What is the disposition for a patient who ingested glass?

Management of Glass Ingestion

Patients who have ingested glass should undergo immediate radiographic evaluation with neck, chest, and abdominal radiographs to determine the presence, location, shape, and size of the glass fragments, followed by appropriate management based on imaging findings and symptoms. 1

Initial Assessment

• History taking:

  • Determine quantity and type of glass ingested
  • Timing of ingestion
  • Presence of symptoms (dysphagia, odynophagia, drooling, retrosternal pain, hematemesis)
  • Circumstances of ingestion (accidental vs. intentional)

• Physical examination:

  • Assess for signs of airway compromise
  • Check for cervical subcutaneous emphysema, erythema, or tenderness (signs of perforation)
  • Evaluate for hemodynamic instability

Diagnostic Evaluation

• Radiographic studies:

  • Plain radiographs of neck, chest, and abdomen are first-line to locate glass fragments 1
  • CT scan is indicated if perforation is suspected or if complications require surgical intervention 1

• Laboratory tests:

  • Complete blood count (CBC)
  • C-reactive protein (CRP)
  • Blood gas analysis for base excess and lactate if perforation suspected 1

Management Algorithm

For Asymptomatic Patients with Visible Glass on Imaging:

1. Small, smooth glass fragments:

   • Observation with serial radiographs
   • Most will pass spontaneously through the gastrointestinal tract 2
   • Follow-up radiographs to confirm passage

2. Large (>2 cm) or sharp glass fragments:

   • Urgent endoscopic removal if located in esophagus or stomach
   • Endoscopy should be performed within 6 hours for sharp-pointed objects 1

For Symptomatic Patients:

1. Patients with dysphagia, odynophagia, or pain:

   • Immediate endoscopic evaluation regardless of radiographic findings
   • NPO (nothing by mouth) until endoscopic assessment

2. Patients with signs of perforation (subcutaneous emphysema, fever, severe pain):

   • CT scan of neck, chest, and abdomen
   • Surgical consultation
   • Broad-spectrum antibiotics
   • NPO status

For Patients with Complications:

1. Esophageal perforation:

   • Surgical intervention with primary repair if identified early 1
   • Minimally invasive techniques should be considered first-line in referral centers 1

2. Gastrointestinal bleeding:

   • Endoscopic management
   • Supportive care including fluid resuscitation if significant bleeding

Important Considerations

• Do not:

  • Induce vomiting as this may cause additional trauma or perforation 1
  • Administer anything by mouth unless advised by poison control or emergency personnel 1
  • Administer activated charcoal or ipecac 1

• Contact poison control:

  • The Poison Help hotline (800-222-1222 in the US) should be contacted for additional guidance 1

Follow-up

• Patients with uncomplicated glass ingestion who pass the fragments should have confirmation radiographs
• Patients who underwent endoscopic removal should be monitored for delayed perforation or bleeding
• Patients with high-risk ingestions (large or sharp fragments) may require serial imaging to ensure complete passage

Pitfalls to Avoid

• Assuming all glass will be visible on plain radiographs (some types may be radiolucent)
• Delaying endoscopy for sharp objects in the esophagus, which can lead to perforation
• Discharging patients without confirming passage of the glass or resolution of symptoms
• Underestimating the risk of perforation, which can occur even with small glass fragments

Glass ingestion is generally less harmful than caustic substance ingestion, but proper evaluation and management are essential to prevent complications such as perforation, which can lead to significant morbidity and mortality.