ray.

What happens if a child swallows a coin?

Most coins pass without problems. However, a coin can lodge in the esophagus, so a child who swallowed a coin should usually have an X-ray, especially with drooling, pain or feeding problems. A coin stuck in the esophagus is removed by endoscopy.

Why is swallowing a button battery so dangerous?

A button battery stuck in the esophagus generates an electrical current that creates a strong alkali, burning through tissue within about 2 hours. It can damage the windpipe or a major blood vessel. Any suspected battery swallowing needs an immediate ER visit.

What should I do if I swallowed a small sharp object?

Go to an urgent care center or ER. Sharp objects such as pins, bones and glass have a higher risk of piercing the gut. If reachable, they are usually removed by endoscopy. Do not make yourself vomit.

Can food get stuck in your esophagus?

Yes. Meat is the most common culprit in adults. If you cannot swallow your own saliva, go to the ER now. Repeated food sticking often means an underlying narrowing or inflammation such as eosinophilic esophagitis that needs investigation.