An Overview of Swallowed Foreign Objects

Accidentally swallowing glass, metal, plastic, or another foreign object is not unusual, especially for children. In some cases, the object can pass through the body without causing any problems. However, if something is sharp, gets lodged in your esophagus (food pipe), or contains dangerous materials (like battery acid), it can cause serious injury.

Here is what to do if you or someone else swallows a foreign object, including symptoms to watch out for, how accidents are treated, and when to seek emergency care.

What Happens If You Swallow a Foreign Object

A foreign object is something that is in the body but doesn't belong there. This includes swallowed objects that are not food as well as oral medications like pills.

When a foreign object is swallowed, it will move through the gastrointestinal (GI) tract which starts at the mouth and moves through the pharynx (throat), esophagus, stomach, duodenum, (first section of the small intestine), small intestine, large intestine (colon), and rectum.

The object is moved with rhymic muscular contractions called peristalsis. Along the route are six muscular valves called sphincters that the foreign object will need to pass through.

At any stage of this journey, the object can get stuck or cause damage if it is large, sharp, or irregularly shaped. If the object is small, soft, or smoothly textured, it may pass without incident. Most objects will spontaneously pass within a few days to a week.

Symptoms of Swallowed Foreign Objects

If you swallow a foreign object, there may or may not be any immediate symptoms.

In some cases, a person may experience immediate symptoms, particularly if it gets stuck in the esophagus. In others, the symptoms may be delayed until the foreign object causes a tear or gets lodged somewhere in the GI tract.

Signs of a swallowed foreign object vary by the part of the GI tract affected and may include:

• Coughing
• Gagging
• Chest pain
• Wheezing or gasping
• Trouble breathing
• Noisy breathing
• Difficulty swallowing
• Turning red, white, or blue in the face
• Bloody saliva
• Vomiting with or without blood
• Sharp or burning abdominal pain
• Abdominal distension and tenderness
• Rectal pain
• Rectal bleeding or bloody stool

With small children, you may not even be aware that an object has been swallowed and only recognize that something is wrong because the child is crying.

Causes in Children

Young children explore the world by using their senses, including taste. This can lead them to place objects in their mouth that shouldn't be there, resulting in accidental swallowing.

One study suggests that 20% of children between the ages of 1 to 3 have swallowed a non-food item. Others report that children under 5 were responsible for 75% of all reported cases. The most common items swallowed are coins, toys, jewelry, and, most worryingly, batteries.

Button batteries, like the ones used in watches, can pose serious risks if swallowed. Sodium hydroxide batteries can cause chemical burns, while lithium batteries can generate electrical currents that can damage tissues. Button batteries larger than 3/4 inch (20 millimeters) cause the worst injuries.

Sharp objects, like broken glass or metal, can injure the walls of the esophagus and cause bleeding. If the tear is significant, it can cause an infection of the esophagus and the adjacent mediastinum (the space between the lungs that houses the heart).

This, in turn, can lead to a bacterial chest infection, myocarditis, (heart muscle inflammation), pneumonia, and sepsis (a potentially serious immune overreaction to an infection).

Magnets are also problematic, especially if the magnet is large or more than one was swallowed. Magnets pose a unique risk in that they can attract each other (or pieces of metal) and pinch off the walls of the GI tract, leading to ischemia (the obstruction of blood flow) and tissue necrosis (death).

Causes in Adults

Children are not the only ones who can swallow non-food items. Swallowing accidents can occur anytime you place a smaller object in your mouth. Examples include a carpenter holding nails between their lips or a dressmaker doing the same with a button.

Certain people are at special risk. This includes people with dementia, intoxication, or psy, chiatric disorders. There is also a disorder called pica, in which people compulsively eat non-food items.

In adults, the most commonly swallowed foreign objects are bones from food (like fish or chicken) and dental appliances like caps or veneers.

An intentional and potentially deadly cause is a practice called body packing. This is when illegal drugs are packed in condoms or balloons and either swallowed or inserted into the rectum. There have been cases when the balloon or condom bursts inside the body, leading to overdose and death.

Diagnosing a Swallowed Foreign Object

If you or someone you know has swallowed a foreign object, the first step is to call your healthcare provider or visit the nearest emergency room. Emergency treatment is especially needed if a sharp object, broken glass, magnets, or a battery has been swallowed.

The healthcare provider will perform a physical exam and order imaging studies like an X-ray or computed tomography (CT) scan to locate the swallowed object.

Treatment Options for a Swallowed Foreign Object

A swallowed foreign object doesn't always need to be treated and may resolve on its own. However, in about 20% of cases, a swallowed object can get stuck in a narrower part of the GI tract and need to be manually or surgically removed.

The decision to treat or not treat is based on several factors.

Observation

In about 80% of cases, a swallowed foreign object will pass on its own without treatment. In such cases, you will be sent home and asked to check your stools for evidence of the swallowed object. You will also be advised of the signs of intestinal perforation to know if and when to seek 911 emergency assistance.

You may also be advised to come back for an X-ray or CT scan every 72 hours to check how the object is progressing through the GI tract.

Foreign bodies that are small and blunt that have reached the stomach will likely pass through the GI tract with minimal risk of perforations. While the timing can vary, many smaller objects like coins or buttons will pass without complications within 24 to 48 hours.

Endoscopy

There are times with the manual extraction of a swallowed foreign object is needed. This is especially true if an object gets stuck in the esophagus. Extraction is essential within 24 hours; any delays increase the risk of complications.

Esophageal blockages carry the highest risk of complication (25% higher than other parts of the GI tract). Some complications can be life-threatening given the proximity of the esophagus to the heart and lungs.

In such cases, a healthcare provider will perform an upper endoscopy. This is a procedure in which a lighted scope (called an endoscope) is inserted into your mouth and esophagus to locate the foreign object. Different tools can then be threaded through the neck of the scope to dislodge and remove the object.

Endoscopy is usually performed with conscious sedation, but general anesthesia may be needed in difficult cases.

Urgent endoscopy is required if a foreign body is lodged in the upper third section of the esophagus, if there is complete obstruction of the airway, or if a battery or sharp object has been swallowed.

Surgery

In only about 1% of cases, surgery is needed to remove a foreign object from the GI tract.

In most cases, this involves laparoscopic retrieval in which several small incisions are strategically made to accommodate a narrow, lighted scope (called a laparoscope) and specialized tools that can access and remove the foreign object.

Large objects or those causing severe perforation may need to be removed with traditional open surgery involving a scalpel, a large incision, and general anesthesia.

Surgery may be indicated if:

• An endoscopic extraction fails
• A long sharp or pointed object is swallowed
• A battery or magnet has passed beyond the duodenum (as the sharp angle into the small intestine is vulnerable to perforation)
• A blunt object has not progressed beyond the duodenum after 72 hours (based on an X-ray or CT scan)
  
• There are signs of intoxication in someone who is body-packing