Gastrointestinal Foreign Bodies
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Gastrointestinal foreign body ingestion was first reported in India in the form of gastric bezoars in 1200 B.C. The seventh century Greek text “Medical Compendium in Seven Books” contains a technique for removal of an esophageal foreign body by swallowing a small dry sponge on a string, allowing it to moisten and expand in the stomach and then extracting the foreign body by pulling on the string . Surgical removal of a swallowed knife by open gastrostomy was first performed in 1635 in Prussia . Finally, in 1692 four year old Frederick II (later Frederick the Great) swallowed and passed a metal belt buckle marking the first known pediatric ingested foreign body . Early on, the removal of ingested foreign bodies was limited to open surgery with a high morbidity. In 1936 Chevalier Jackson, considered the father of modern endoscopy, and his son Chevalier L. Jackson published their text “Diseases of the Air and Food Passages of Foreign-Body Origin”. This text described over 3200 cases involving ingested foreign bodies and describes techniques for removal using early rigid endoscopes - forever changing the treatment of ingested foreign bodies . More than 2300 of these extracted specimens are still on display at the Mütter Museum in Philadelphia . The first description of using a Foley catheter to extract a foreign body from the esophagus was made in 1966 by Bigler . Finally, the first use of a flexible endoscope for foreign body removal is credited to John Morrissey in 1972 .
The most common items ingested into the gastrointestinal tract in children include coins, toys, jewelry, bones, pieces of food, batteries, magnets, pins and hardware . Most western studies show coins to be the most commonly ingested item whereas fish bones may be more common in cultures where fish represents a dietary staple . Although there are exceptions, including disc batteries in the esophagus and magnets, the majority of gastrointestinal foreign bodies can initially safely be observed. Approximately 20% of ingested foreign bodies will require endoscopic intervention for removal and less than one percent will require operative intervention for removal or to address complications related to ingestion . Three factors will dictate the need for and timing of intervention:
- type of foreign body
- location in the gastrointestinal tract
- the presence of symptoms
Additionally, foreign body ingestion has led to significant advances in public health. Input from physicians was paramount to inclusion of size restrictions for parts in toys designed for children under the age of three years in the 1972 Consumer Product Safety Act . Recently, physician advocates were crucial in getting multiple recalls for small, strong magnets marketed to children as toys .