On the Bleeding Edge: Mastering GI Emergencies and Inpatient GI Consultation (On-Demand)

Pdf Summary

This presentation reviews the evaluation and management of food bolus impaction and gastrointestinal foreign bodies, including esophageal, gastric, intestinal, rectal, and drug packet ingestions. It opens with a classic food impaction case (“the chicken situation”) to emphasize the importance of rapid assessment, especially when a patient cannot handle secretions. Key initial steps include obtaining a careful history, identifying the object if possible, determining timing of ingestion and last oral intake, reviewing medical/surgical history and anticoagulant use, and considering coingestions or self-harm intent.<br /><br />The talk highlights that localization is reliable only above the upper esophageal sphincter; below that, symptoms are often poorly localized. Imaging with x-ray or CT can help identify, localize, and characterize the object, though not all items are radiopaque. Timing is critical: emergent removal is needed for esophageal obstruction, inability to manage secretions, button battery ingestion, and sharp or pointed objects. Urgent removal is recommended for many stomach objects, sharp items, magnets, and long objects, while other items may be observed depending on size and progression.<br /><br />The presentation reviews endoscopic tools and special techniques, including when fluoroscopy is helpful. It also stresses that food impaction should prompt evaluation for underlying disease, such as eosinophilic esophagitis, strictures, rings/webs, or achalasia, with esophageal biopsies recommended during the index endoscopy when appropriate.<br /><br />Additional sections address rectal foreign bodies, emphasizing careful extraction strategies, avoidance of digital rectal exam in certain high-risk cases, and the need for surgical backup in difficult cases. A final section covers body packers, stuffers, and pushers, focusing on toxicologic risk, observation, activated charcoal, poison center consultation, and surgical or endoscopic escalation when needed.<br /><br />Key takeaways: assess the patient and object carefully, use the right timing and tools, obtain biopsies when indicated, and know when endoscopy is not enough.

Meta Tag

Concept Esophageal Foreign Body

Concept Food Bolus Obstruction

Concept Endoscopic Removal

Concept Surgical Removal

Concept Plain Radiograph

Keywords

food bolus impaction

gastrointestinal foreign bodies

esophageal obstruction

endoscopic removal

button battery ingestion

sharp objects

eosinophilic esophagitis

rectal foreign body

body packers

poison center consultation

foreign body ingestion

sharp object ingestion

rectal foreign bodies

Esophageal Foreign Body

Food Bolus Obstruction

Endoscopic Removal

Surgical Removal

Plain Radiograph