When You Swallow What You're Not Supposed to Swallow

Gut Check: Foreign Objects Down the Hatch

Portrait of baby girl eating a toy
Kids from six months to six years are the most likely to swallow things, and toys are near the top of the list. Rune Johansen / Getty Images

Swallow food, not stuff. When we swallow things we aren't supposed to swallow, like glass, coins, batteries, jewelry, marbles, and pretty much anything small enough to get in the mouth, they can cause all sorts of complications. They can also pass right on through without causing any problems at all. It depends on what you swallowed and whether it got stuck on the way down.

Esophageal Foreign Bodies

The most common place in your gut for foreign objects to get stuck is in your esophagus.

Gut is a medical term of endearment for the gastrointestinal tract, which runs from your mouth, through your esophagus, stomach, small intestines, large intestine, and out the rectum. Foreign objects, which are any items other than food, are more likely to get stuck in the esophagus because it's soft and small, and it narrows even more in a couple of spots.

The esophagus is at the beginning of your gastrointestinal tract. If a foreign body makes it past your esophagus, it has a pretty good chance of making it all the way through to the final destination. No guarantees of course, but that's why we don't see as many foreign bodies in the stomach or the intestines.

The esophagus has thin, very pliable walls that can easily catch and bind hard objects that are trying to pass. The walls of the esophagus are so pliable that when there isn't any food or stuff in there, it collapses almost flat, like a fire hose with no water in it.

Removing Esophageal Foreign Bodies

Getting things out of the esophagus isn't easy if they're stuck in there. In most cases, doctors have to reach into the esophagus with a device called an endoscope to see the foreign body and grab it. An endoscope is a tube with a light, a camera, and some sort of way to grab an object.

The endoscope can be rigid or flexible. Rigid endoscopes are better for removing objects, because the rigid walls of the endoscope protect the delicate walls of the esophagus.

A flexible endoscope has to drag the object out of the esophagus, which exposes the thin walls to damage if the object has any sharp edges. On the other hand, flexible endoscopes can be used without general anesthesia (knocking the patient out and breathing for him or her). Rigid endoscopes cannot be used without general anesthesia.

Most of the time, the doctor will take an x-ray to see if he or she can see the foreign body before going in after it with an endoscope. Whether or not the object can be seen on an x-ray depends on what it's made of. The denser the object is, the better. Metal coins, for example, show up very well on an x-ray image. Plastic buttons, on the other hand, might be completely invisible despite being similar in size to a coin.

It's only the density of the object that determines if it will be seen on an x-ray.

What if you swallowed glass, for example? It's highly visible on an x-ray despite the fact that it might not be very easy to see with the endoscope (or the naked eye).

Signs and Symptoms of Esophageal Foreign Bodies

No one is certain how many foreign objects are swallowed every year by adults or children. Unless it's known and reported, an ingested foreign body is not going to show up in the statistics. It's thought that somewhere between 40 to 50 percent of all the reported ingestion cases pass without symptoms. Who knows how many more are completely undetected?

There are definite signs and symptoms that should make you pay attention, especially if you suspect something was swallowed that shouldn't have been. If any of the following are seen or felt, call 911 immediately:

  • gagging
  • inability to swallow or drooling
  • shortness of breath
  • vomiting
  • stridor (a loud wheezing sound when breathing that reminds you of Darth Vader)
  • coughing blood

All of the above indicate that the foreign body is stuck near the top of the esophagus. This can lead to things getting into the trachea (airway) and if the item is big enough, it can actually push on the trachea from behind, causing an obstruction to airflow.

Besides the immediate life threats, anytime you suspect something was swallowed and it can be felt (by the person who swallowed it) in the throat or deep in the chest, see a doctor immediately. We've all had a chip go down the wrong way and ignored it, but a non-food object is much more dangerous. If you think it's a foreign body and you can feel it, it's time to see a doc.

Especially Dangerous Objects

Kids swallow more non-food items than adults and the favorite things on the menu are coins. Boys swallow more than girls (even as adults). After coins, favorites include food that's too large to be swallowed, toys (or parts of toys), and jewelry.

The worst case scenario is swallowing something sharp, like glass or metal, or swallow batteries (see below). Sharp objects can perforate the thin walls of the esophagus, leading to bleeding or an infection in the mediastinum (cavity in the middle of the chest, between the lungs).

Button batteries (also known as disk batteries) are small, flat, circular batteries found in watches and other electronics. They make up only a small percentage of all ingested foreign bodies, but they are arguably the most dangerous.

Button batteries have an electrical charge that be conducted by the tissues of the esophagus. The electrical charge of a button battery generates enough heat to burn the tissues of the esophagus, causing ulcers and potentially perforating the walls of the esophagus much like sharp objects. Burns from the batteries can lead to scar tissue and long term complications.

Button batteries have been documented burning completely through the walls of the esophagus in as little as six hours after ingestion. Even after removing the batteries, residual alkali from the batteries can cause additional damage for days or weeks.

In button batteries, size matters. The worst outcomes overwhelmingly (94 percent) came from batteries of at least 20mm diameter. The best cure is prevention when it comes to button batteries, so take extra special care to keep them away from children, especially toddlers. If you suspect that a button battery was swallowed, go to the emergency department right away.

Esophageal Foreign Bodies in Adults

Kids swallow things because they're curious. Adults swallow non-food things because they accidentally came along with the food (bones, pits, rocks, dentures, etc.) or due to some sort of medical or behavioral disorder. Essentially, treat the ingestion of foreign bodies in adults the same as you would in children—go to the doctor.

Most of the time, adults can be observed to see if the foreign body will pass on its own. Doctors are less likely to take this tact with kids. Just because an item can pass, doesn't mean it will, and it's very important to try this only under the care of a physician. The doctor will monitor the patient, often with the help of imaging equipment like x-rays or CT scans, and make sure the item gets out without causing any significant damage. 

Sources:

Ambe P, Weber SA, Schauer M, Knoefel WT. (2012). Swallowed Foreign Bodies in AdultsDeutsches Ärzteblatt International109(50), 869. Retrieved 25 October 2016.

Disk Battery Ingestion: Background, Pathophysiology, Epidemiology. (2016).Emedicine.medscape.com. Retrieved 25 October 2016.

Management of ingested foreign bodies and food impactions. National Guideline Clearinghouse. (2016). Guideline.gov. Retrieved 25 October 2016.

Rybojad, B., Niedzielska, G., Niedzielski, A., Rudnicka-Drozak, E., & Rybojad, P. (2012). Esophageal Foreign Bodies in Pediatric Patients: A Thirteen-Year Retrospective Study. The Scientific World Journal2012, 1-6. doi:10.1100/2012/102642

Uyemura, M. (2016). Foreign Body Ingestion in Children - American Family PhysicianAafp.org. Retrieved 25 October 2016, from http://www.aafp.org/afp/2005/0715/p287.html

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