Internal Medicine

0521779407-07 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

590 Foreign Bodies and Bezoars

tests

■For foreign bodies: a plain radiograph (anteroposterior and lateral

views) for localization

■For bezoars: endoscopy most effective diagnostic test, followed by

barium or gastrografin studies

differential diagnosis

n/a

management

What to Do First

■Locate the position of the foreign body or bezoar

General Measures

■If an ingested foreign object has advanced beyond the reach of an

endoscope:

➣Passage should be documented with daily radiographs

➣Add bulk-forming agents to facilitate passage

➣If it remains in the same place for more than 2–3 days, surgical

removal should be considered

specific therapy

Indications for Treatment

■Endoscopy is indicated for:

➣Meat impaction

➣Sharp objects that may result in perforation

➣Button batteries lodged in the esophagus

➣Any kind of object impacted in the alimentary tract and causing

symptoms

Treatment

■Endoscopic removal of a foreign body in the upper gastrointestinal

tract requires:

➣Use of a number of devices such as snares, baskets, or forceps

➣Use of an overtube to protect the airway and reduce the number

of times the esophagus must be intubated, or alternatively,

➣Use of a latex hood fitted on to the distal end of the endoscope,

particularly for sharp or pointed objects

■For an inserted foreign body in the rectum (low-lying):

➣Intravenous sedation necessary to relax the pelvic musculature

➣Topical anesthesia is added to relax the sphincter