What is the management for ingestion of a foreign glass body?

Management of Ingested Glass Foreign Body

For ingested glass foreign bodies, most will pass spontaneously through the gastrointestinal tract without intervention, but sharp glass fragments require close monitoring and potential endoscopic removal if they fail to progress or cause symptoms. 1

Initial Risk Stratification

The management approach depends critically on the characteristics of the glass object and patient risk factors:

• 80% of ingested foreign bodies that reach the stomach will pass uneventfully through the gastrointestinal tract without complications 1
• Sharp objects, including glass fragments, carry increased risk of obstruction, perforation, or hemorrhage 1
• Patients with prior abdominal surgery (adhesions), pre-existing intestinal disease (Crohn's disease, intestinal stenosis), or anatomical abnormalities are at higher risk for complications 1

Diagnostic Evaluation

Imaging Strategy

• Plain radiographs have limited utility for glass detection - glass may not be radiopaque depending on its composition 2
• CT scan of the abdomen and pelvis is the preferred imaging modality when there is suspicion of complications such as obstruction or perforation, with sensitivity of 90-100% compared to only 32% for plain X-rays 2, 3
• Serial abdominal examinations and imaging should be used to monitor progress of the foreign body through the GI tract 4
• Contrast swallow studies are NOT recommended as they may increase aspiration risk and impair subsequent endoscopic visualization 2

Laboratory Assessment

• Obtain complete blood count, C-reactive protein, blood gas analysis, and lactate as part of initial evaluation if complications are suspected 2

Management Algorithm

For Glass in the Esophagus

• If the glass is lodged in the esophagus with complete obstruction: emergent flexible endoscopy within 2-6 hours is required due to risk of aspiration and perforation 2
• For esophageal impaction without complete obstruction: urgent flexible endoscopy within 24 hours is recommended 2
• During endoscopy, first attempt gentle pushing of the object into the stomach using air insufflation (90% success rate), then use retrieval techniques with baskets, snares, or grasping forceps if pushing fails 2
• The use of overtubes during endoscopic removal makes extraction of sharp objects safer by protecting the mucosa from injury during withdrawal 1, 5

For Glass That Has Passed to the Stomach

• Most glass objects that reach the stomach will pass spontaneously and can be managed with observation 1, 6
• Monitor with serial abdominal examinations and imaging to confirm progression through the GI tract 4
• A bowel regimen with polyethylene glycol can facilitate passage of foreign bodies 4

Indications for Endoscopic Removal from Stomach/Duodenum

• Sharp glass fragments >5-6 cm in length should be removed endoscopically as they are unlikely to pass the duodenal sweep 1
• Patients at increased risk for complications (prior surgery, intestinal disease) should undergo early endoscopic retrieval even for smaller sharp objects 1
• Objects that fail to progress beyond the stomach after 3-4 weeks require endoscopic removal 5

Indications for Surgical Intervention

• Surgery is indicated for perforation, obstruction, or failure of endoscopic management 1, 3, 6
• Less than 1% of cases require surgery 3, 6
• Signs of perforation include peritoneal signs, free air on imaging, or clinical deterioration 3

Monitoring and Follow-Up

• Serial abdominal X-rays every 24-48 hours to document progression through the GI tract for objects being managed conservatively 4
• Patients should be instructed to return immediately for worsening abdominal pain, fever, vomiting, hematemesis, melena, or inability to tolerate oral intake 3
• Most foreign bodies that pass the pylorus will transit the remainder of the GI tract within 4-6 days 5

Common Pitfalls

• Avoid nonendoscopic methods of removal (such as Foley catheter extraction or pushing with bougies) as these are associated with increased risks of perforation and aspiration 5
• Do not delay endoscopic intervention in high-risk patients or those with esophageal impaction 2, 1
• Pharmacologic interventions (glucagon, fizzy drinks) have limited evidence and should not delay definitive endoscopic management 2
• Maintain high index of suspicion in patients unable to provide accurate history (children, psychiatric patients, prisoners) 5, 4