Foreign Body Ingestion

Today, Dr. Jason Mannion presented an interesting case of a young male with sickle cell anemia and Cluster B personality disorder who presented with sharp, substernal chest pain concerning initially for acute chest syndrome, but was found on CXR to have swallowed a foreign body.

Learning Points: The diagnostic criteria for acute chest syndrome include:

  • A new segmental radiographic pulmonary infiltrate AND at least one of the following:
  • Temperature > 38.5C
  • A >2% decrease in SpO2
  • PaO2 <60 data-preserve-html-node="true" mmHg
  • Tachypnea
  • Intercostal retractions, nasal flaring, or use of accessory muscles of respiration
  • Chest pain
  • Cough
  • Wheezing
  • Rales

Management of ACS includes: adequate and immediate pain control, fluid management to prevent hypovolemia, supplemental oxygen and IS, blood transfusion, antibiotics, and VTE prophylaxis.

Check out this excellent article in Gastroenterology & Hepatology. The highlights of the article are below:

  • Intentional foreign body ingestion is most commonly seen in adults with intellectual or mental disabilities, significant substance abuse, psychiatric disorders, or external motivations (such as avoidance of a jail sentence).
  • The management protocol of foreign body ingestions depends on the object type, shape, location, associated symptoms, time course, and complications.
  • Treatment should include a multidisciplinary team including endoscopists, surgeons, and psychiatrists.