What should I do if I ingest a small shard of glass?

Management of Glass Ingestion

If you swallow a small shard of glass, you should seek immediate medical attention for radiographic evaluation to determine the location and size of the glass fragment, as glass fragments can cause serious injury including perforation of the gastrointestinal tract. 1

Initial Assessment and Evaluation

• Do NOT:

  • Induce vomiting (this may cause additional trauma or perforation) 2, 1
  • Administer anything by mouth unless advised by poison control or emergency personnel 1
  • Use ipecac syrup or activated charcoal 2, 1

• Do:

  • Contact the Poison Help hotline (800-222-1222 in the US) for immediate guidance 1
  • Seek medical attention promptly, even if you're not experiencing symptoms 2

Medical Evaluation Process

Imaging Studies

• Plain radiographs of neck, chest, and abdomen are the first-line imaging studies to locate glass fragments 2, 1
  • Note: Glass fragments may be difficult to visualize on X-rays with false-negative rates up to 85% 2
• CT scan should be performed if:
  • Plain radiographs are negative but suspicion remains high
  • Perforation is suspected
  • Complications requiring intervention are present 2, 1

Laboratory Tests

• If perforation is suspected, the following tests should be performed:
  • Complete blood count (CBC)
  • C-reactive protein (CRP)
  • Blood gas analysis for base excess and lactate 2, 1

Management Based on Clinical Findings

Asymptomatic Patients with Confirmed Small Glass Fragment

• Most foreign bodies (80-90%) pass spontaneously through the gastrointestinal tract 2
• Close monitoring and follow-up may be appropriate if the glass fragment is small and smooth

Symptomatic Patients or Large/Sharp Glass Fragments

• Urgent endoscopic removal is recommended for:
  • Sharp glass fragments (within 6 hours of ingestion) 2, 1
  • Large fragments (>2 cm) 1
  • Patients with symptoms such as dysphagia, odynophagia, or pain 1
  • Glass fragments causing complete esophageal obstruction 2

Complications Requiring Surgical Intervention

• Surgery is indicated for:

  • Perforation of the gastrointestinal tract
  • Glass fragments close to vital structures (e.g., aortic arch)
  • Irretrievable foreign bodies 2
  • Severe bleeding or persistent complete bowel obstruction 3

• The surgical approach depends on the location of the glass fragment:

  • Minimally invasive techniques should be considered first-line in referral centers 2
  • Esophagotomy with primary closure for limited contamination 2

Important Caveats and Pitfalls

• Delayed diagnosis can lead to serious complications such as retropharyngeal abscess and mediastinitis 4
• Glass fragments may not be visible on standard radiographs, leading to false-negative results 2
• Even small glass fragments can cause significant injury if they are sharp
• Patients with psychiatric disorders may repeatedly swallow foreign bodies, requiring a more comprehensive management approach 3

Follow-up

• Follow-up imaging may be necessary to confirm passage of the glass fragment
• If the glass fragment was removed endoscopically, follow-up to assess for delayed complications may be warranted