Management of Swallowed Foreign Objects

Initial Assessment and Imaging

The World Journal of Emergency Surgery recommends emergent flexible endoscopy within 2-6 hours for sharp-pointed objects, batteries, magnets, and complete esophageal obstruction, while other esophageal foreign bodies without complete obstruction require urgent endoscopy within 24 hours 1, 2
Plain radiographs have false-negative rates up to 47-85% for foreign body detection and are only useful for identifying radiopaque objects, according to the World Journal of Emergency Surgery 2, 3
The World Journal of Emergency Surgery states that CT scan is the definitive imaging modality with a sensitivity of 90-100% compared to only 32% for plain x-rays 2, 3

The World Journal of Emergency Surgery indicates that sharp-pointed objects have up to 35% risk of full-thickness perforation and require emergent intervention 1
Button/disk batteries pose a risk of pressure necrosis, electrical burns, and chemical injury, and magnets pose a risk of pressure necrosis between magnets or with other metallic objects, perforation, and fistula formation, according to the World Journal of Emergency Surgery 1, 3
Complete esophageal obstruction from a food bolus has a risk of aspiration and perforation, and other esophageal foreign bodies without complete obstruction require urgent but not emergent removal, as stated by the World Journal of Emergency Surgery 1, 2

The World Journal of Emergency Surgery recommends a sequence of gentle pushing of the bolus into the stomach using air insufflation and instrumental pushing, followed by retrieval techniques with baskets, snares, or grasping forceps if pushing fails 1, 2
Rigid endoscopy serves as second-line therapy when flexible endoscopy fails, particularly for foreign bodies in the upper esophagus, according to the World Journal of Emergency Surgery 1, 2

The World Journal of Emergency Surgery suggests obtaining at least 6 biopsies from different anatomical sites in the esophagus during the initial endoscopy to evaluate for underlying pathology, which is found in up to 25% of patients with foreign body impaction 1, 2
Underlying esophageal disorders such as eosinophilic esophagitis, esophageal stricture, hiatus hernia, esophageal web or Schatzki ring, achalasia, and tumors can be identified through biopsies, as stated by the World Journal of Emergency Surgery 1, 2

The World Journal of Emergency Surgery lists potential indications for surgical treatment, including irretrievable foreign body, esophageal perforation, foreign body close to vital structures, and other complications 1
Upfront surgery should be performed immediately for esophageal perforation with extensive pleural/mediastinal contamination, according to the World Journal of Emergency Surgery 1