Foreign Body Ingestion Clinical Pathway – Emergency Department, ICU, and Inpatient – Other Foreign Bodies

Foreign Body Ingestion Clinical Pathway – Emergency Department, ICU, and Inpatient

Other Foreign Bodies

Bezoar
  • Trichobezoars
    • Consult General Surgery and GI
    • Large trichobezoars are almost impossible to remove endoscopically
    • Do not use electrocautery to break up hair
  • Phytobezoars
    • Consult GI
    • Soda (Coca-Cola) has been demonstrated to help dissolve these bezoars
    • Endoscopic management depends on size of bezoar and length of expected procedure
    • Endotracheal intubation is required during procedure
Super-absorbent Objects
e.g., water orbs, tampons, etc.
  • Consult GI
  • Consult General Surgery if symptomatic
  • Consider endoscopic removal
  • Objects rapidly expand within the GI tract
    • 30-60 times original volume
    • Cause gastric outlet or bowel obstruction
    • Radiolucent on X-ray
Narcotic Packets
  • Consult Toxicology and Poison Control Center
  • Do not remove endoscopically
Lead-containing Foreign Bodies or Large Burdens of Lead Paint Chips
  • Lead-containing FBs may result in significantly elevated blood lead levels
    within 24 hrs
    • Consult Toxicology and GI
    • Obtain baseline venous lead level
    • Gastric location
      • Consider prompt endoscopic removal
      • Consider proton pump inhibitor and prokinetic therapy
    • Location beyond pylorus
      • Consider whole bowel irrigation with Golytely, especially for large burdens of lead paint chips
      • Endoscopy or surgery are rarely indicated