Foreign Bodies

When people ingest or insert foreign bodies, a brief history may be sufficient to establish the diagnosis, guide initial management decisions, and predict the process required for definitive removal. Sometimes, however, diagnosis and management of a foreign body might require a meticulous history and insightful care. Those at higher risk of having a foreign body include neurologically impaired patients, edentulous individuals, patients with certain psychiatric diagnoses, incarcerated individuals, and individuals at the extremes of age. In these same groups, definitive history is often elusive, and the clinician should use situational clues. Even when patients are fully cooperative, the diagnosis of foreign body ingestion or insertion can be difficult, especially when the expression of the foreign body is delayed. Although foreign body cases are usually not diagnostic dilemmas, the emergency physician should keep in mind the unusual possibility of “foreign body mimics” (e.g., angioedema manifesting as esophageal foreign body sensation).