Foreign Objects


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Foreign Objects

 

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 shiny objects, such as coins or button batteries, into their mouths. They also like to stick things in their ears and up their noses. Adults may accidentally swallow a non-food object or inhale a foreign body that gets stuck in the throat. 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 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 conjunctiva (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 things 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, and 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 foreign bodies in the nose.

Airways 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 right on through and come out the other end. The progress of metal objects has been successfully followed with a metal detector. Others, like sharp bones, can get stuck and cause trouble. 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 a child's windpipes. These items always cause symptoms (difficulty swallowing and spitting up saliva, for instance) and may elude detection for some time while the 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 inappropriate objects, such as toothbrushes.

Rectum

Sometimes a foreign object will successfully pass throught 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 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 the object started out sterile, germs 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, the 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 opthalmic 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 opthalmic 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 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 by q-tips with super glue. Tweezers often work well, too. 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 the airways, 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 the 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. The 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 neither irritating, sharp nor large may be followed as they continue on through. Sterile objects that are causing no symptoms may be left in place. Surgical removal of the offending object is necessary if it is causing 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 recturm.

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 fish them out of 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. Many eye injuries can be prevented by wearing safety glasses while using tools

Resources

Periodicals

Gilchrist, B. F., et al. "Pearls and Perils in the Management of Prolonged, Peculiar, Penetrating Esophageal Foreign Bodies in Children." Journal of Pediatric Surgery 32, no. 10 (October 1997): 1429-31.

Key terms

Bronchoscope — An illuminated instrument that is inserted into the airway to inspect and retrieve objects from the bronchial tubes.
Conjunctiva — 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 his 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 victim's trachea.
References in periodicals archive ?
Charles Nozicka, a pediatric emergency department physician at Advocate Children's Hospital in Park Ridge, has treated many children over the years who have accidentally swallowed foreign objects. While swallowing certain items may not pose a severe risk and only require minimal treatment, ingesting oddly shaped objects could cause serious damage to a child's esophagus or gastrointestinal tract.
Under x-ray inspection, such a foreign object is clearly visible, but would not be seen optically in this example unless all sides of the component were patiently examined using a side-viewing microscope.
As Gulf News reported earlier this month, there have been more than 250 cases reported in the last two years in which Abu Dhabi residents have swallowed foreign objects. Eight of these pertained to young girls who had swallowed scarf pins.
Bfar said the initial diagnosis is the ingestion of some 88 pounds of foreign objects of mostly plastics and cellophane.
Good food plant personal hygiene policies, practices and standard sanitation operating procedures can provide an excellent foundation for eliminating foreign objects. Separation and detection strategies, including sieving, screening, filtration, float tanks and magnetic separation, can identify and remove contaminants from product streams.
Most cases of foreign objects are reported in immature teeth following trauma and communication of the pulp chamber to the oral cavity.
The two 'retained foreign objects' mistakes happened during procedures for gynaecology and in an emergency department.
BY STEPHEN MCDERMOTT TEETH, rodent droppings and insect larvae were among the foreign objects found in grub last year, the Food Safety Authority of Ireland has revealed.
'Currently, our runway inspection activities we are more on corrective and preventive measures but by having this system, it can give us the real-time preventive measures to ensure the runway is safer by the enhanced detection of foreign objects,' he said.
Surgical options should only be considered following failure of less invasive methods of retrieval of foreign objects. The present study incorporates diagnosis and endoscopic retrieval of tracheal foreign body in a pup.
Ziyad al-Balawi, the director general of the customs department there said that the customs inspector was aware of the existence of foreign objects inside the truck's side tanks.
Inspecting these products for foreign objects is especially challenging because of what is known as "product effect," where the signal from a particular type of metal can be hidden inside the electromagnetic response of the product.

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