INGESTED FOREIGN-BODIES OF THE GASTROINTESTINAL-TRACT - RETROSPECTIVEANALYSIS OF 542 CASES

Ingested foreign bodies (FBs) present a common clinical problem. As th e incidence of FBs requiring operative removal varies from 1% to 14%, it was decided to perform this study and compare the data with those f rom the world literature, as well as to outline an algorithm for manag ement, including indications for surgery. We reviewed all patients wit h FB ingestion from 1973 to 1993. There were 542 patients with 1203 in gestions, aged 15 to 82 years. Among them, 69.9% (n = 379) were jail i nmates at the time of ingestion, 22.9% (n = 124) had a history of psyc hosis, and 7.2% (n = 39) were alcoholics or denture-wearing elderly su bjects. Most foreign bodies passed spontaneously (75.6%; n = 410), End oscopic removal was possible in 19.5% (n = 106) and was not associated with any morbidity. Only 4.8% (n = 26) required surgery, Of the latte r, 30.8% (n = 8) had long gastric FBs with no tendency for distal pass age and were removed via gastrotomy; 15.4% (n = 4) had thin, sharp FBs , causing perforation; and 53.8% (n = 14) had FBs impacted in the ileo cecal region, which were removed via appendicostomy. Conservative appr oach to FB ingestion is justified, although early endoscopic removal f rom the stomach is recommended. In cases of failure, surgical removal for gastric FBs longer than 7.0 cm is wise. Thin, sharp FBs require a high index of suspicion because they carry a higher risk for perforati on. The ileocecal region is the most common site of impaction. Removal of the FB via appendicostomy is the safest option and should not be d elayed more than 48 hours.