Foreign Bodies

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Foreign bodies

Definition

"Foreign" means "originating elsewhere" or simply "outside the body." Foreign bodies typically become lodged in the eyes, ears, nose, airways, and rectum of human beings.

Description

Both children and adults experience problems caused by foreign objects getting stuck in their bodies. Young children in particular are naturally curious and may intentionally put such shiny objects as coins or button batteries into their mouths. They are also prone to inserting objects in their ears and nostrils. Adults may accidentally swallow a non-food object or inhale a foreign body that gets stuck in the throat or lungs . Even if an object like a toothpick successfully passes through the esophagus and into the stomach , it can get stuck inside the rectum. Airborne particles can lodge in the eyes of people at any age.

Foreign bodies can be in hollow organs (like swallowed batteries) or in tissues (like bullets). They can be inert or irritating. If they irritate they will cause inflammation and scarring. They can bring infection with them or acquire it and protect it from the body's immune defenses. They can obstruct passageways either by their size or by the scarring they cause. Some foreign bodies can be toxic.

Causes and symptoms

Eyes

Dust, dirt, sand, or other airborne material can lodge in the eyes, causing minor irritation and redness. More serious damage can be caused by hard or sharp objects that penetrate the surface and become embedded in the cornea or conjunctivae (the mucous membranes around the inner surface of the eyelids). Swelling, redness, bleeding from the surface blood vessels , sensitivity to light, and sudden vision problems are all symptoms of foreign matter in the eyes.

Ears and nose

Children will sometimes put objects into their noses, ears, and other openings. Beans, popcorn kernels, raisins, and beads are just a few of the many items that have been found in these bodily cavities. On occasion, insects may also fly into the ears and nose. Pain , hearing loss , sounds or a sense of something stuck in the ear are symptoms of foreign bodies in the ears. A smelly, bloody discharge from one nostril is a symptom of a foreign body in the nose.

Airway and stomach

At a certain age children will eat anything. A very partial list of items recovered from young stomachs includes the following: coins, chicken bones, fish bones, beads, rocks, plastic toys, pins, keys, round stones, marbles, nails, rings, batteries, ball bearings, screws, staples, washers, a heart pendant, a clothespin spring, and a toy soldier. Some of these items will pass completely through the digestive system to be excreted some time later. The progress of metal objects has been successfully followed with a metal detector. Others, like sharp bones, can get stuck and cause problems. Batteries are corrosive and must be removed immediately.

Children eat things and stick things into their bodily openings of their own volition. But they inhale them unwittingly. The most commonly inhaled item is probably a peanut. A crayon and a cockroach have been found in the windpipes (tracheas) of children. These items always cause symptoms (difficulty swallowing and spitting up saliva, for instance) and may elude detection for some time while a child is being treated for asthma or recurring pneumonia .

Adults are not exempt from unorthodox inedibles. Dental devices are commonly swallowed. Adults with mental illness or subversive motives may swallow such inappropriate objects as toothbrushes.

Rectum

Sometimes a foreign object will successfully pass through the throat and stomach only to get stuck at the juncture between the rectum and the anal canal. Items may also be self-introduced to enhance sexual stimulation and then get stuck. Sudden sharp pain during elimination may signify that an object is lodged in the rectum. Other symptoms vary depending upon the size of the object, its location, how long it has been in place, and whether or not infection has set in.

Diagnosis

The symptoms of foreign bodies are as diverse as the objects and their locations. The most common manifestation of a foreign object anywhere in the body is infection. Even if an object entered in a sterile condition, bacteria still seem to find it and are able to hide from the body's defenses there. Blockage of passageways—breathing, digestive or excretory—is another result. Pain is common.

Treatment

Eyes

Small particles like sand may be removable without medical help, but if the object is not visible or cannot be retrieved, prompt emergency treatment is necessary. Trauma to the eyes can lead to loss of vision and should never be ignored. Before attempting any treatment, a person should move to a well-lighted area where the object can be more easily spotted. Hands should be washed, and only clean, preferably sterile, materials should make contact with the eyes. If the particle is small, it can be dislodged by blinking or pulling the upper lid over the lower lid and flushing out the speck. A clean cloth can also be used to pick out the offending particle. Afterwards, the eye should be rinsed with clean, lukewarm water or an ophthalmic wash.

If the foreign object cannot be removed at home, the eye should be lightly covered with sterile gauze to discourage rubbing. A physician will use a strong light and possibly special eyedrops to locate the object. Surgical tweezers can effectively remove many objects. An antibiotic sterile ointment and a patch may be prescribed. If the foreign body has penetrated the deeper layers of the eye, an ophthalmic surgeon will be consulted for emergency treatment.

Ears and nose

A number of ingenious extraction methods have been devised for removing foreign objects from the nose and ears. A bead in a nostril, for example, can often be popped out by blowing into the mouth while holding the other nostril closed. Skilled practitioners have removed peas from the ears by tiny improvised corkscrews. Marbles have been extracted by using cotton swabs and super glue. Tweezers often work well. Insects can be floated out of the ear by pouring warm (not hot) mineral oil, olive oil, or baby oil into the ear canal. Items that are lodged deep in the ear canal are more difficult to remove because of the possibility of damaging the ear drum. These require emergency treatment from a qualified physician.

Airways and stomach

Mechanical obstruction of an airway, which commonly occurs when food gets lodged in the throat, can be treated by applying the Heimlich maneuver . If the object is lodged lower in the airway, a bronchoscope (a special instrument to view the airway and remove obstructions) can be inserted. On other occasions, as when an object is blocking the entrance to the stomach, a fiberoptic endoscope (an illuminated instrument that views the interior of a body cavity) may be used. A physician typically administers a sedative and anesthetizes the throat. The foreign object will then either be pulled out or pushed into the stomach, depending on whether or not the physician thinks it will pass through the digestive tract on its own. Objects in the digestive tract that are not irritating, sharp or large may be followed as they continue on through. Sterile objects that are causing no symptoms may be left in place. Surgical removal of an offending object is necessary only if it causes symptoms.

Rectum

A rectal retractor can remove objects that a physician can feel during physical examination . Surgery may be required for objects deeply lodged within the rectum.

Prognosis

Once foreign objects are removed, persons have no further medical problems. If surgery is required (such as to remove a bullet), permanent damage may be sustained when the object initially enters the body. Once surgical incisions have healed, many persons have no further medical problems. Counseling may be needed to help persons cope with potential after-effects.

Health care team roles

First aid may be provided by trained persons. Emergency medical technicians may provide support while transporting people to a hospital or emergency treatment facility. Physicians remove most foreign objects. Surgeons may be needed to remove some objects from the eye (ophthalmologists), ears (otolaryngologists), gastrointestinal system (gastroenterologists), brain (neurosurgeons) or body tissues (general surgeons). Radiologists may document progress of an object through the body. Nurses supply supportive care and prevention education to the patient or family. Therapists may be needed to cope with such after-effects as physical impairment, mental distress or simple embarrassment.

KEY TERMS

Bronchoscope —An illuminated instrument that is inserted into the airway to inspect and retrieve objects from the bronchial tubes.

Conjunctivae —Mucous membranes around the inner surface of the eyelid.

Cornea —The rounded, transparent portion of the eye that covers the pupil and iris and lets light into the interior.

Endoscopy —The surgical use of long, thin instruments that have both viewing and operating capabilities.

Heimlich maneuver —An emergency procedure for removing a foreign object lodged in the airway that is preventing the person from breathing. To perform the Heimlich maneuver on a conscious adult, the rescuer stands behind the victim and encircles the choking person's waist. The rescuer makes a fist with one hand and places the other hand on top, positioned below the rib cage and above the waist. The rescuer then applies pressure by a series of upward and inward thrusts to force the foreign object back up the choking person's trachea.

Trachea —Windpipe. The tube that connects the pharynx with the lungs.

Prevention

Using common sense and following safety precautions are the best ways to prevent foreign objects from entering the body. For instance, parents and grandparents should toddler-proof their homes, storing batteries in a locked cabinet and properly disposing of used batteries, so they are not in a location where curious preschoolers can retrieve them from a wastebasket. To minimize the chance of youngsters inhaling food, parents should not allow children to eat while walking or playing. Adults should chew food thoroughly and not talk while chewing. Foods should not be thrown up into the air and caught in an open mouth. Many eye injuries can be prevented by wearing safety glasses while using power tools.

Resources

BOOKS

Orenstein, David M. "Foreign bodies in the larynx, trachea and bronchi." In Nelson Textbook of Pediatrics, 16th Edition, edited by Richard E. Behrman et al., Philadelphia: Saunders, 2000, 1279-1282.

Schwartz, Seymour, Tom Shires, and Frank C.Spencer, Principles of Surgery, 7th ed. New York: McGraw Hill, 1998.

Simon, Robert R., and Barry E. Brenner, Emergency Procedures and Techniques. Philadelphia: Lippincott Williams & Wilkins, 2001.

Tintinalli, Judith E, J Stephen Stapcynski, and Gabor D. Kelen, Emergency Medicine. New York: Appleton and Lange, 2000.

Townsend, Courtney M. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 16th ed. Philadelphia: Saunders, 2001.

PERIODICALS

Cook DS. "Dietary dangers: ingestion of a bread bag clip." Journal of Clinical Pathology 54, no. 1 (2001): 79-81.

Eliashar R, Gross M, Dano I, Sichel JY. "Esophageal fish bone impaction." Journal of Trauma 50, no. 2 (2001): 384-385.

Faust J, Schreiner O. "A swallowed toothbrush." Lancet 357, no. 9261 (2001): 1012-1014.

Horton LK, Jacobson JA, Powell A, Fessell DP, Hayes CW. "Sonography and radiography of soft-tissue foreign bodies." American Journal of Roentgenology 176, no. 5(2001): 1155-1159.

Lau KF, Jayaram R, Fitzgerald DA. "Diagnosing inhaled foreign bodies in children." Medical Journal of Australia 174, no. 4 (2001): 194-196.

Nakashabendi IM, Maldonado ME, Brady PG. "Chest pain: overlooked manifestation of unsuspected esophageal foreign body." Southern Medical Journal 94, no. 3 (2001): 333-335.

Reedy IS. "Foreign bodies in the nasal cavities: a comprehensive review of the aetiology, diagnostic pointers, and therapeutic measures." Postgraduate Medicine Journal 77, no. 905 (2001): 215-217.

ORGANIZATIONS

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (847) 434-4000. Fax: (847) 434-8000. <http://www.aap.org/default.htm,> E-mail: kidsdoc@aap.org.

American College of Radiology. 1891 Preston White Drive, Reston, VA 20191. (703) 648-8900. Fax: (703) 262-9319. <http://www.acr.org>. info@acr.org.

American Osteopathic College of Radiology. 119 East Second St., Milan, MO 63556. (660) 265-4011. Fax: (660) 265-3494. <http://www.aocr.org/>. aocr@nemr.net.