Regional Gastrointestinal Consultants

Bezoars and Foreign Bodies

Bezoars and Foreign Bodies

Bezoars and Foreign Bodies

Overview

Bezoars are tightly packed collections of partially digested or undigested material, such as ingestion of hair, stuck in the stomach or other parts of the digestive tract. Foreign bodies are small ingested objects that can also get stuck in the digestive tract and sometimes perforate (pierce) it.

  • Masses of indigestible materials can get stuck in various parts of the digestive tract.
  • Most bezoars and foreign bodies cause no symptoms.
  • The diagnosis is based on x-rays and sometimes on a visual examination of the digestive tract using endoscopy.
  • Most bezoars and foreign bodies pass without treatment, but some need to be broken down manually, or with swallowed agents, or removed surgically.

The stomach is a common collection site for hardened, partially digested, or undigested masses of food or other materials (bezoars) or for foreign objects (bodies). Reasons include the curved shape of the stomach and the narrow opening (pyloric sphincter) that the stomach’s contents must pass through to enter the first segment of the small intestine (duodenum). Bezoars or foreign bodies larger than ¾ of an inch (about 2 centimeters) in diameter are rarely able to pass out of the stomach.

Bezoars may consist of partially digested hair (called trichobezoars), fiber from fruits (particularly persimmons) or vegetables (called phytobezoars), and even hardened blocks of drugs (such as antacids—called pharmacobezoars), which accumulate most often in the stomach but sometimes elsewhere in the digestive tract. These hairballs or foodballs cannot pass through narrow openings or spaces and thus get stuck in the digestive tract.

Phytobezoar

Foreign bodies are sometimes swallowed by children and even adults, especially intoxicated adults. If these indigestible objects are small, they pass through the digestive system until they are excreted with stool. However, larger objects or sharp ones, such as fish bones, may get stuck in the esophagus or stomach or, less often, in other parts of the digestive tract. Sometimes foreign bodies are swallowed purposely, as when smugglers swallow balloons filled with illegal drugs to get through customs.

Foreign bodies may be inserted in the rectum intentionally (such as during sexual play) but may become stuck unintentionally.

Food or other materials can collect in anyone but do so more often under certain circumstances. People who have a low level of hydrochloric acid in their stomach, people whose stomach does not move food appropriately, people who wear dentures, and people who chew their food incompletely are at risk of bezoars and foreign bodies. These risks are more common among older people. People who have undergone surgery to their digestive tract, particularly if they have had part of their stomach or intestines removed to treat obesity, are particularly prone to bezoars and foreign bodies becoming stuck. People with diabetes sometimes develop a condition in which the stomach does not empty properly (called diabetic gastroparesis), resulting in problematic collections of food.

Symptoms

Most bezoars and foreign bodies do not completely block the digestive tract and thus cause no symptoms. However, people may feel very full after eating a normal-sized meal and may have nausea, vomiting, and pain.

A small blunt object that is swallowed may cause the sensation of something being stuck in the esophagus. This feeling may persist for a short time even after the object has passed into the stomach. A small sharp object that is swallowed may become lodged in the esophagus and cause pain, even though the person is able to swallow normally. When the esophagus is completely blocked, the person is unable to swallow anything, even saliva, and drools and spits constantly. The person may try to vomit, but nothing comes up. If a sharp object pierces the esophagus, consequences may be serious. People who have swallowed button batteries, which eat away at the lining of the esophagus, may have internal burns.

Sometimes bezoars or foreign bodies lead to blood in the stool. If they are partially or completely obstructing the stomach, the small intestine, or, rarely, the large intestine, they cause cramps, bloating, loss of appetite, vomiting, and sometimes fever. If a sharp object has pierced the stomach or intestines, stool spills into the area around the intestines, causing severe abdominal pain, fever, fainting, and sometimes shock. Such a leakage is a medical emergency. If a person has swallowed a drug-filled balloon, the balloon may rupture, which can then lead to an overdose of the drug.

Treatment

Bezoars

Most bezoars and foreign bodies require no treatment. Even a small coin is likely to pass without a problem. A doctor advises the person to check the stool to see when the object is excreted. Sometimes a doctor recommends that the person consume a liquid diet to help excrete the object. Some objects, such as toothpicks, remain in the gastrointestinal tract for many years.

Also, to help break down a bezoar, a doctor may prescribe a regimen of enzymes such as papain and meat tenderizer, which are taken with meals, or cellulase, which is dissolved in a liquid and taken by mouth for 2 to 3 days.

Sometimes doctors use forceps, a laser, or other instruments to break up bezoars so that they can pass through or be removed more easily. Bezoars that are hard as rocks usually need to be removed surgically.

Foreign bodies

When a doctor suspects that a blunt foreign body is stuck in the esophagus, the drug glucagon may be given by vein (intravenously) or the drug lorazepam may be given by vein to relax the esophagus and allow the object to pass through the digestive tract.

Doctors can remove some objects that are stuck in the esophagus with forceps or a basket passed through an endoscope. Because sharp objects may pierce the wall of the esophagus, they must be removed, either by endoscopy or surgery. Batteries are also removed from the esophagus or stomach because they can cause internal burns. When an object suspected of being a drug-filled balloon is detected, it is removed to prevent the drug overdose that can occur if such a balloon ruptures.

Foreign bodies in the rectum may need to be removed manually. After the person’s anus has been numbed with injections of a local anesthetic and held open with a special instrument, doctors are able to use forceps to grasp and remove the object. This procedure often also requires general anesthesia or heavy sedation.

IMPORTANT HEALTH NOTE

We recommend that people experiencing gastrointestinal symptoms do not attempt self-treatment. With many medications being available over the counter, and numerous do-it-yourself online unqualified remedy recommendation, it is natural to consider treating yourself but we highly recommend against this.

If you are experiencing gastrointestinal symptoms you may have a more significant issue than you would expect from the sometimes muted or infrequent symptom you may be experiencing. It is important to keep in mind that is you are having gastrointestinal symptoms or concerns it is best see a doctor to have those symptoms diagnosed and any conditions treated. Also, it is worth noting, that if health conditions do exist, the earlier they are diagnosed and treated, the greater the probability will be to successfully eliminate or manage a present condition, in fact successful outcomes will increase significantly with early detection.

If you have gastrointestinal concerns or are experiencing any gastrointestinal symptoms, please contact us promptly to schedule a consultation with a physician.


DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general information. In no way, does any of the information provided reflect definitive medical advice and self-diagnoses should not be made based on information obtained online. It is important to consult a best in class physician regarding ANY and ALL symptoms or signs as it may a sign of a serious illness or condition. A thorough consultation and examination should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call a physician or call our office today at (215) 321-4700 to schedule a consultation.