Please confirm that you would like to log out of Medscape.
If you log out, you will be required to enter your username and password the next time you visit.
Log outCancel
Foreign Bodies in the Gastrointestinal and Genitourinary Tracts: Interesting Images
Lars Grimm, MD, MHS | August 3, 2022
| Contributor Information
Swipe to advance
Image courtesy of Medscape | Sam Shlomo Spaeth.
Foreign Bodies in the Gastrointestinal and Genitourinary Tracts: Interesting Images
Lars Grimm, MD, MHS | August 3, 2022 | Contributor Information
Gastrointestinal Tract Foreign Bodies
Foreign bodies in the gastrointestinal (GI) and genitourinary (GU) tracts are common presenting complaints in emergency departments (EDs) and clinics. Depending on the location, size, and shape of the foreign body, there are unique sets of presentations, risks, and treatment options. When an obvious history is not available to explain a patient's presentation, clinicians must maintain a high index of suspicion for foreign bodies to prevent subsequent morbidity or mortality. Radiography, ultrasonography (US), and magnetic resonance imaging (MRI) all may play a role, depending on the suspected location and composition of the foreign body.
Shown is a radiograph from a child who ingested a board game piece.
Image courtesy of Lars Grimm, MD, MHS..
Foreign Bodies in the Gastrointestinal and Genitourinary Tracts: Interesting Images
Lars Grimm, MD, MHS | August 3, 2022 | Contributor Information
Adults who have ingested a foreign body usually present to the ED or clinic soon thereafter. In children, ingested foreign objects are frequently not detected until they cause a complication (eg, dysphagia, weight loss, hypersalivation, emesis, chest pain, sore throat, stridor, cough, altered mental status, or fever). Most foreign bodies ingested by children will be entrapped in the esophagus.[1]
Shown is a neck radiograph revealing a hook in the hypopharynx of a 1-year-old patient.
Image courtesy of Lars Grimm, MD, MHS.
Foreign Bodies in the Gastrointestinal and Genitourinary Tracts: Interesting Images
Lars Grimm, MD, MHS | August 3, 2022 | Contributor Information
After taking a careful history of a known or potential foreign body ingestion, obtain plain radiographs. Radiopaque objects (eg, metal, glass, or stone) will readily appear on plain films, but even radiolucent objects (eg, wood or plastic) may be appreciated in the presence of secondary signs (eg, airway compression).[2] In addition, handheld metal detectors are both sensitive and specific for identifying the location of ingested metallic objects.
Foreign body ingestion in adults is typically accidental. However, the image shown demonstrates numerous thumb tacks ingested in a suicide attempt.
Image courtesy of Lars Grimm, MD, MHS.
Foreign Bodies in the Gastrointestinal and Genitourinary Tracts: Interesting Images
Lars Grimm, MD, MHS | August 3, 2022 | Contributor Information
Shown is a button battery in the bowel of an adult.
Fortunately, most ingested foreign bodies pass harmlessly through the GI tract. Avoid attempts to induce vomiting by giving abdominal thrusts or syrup of ipecac.
Foreign bodies identified within the esophagus should generally be considered impacted and should be removed via endoscopy. Rigid endoscopy is recommended for sharp objects because it enables the use of optical forceps with strong grasping capacity.[1] If esophageal perforation occurs, surgery may involve rigid sigmoidoscopy or thoracotomy.[3]
However, blunt foreign bodies ingested within the preceding 24 hours can usually be monitored. These objects typically pass through the GI tract spontaneously. However, if foreign bodies are impacted, tracheoesophageal or aortoesophageal fistulas may develop.[4]
Foreign bodies in the stomach or intestines also typically pass through spontaneously. However, very sharp or pointed objects (eg, sewing needles) may perforate the intestinal wall and should be removed endoscopically. The progression of radiopaque foreign bodies can be monitored via daily radiography.
Images courtesy of Medscape/Casey M Calkins, MD (left, top right inset); US Mint via Wikimedia Commons (bottom right inset).
Foreign Bodies in the Gastrointestinal and Genitourinary Tracts: Interesting Images
Lars Grimm, MD, MHS | August 3, 2022 | Contributor Information
The image on the left is from a child with an incomplete intestinal web in whom a coin had become impacted in the jejunum. Laparotomy was required to resect the dilated jejunum and remove the eroded penny.
Although some foreign bodies are likely to pass spontaneously, patients with recurrent symptoms should be evaluated. Objects that are too long (>6 cm) or too wide (>2 cm) to pass through the pyloric sphincter should be removed. Patients with narrowing of the GI tract, typically from congenital or postsurgical causes, are at risk for impaction.
Endoscopy is typically effective for upper GI foreign bodies, but surgical laparotomy is indicated for obstructive foreign bodies that cannot be reached or removed via endoscopy.[5] A potential complication of ingested foreign bodies is a local inflammatory process, which can lead to pain, bleeding, fibrosis, obstruction, or perforation.
Adapted image from Kelly J, Corrigan M, Cahill RA, Redmond HP. World J Emerg Surg. 2007;2:9. PMID: 17448234, PMCID: PMC1868019. [Creative Commons Attribution License 2.0 Generic (CC by 2.0).]
Foreign Bodies in the Gastrointestinal and Genitourinary Tracts: Interesting Images
Lars Grimm, MD, MHS | August 3, 2022 | Contributor Information
Body Packing/Body Stuffing of Drugs
The image demonstrates multiple cocaine capsules (asterisks) within the stomach and intestines.
Body packers and body stuffers ingest packets filled with drugs, most commonly heroin or cocaine, to avoid detection. Body packers engage in the planned ingestion of drugs, often wrapped in latex condoms or gloves, at one location, and then defecate the packets at another location, typically in a different country. Packets may also be hidden in the anus or vagina. If the packets rupture anywhere within the carrier's body, death may result from massive drug release. The typical packer is male and 30 years of age at an international airport.[6]
Body stuffers impulsively ingest less carefully wrapped drugs to avoid imminent detection; these individuals are also at high risk for toxicity or death. Consider hospitalization for patients who ingest drug packets. Most asymptomatic cases are treated with laxatives or enemas, but laparotomy or surgery may be needed for complicated cases or in symptomatic patients.[7]
Image courtesy of Medscape/David W Munter, MD, MBA.
Foreign Bodies in the Gastrointestinal and Genitourinary Tracts: Interesting Images
Lars Grimm, MD, MHS | August 3, 2022 | Contributor Information
Rectal Foreign Bodies
Shown is a vibrator in the rectum along with a pair of salad tongs that became lodged during the patient's attempts at self-removal.
Most rectal foreign bodies are found in men with an increased incidence in the United Kingdom.[8] Rectal foreign bodies may be self-inserted by children, psychiatric patients, or for sexual gratification in adults.[9]
Typically found objects are vibrators, dildos, light bulbs, candles, shot glasses, and bottles. Some rectal foreign bodies were swallowed but produce complications only after transiting to the rectum. Patients may be very embarrassed to disclose the circumstances regarding the foreign body insertion and may have made multiple attempts at self-removal.
Image courtesy of Lars Grimm, MD, MHS.
Foreign Bodies in the Gastrointestinal and Genitourinary Tracts: Interesting Images
Lars Grimm, MD, MHS | August 3, 2022 | Contributor Information
The image shows a component of a video game system that was self-inserted into the rectum after a night of binge drinking.
Typical clinical findings of a rectal foreign body are pain upon defecation, abdominal pain, rectal bleeding, pruritus, and constipation. Delays in seeking medical attention and multiple attempts at self-removal can lead to mucosal edema and muscular spasms, making removal of the object more difficult.
A rectal examination should initially be deferred until the location and type of foreign body can be determined so as to reduce the chances that a fragile object (eg, light bulb) might be broken, the examiner might be injured if the object is sharp, or the object might be accidentally pushed deeper within the body. Plain radiography of the abdomen or pelvis is typically sufficient to identify most objects. Upright chest radiography may be indicated if perforation is suspected.
Image from Cawich SO, et al. Case Rep Emerg Med. 2015;2015:815616. PMID: 25945267; PMCID: PMC4405213. [CC by 3.0 Unported.]
Foreign Bodies in the Gastrointestinal and Genitourinary Tracts: Interesting Images
Lars Grimm, MD, MHS | August 3, 2022 | Contributor Information
Radiographs of the pelvis, left and center, outline a foreign body within the rectum, specifically the tip of a cigar sheath. At right, laparoscopic graspers were used to retrieve the foreign object.
High-lying bodies may have to be removed by means of colonoscopy or surgical intervention. Low-lying bodies below the sacral curve and the rectosigmoid junction can be removed via direct visualization after insertion of a retractor or rectal speculum.
Gentle traction with forceps can remove most objects. If a strong amount of negative suction is created, passage of a Foley catheter beyond the object will equalize the pressure. Very low–lying objects may be removed via digital manipulation while the patient performs a Valsalva maneuver.
General anesthesia or conscious sedation may be needed to facilitate manual removal of rectal foreign bodies.[10] Bleeding, mucosal injury, and rectal perforation are the most common complications, but the prognosis is still very good. Avoid the use of enemas, laxatives, and cathartics to aid in removal.
Image courtesy of Lars Grimm, MD, MHS.
Foreign Bodies in the Gastrointestinal and Genitourinary Tracts: Interesting Images
Lars Grimm, MD, MHS | August 3, 2022 | Contributor Information
Urethral Foreign Bodies
The image demonstrates a cylindrical foreign body—likely a pen—projecting over the urethra and bladder.
Urethral foreign bodies are often the result of autoerotic activities. These objects can cause severe damage to the urethra and lead to fistula formation. Retrograde urethrography (RUG) may be performed to evaluate for urethral patency. Retrograde migration of the foreign body may also occur, leaving the item within the bladder. Acute presentation of foreign bodies are typically infection and urethral injury, but chronic presentations can lead to erosion of the surrounding tissue and urethra or tunica albuginea.[11]
Consultation with a urologist is important if there is any concern about urethral injury and if removal via direct visualization needs to be performed. Patients with previous injury to the urethra are at risk for subsequent stricture formation.
Image courtesy of Lars Grimm, MD, MHS.
Foreign Bodies in the Gastrointestinal and Genitourinary Tracts: Interesting Images
Lars Grimm, MD, MHS | August 3, 2022 | Contributor Information
The image demonstrates a metallic foreign body from a BB gun without evidence of urethral injury.
For male patients with suspected urethral injury involving a foreign body, RUG may be performed. Contrast material is injected into the urethra through the urinary meatus, and fluoroscopic images are obtained. Any extravasation of contrast medium beyond the lumen of the urethra is readily visible. Knowledge of the exact location of luminal injury is important for presurgical planning.
Image courtesy of Lars Grimm, MD, MHS.
Foreign Bodies in the Gastrointestinal and Genitourinary Tracts: Interesting Images
Lars Grimm, MD, MHS | August 3, 2022 | Contributor Information
Vaginal Foreign Bodies
Retained vaginal foreign bodies may be an occult cause of gynecologic complaints. Young girls may have unusual small objects retained in the vagina, but in postmenarchal female patients, tampons are the most commonly retained objects. Depending on the object found, the possibility of sexual abuse must be a consideration, especially in young children or patients with psychiatric disorders.
Vaginal foreign bodies may result in chronic vaginal discharge, bleeding, or a foul-smelling odor due to inflammation and infection. Retained highly absorbent tampons may lead to the development of toxic shock syndrome.
Pelvic examination with a speculum or plain radiography is typically sufficient to confirm the location of the foreign body, but occasionally, the diagnosis may first be made with computed tomography (CT) (shown). Removal of the object usually leads to resolution of signs and symptoms, and no additional measures are generally required. If injury to the vaginal mucosa is suspected, treatment with antibiotics is typically sufficient for a full recovery.
Image courtesy of Lars Grimm, MD, MHS.
Foreign Bodies in the Gastrointestinal and Genitourinary Tracts: Interesting Images
Lars Grimm, MD, MHS | August 3, 2022 | Contributor Information
Obtaining an accurate history may be important for localizing a foreign body, especially when the object in question is of a more sensitive nature.
The pelvic radiograph (shown) demonstrates a vibrator that "slipped" into the vaginal vault during consensual sex. The radiograph alone would not be able to distinguish between the vaginal vault and the rectal vault. This device was successfully extracted in the ED at the bedside.
Commenting is limited to medical professionals. To comment please Log-in.
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Close
Contributor Information
Author
Lars Grimm, MD, MHS
Associate Professor
Department of Diagnostic Radiology
Duke University Medical Center
Durham, North Carolina
Disclosure: Lars Grimm, MD, MHS, has disclosed no relevant financial relationships.
Close
References
Ergun E, Ates U, Gollu G, et al. An algorithm for retrieval tools in foreign body ingestion and food impaction in children. Dis Esophagus. 2021 Jan 11;34(1):doaa051. PMID: 32519749
Tseng HJ, Hanna TN, Shuaib W, Aized M, Khosa F, Linnau KF. Imaging foreign bodies: ingested, aspirated, and inserted. Ann Emerg Med. 2015 Dec;66(6):570-82.e5. PMID: 26320521
Peters NJ, Mahajan JK, Bawa M, et al. Esophageal perforations due to foreign body impaction in children. J Pediatr Surg. 2015 Aug;50(8):1260-3. PMID: 25783392
Gao Y, Wang J, Ma J, et al. Management of button batteries in the upper gastrointestinal tract of children: A case-series study. Medicine (Baltimore). 2020 Oct 16;99(42):e22681. PMID: 33080713.
Yao CC, Wu IT, Lu LS, et al. Endoscopic management of foreign bodies in the upper gastrointestinal tract of adults. Biomed Res Int. 2015;2015:658602. PMID: 26258140.
Grewal V, Kapil A. Body packing: Hiding in plain sight. J Emerg Med. 2022 Jan;62(1):101-102. PMID: 34893380.
Covarelli P, Burini G, Castellani E, et al. Therapeutic options for body packers: surgical or conservative treatment? A single center experience and review of literature. Ann Ital Chir. 2015 Jul-Aug;86(4):371-7. PMID: 26344494.
Bhasin S, Williams JG. Rectal foreign body removal: Increasing incidence and cost to the NHS. Ann R Coll Surg Engl. 2021 Nov;103(10):734-737. PMID: 34719960.
Obinwa O, Robertson I, Stokes M. Removal of a sex toy under general anaesthesia using a bimanual-technique and Magill's forceps: a case report. Int J Surg Case Rep. 2015;15:96-8. PMID: 26322821..
Albasha H, Wang SS, Revels JW, et al. Imaging review of penile pathologies encountered in the emergency department. Emerg Radiol. 2022 Feb;29(1):147-159. PMID: 34596782.
Ma W, Sun Y-F, Liu J-H, et al. Vaginal foreign bodies in children: A single-center retrospective 10-year analysis. Pediatr Surg Int. 2022 Apr;38(4):637-641. PMID: 35129659
Please do not use this form to submit personal or patient medical information or to report adverse drug events. You are encouraged to report adverse drug event information to the FDA.
Comments