FOREIGN BODY LOCATIONS
Use sterile saline to wash out a foreign body embedded in the
conjunctiva or, after administering a topical anaesthetic,
wipe it away with a sterile, cotton tipped applicator. Eversion
of the lid may be necessary to expose the foreign body.
If the patient complains of the feeling of a foreign body but
none is seen, instil two drops of 2% sodium fluorescein. A
corneal abrasion, which the patient cannot distinguish from
a foreign body, will be confirmed by the retention of green
pigment in the abrasion. To remove a superficial corneal foreign
body, use a 27-gauge needle. Apply antibiotic eye ointment
and an eye patch for 24 hours. Refer patients with corneal
foreign bodies that cannot be removed and ones that have corneal
inflammation that persists more than 3 days.
Intraocular foreign body
An intraocular foreign body is determined by X-ray or clinical
examination. Apply atropine 1%, dress the eye with a sterile
pad and shield and refer the patient to an ophthalmologist.
Immunize all patients with injuries to the globe for tetanus.
Children often insert foreign bodies, such as beans, peas,
rice, beads, fruit seeds or small stones into their ears. Accumulated
ear wax is often confused with foreign bodies. Visualize both
the symptomatic and asymptomatic auditory canal to confirm
the presence of a foreign body.
Use a syringe to wash the ear; this will remove most foreign
bodies, but is contraindicated if the foreign body absorbs
water: for example, grain or seeds. If needed, use gentle suction
through a soft rubber tube. Rest the suction tip against the
object (Figure 5.25).
an alternative, pass an aural curette or hook beyond the
foreign body and then turn so that the foreign body is withdrawn
by the hook (Figures 5.26, 5.27).
This requires gentle technique and a quiet patient; children
may require a general anaesthetic. To remove a mobile insect
from the ear, immobilize it with glycerol irrigation followed
by a wash with a syringe.
remove accumulated ear wax, syringe the ear with warm water.
If the wax remains, instruct the patient to instil glycerol
or vegetable oil drops twice daily for 2 days then repeat the
Visualize nasal foreign bodies to determine their nature and
position. Remove a foreign body with rough surfaces with angled
forceps or pass a hook beyond it, rotate the hook, and pull
the object out. Alternatively, use rubber tube suction.
Airway foreign bodies are common in children; peanuts are the
most frequent object. They usually lodge in the right main
stem bronchus and follow an episode of choking while eating.
The post aspiration wheeze may be misdiagnosed as asthma and
cause a delay in diagnosis. Bronchoscopic removal is indicated.
Obstruction of the upper airway with a bolus of food occurs
from improper chewing. It may be associated with poor dentition.
Patients present with a sudden onset of respiratory distress
while eating. Treatment is the Heimlich manoeuvre (see Unit
13: Resuscitation and Preparation for Anaesthesia and Surgery).
Oesophageal and stomach foreign bodies in children usually
are coins, while bones and boluses of meat are more common
in adults. Objects lodge at the cricopharyngeus in the upper
oesophagus, the aortic arch in the mid-oesophagus and the gastro-oesophageal
junction in the distal oesophagus.
Remove objects in the upper oesophagus with a laryngoscope
and Magill forceps. A rigid or flexible oesophagoscope is needed
for mid and lower oesophageal objects and the patient should
be referred for this treatment.
Superficial lacerations at the oesophageal entrance by fish
bones result in a foreign body sensation to the patient. This
will resolve in 24 hours, but may need endoscopic examination
to rule out the presence of a bone.
Smooth objects that reach the stomach will generally pass through
the entire gastrointestinal tract and do not require retrieval.
Instruct patients or parents to check the bowel contents to
confirm passage of the object. Consider removal of sharp objects
by endoscopy. Adults with mental disorders may ingest large
objects requiring laparotomy for removal. Treat bezoars (conglomerates
of vegetable matter) by dissolving them with proteolytic enzymes
Blunt foreign bodies in the small intestine usually pass and
exit the gastrointestinal tract without difficulty. Sharp objects
require careful observation with serial X-rays and operative
removal if the clinical signs of intestinal perforation present.
Catharsis is contraindicated.
Colon and rectum
Sharp foreign bodies may perforate the colon during transit.
Remove foreign bodies placed in the rectum using general anaesthesia
with muscle relaxation.
Confirm foreign bodies are present (often pins or needles)
in the foot or knee by X-ray. Make one attempt to remove them
under local anaesthesia. If that fails, perform the procedure
with ketamine or regional anaesthesia with radiological assistance,
Remove bullets in subcutaneous tissue or muscle if they are
grossly contaminated or if the wound requires exploration for
other reasons. Leave deep seated bullets or fragments if vital
structures are not in danger. Remove bullets from joint cavities.
Remove foreign bodies that penetrate the head, chest or abdomen
in the operating room after the patient’s airway has
been secured and preparations are made for the consequences
of removal, which could include severe haemorrhage.
The removal of a foreign body may
be urgent, as in the case of airway compromise or unnecessary,
as in the case of some deep metal fragments
body removal may be difficult or time-consuming; the
patient should therefore be anaesthetized
or fluoroscopy is recommended for the removal of radiopaque
bodies in the cranium, chest or abdomen or in close
proximity to vital structures must be removed in an
operating room with a team prepared to manage possible