Small Bowel Foreign Body

Most ingested foreign bodies that have passed through the stomach continue through the small bowel spontaneously.

Risk increases with sharp objects, multiple magnets, long objects, preexisting strictures, previous bowel surgery and abnormal intestinal anatomy.

Complications include impaction, obstruction, pressure necrosis, perforation and fistulation.

Most patients remain asymptomatic during transit.

New focal abdominal pain, vomiting, distension, gastrointestinal bleeding, fever or peritonism indicates complication.

A patient with Crohn stricture or previous bowel surgery has a lower threshold for impaction than a patient with normal bowel.

Serial plain radiographs: useful for radiopaque objects being monitored for progression.

CT abdomen: use for pain, failure of progression, suspected obstruction, perforation or a radiolucent sharp object.

A small blunt object progressing through the bowel in an asymptomatic patient can be observed.

Sharp objects have a clinically significant perforation risk. Once they have passed beyond endoscopic reach, monitor progression closely. Surgical intervention should be considered if a sharp object fails to progress for approximately 3 days or if abdominal symptoms develop.

Multiple magnets are particularly dangerous because separate bowel loops can become trapped between magnets, producing pressure necrosis, fistula and perforation. If magnets are beyond endoscopic reach, obtain early surgical review and monitor progression closely. Nonprogression or symptoms require operative removal.

Operate immediately for:

• Peritonitis
• Perforation
• Complete mechanical obstruction
• Significant gastrointestinal bleeding
• Entrapped multiple magnets causing bowel injury
• Failure of a hazardous object to progress

At surgery, locate the object and assess bowel viability. A mobile object in healthy bowel may be milked toward a safer enterotomy site. If the object has perforated or produced local necrosis, resect or repair the damaged segment according to tissue viability.

Avoid multiple enterotomies where a single controlled extraction can safely remove several objects.