Gastric Foreign Body
A gastric foreign body is an ingested object that has passed through the oesophagus and remains within the stomach.
Most small blunt objects pass spontaneously. Management depends on shape, size, composition, symptoms and risk of perforation, not simply the presence of an object in the stomach.
Sharp objects, magnets, batteries and long objects require much more aggressive management than coins or other small blunt objects.
Most gastric foreign bodies are asymptomatic.
Symptoms may include epigastric discomfort, nausea or vomiting.
Severe focal abdominal pain, haematemesis, peritonism, fever or systemic deterioration should raise concern for ulceration, perforation or migration into the small bowel.
Obtain an accurate history regarding:
- Object type
- Number of objects
- Length and diameter
- Sharp edges
- Battery or magnet ingestion
- Time since ingestion
Intentional or repeated ingestion should prompt assessment for psychiatric illness, developmental disorders or secondary gain where clinically appropriate.
Plain radiography: useful for radiopaque objects and can determine number, size and progression.
CT: use for suspected perforation, radiolucent sharp objects or uncertain anatomy.
Do not routinely use barium studies before therapeutic endoscopy because retained contrast can impair visualisation and increase aspiration risk.
Small blunt objects
Most objects that have reached the stomach and are less than approximately 2.5 cm in diameter and 6 cm in length will pass spontaneously.
Observation is appropriate when the patient is asymptomatic and the object is low risk.
Objects wider than approximately 2.5 cm may fail to pass the pylorus and should generally be removed endoscopically.
Objects longer than approximately 6 cm are unlikely to negotiate the duodenal sweep and should be retrieved while still endoscopically accessible.
Sharp objects
A sharp object in the stomach or proximal duodenum should be removed endoscopically when this can be performed safely because perforation risk can approach 35%.
Use a protective overtube or hood where appropriate and orient the sharp end so that it trails during withdrawal.
If a sharp object cannot be retrieved safely and has progressed distally, monitor closely. Failure to progress over approximately 3 days, new pain or peritoneal findings should prompt surgical review.
Batteries
An oesophageal button battery is an immediate emergency, but once a battery has reached the stomach the urgency depends on size, symptoms and progression.
Remove a large button battery, particularly above approximately 20 mm, if it remains in the stomach beyond about 48 hours. Remove earlier if there are symptoms or evidence of gastrointestinal injury.
Magnets
Multiple magnets, or a magnet ingested together with another metallic object, can trap bowel between them and cause pressure necrosis, fistulation, obstruction or perforation.
Retrieve magnets endoscopically while they remain accessible.
Surgery
Operate for:
- Perforation
- Peritonitis
- Uncontrolled bleeding
- Complete distal obstruction
- Failure of a dangerous object to progress
- Foreign body that cannot be safely removed endoscopically and remains clinically hazardous
