We reviewed the clinical benefit of hospitalization, esophago-gastroduodenoscopy (EGD), and surgical intervention for ingested foreign bodies (FB) in adults.
METHODS: A 10-year experience is reported. Patient s presenting physical examination, white blood count (WBC), length of stay, number and types of FB ingested, endoscopic interventions, surgical interventions and complications of interventions were reviewed.
RESULTS: 75 separate hospital admissions occurred in 22 male prisoners. 256 FB were ingested (avg 3.4 per admit). Patients incurred 281 hospitalization days (avg 3.7 days per admit). One presented with peritoneal signs. White blood cell counts were less that 10 in 85% (avg 8.3). Only 2 patients had WBC greater than 12. EGD results: 64 EGD s were performed with removal of 79/163 FB (48% success rate). Five patients required general anesthesia due to lack of cooperation. Four complications occurred (6%), one requiring laparotomy. Surgical results 9 laparotomies were performed. One was performed for an acute abdomen on admission and one for the development of an acute abdomen after conservative management. One was performed due to an EGD complication. Two were performed to remove metal bezoars. Four additional laparotomies were performed secondary to surgeon management preference. Conservative management results. In 23 admits managed conservatively, 77 of 79 FB passed spontaneously (97%). One required laparotomy. Summary: Of the 256 ingested FB, 79 were removed endoscopically, 71 were removed surgically, and 106 passed spontaneously. Size, shape and number of FB were not predictive of the ability to transit the intestinal tract.
CONCLUSIONS: Foreign body ingestion is problematic in prisoners. When managed conservatively, most foreign bodies will pass spontaneously. EGD has a high failure rate and is associated with significant complications. Surgical interventions should be reserved for the acute abdomen or large bezoars.
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