Management of ingested foreign objects and food bolus impactions☆,☆☆,★,★★,♢
Section snippets
History and physical examination
In older children and fully conscious, communicative adults, foreign object ingestion may be recognized at the time of the incident and this history conveyed to the physician. The patient may be able to identify the material swallowed and point to the location of discomfort. Patient localization of the level of impaction, however, is not reliable.10 Conversely, in many instances the ingestion goes unrecognized or unreported until the onset of symptoms, which may be delayed hours, days, to even
General
Once a foreign body ingestion is diagnosed, the physician must decide whether or not intervention is necessary, what degree of urgency is called for, and by what best available means. The decision to intervene endoscopically in the management of an ingested foreign body is influenced by the patient's age and clinical condition; the size, shape, and classification of the ingested material; the anatomic location in which the object is lodged; and the technical abilities of the endoscopist.8
The
Acknowledgements
The author thanks David E. Fleischer, MD, Stanley B. Benjamin, MD, and William A. Webb, MD, for their critical review of this manuscript. A draft was distributed to the members of the American Society for Gastrointestinal Endoscopy, Standards of Practice Committee (Gregory Zuccaro Jr., MD, Damian H. Augustyn, MD, Richard D. Baerg, MD, W. Scott Brooks, Jr., MD, D. Roy Ferguson, MD, Peter R. McNally, MD, and John L. Petrini, MD) for critical review and commentary.
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2020, Techniques and Innovations in Gastrointestinal EndoscopyCitation Excerpt :However, this concern has not been evaluated in large series or utilizing atraumatic techniques. Objects generally impact, perforate, or obstruct the gastrointestinal tract at areas of sharp angulation, change in caliber, or at narrowed locations, including the upper esophageal sphincter (UES), lower esophageal sphincter (LES)/gastroesophageal junction, pylorus, duodenal sweep, ileocecal valve, and the rectum/anus [12]. Without an underlying pathologic condition, each of these points has a luminal narrowing to 23 mm or less [13].
Trends and clinical features of intentional and accidental adult foreign body ingestions in the United States, 2000 to 2017
2020, Gastrointestinal Endoscopy
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From the Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Reprint requests: Gregory G. Ginsberg, MD, Hospital of the University of Pennsylvania, Gastroenterology Division, 3 Dulles Building, 3400 Spruce St., Philadelphia, PA 19104.
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