What is the proper treatment for a foreign body?

Treatment of Foreign Bodies

The proper treatment of a foreign body depends critically on its anatomical location, with ocular foreign bodies requiring immediate irrigation and medical attention for persistent symptoms, anorectal foreign bodies necessitating bedside extraction for low-lying objects without perforation, and airway foreign bodies demanding back blows followed by abdominal thrusts for ineffective cough.

Ocular Foreign Bodies

Immediate Actions and Contraindications

• Do not rub the eye under any circumstances 1
• Remove contact lenses immediately if foreign body sensation develops with contact lens use, discontinue use, and seek medical attention 1
• Tape a hard plastic eye shield, paper cup, or plastic cup over the eye to prevent unintentional touching 1

Low-Energy Mechanism (Dust, Dirt, Eyelash)

• It is reasonable to attempt removal by allowing natural tears to wash out the object or irrigating with tap water or commercial eye wash solution 1
• Irrigate with sterile saline first to flush loose material 2, 3

Indications for Immediate Medical Attention

• High-velocity injuries from grinding, nailing, or machinery require immediate medical attention 1
• Penetrating eye injury from sharp or metal objects 1
• Irregular pupil after trauma 1, 2
• Eye bleeding after trauma 1
• Loss of vision after trauma 1
• Persistent foreign-body sensation 1
• Foreign body sensation associated with contact lens use 1

Post-Removal Management

• Apply broad-spectrum topical antibiotic prophylaxis (moxifloxacin four times daily) after removal 2, 3
• Use topical NSAIDs (ketorolac) for pain, photophobia, and foreign body sensation 2, 3
• Oral acetaminophen or NSAIDs are reasonable for residual discomfort 1, 2, 3
• Cycloplegic agents (cyclopentolate) can reduce ciliary spasm pain 2, 3
• All patients require close follow-up within 24-48 hours to assess for corneal infection 2

Anorectal Foreign Bodies

Initial Assessment

• Obtain lateral and anteroposterior plain X-ray films of chest, abdomen, and pelvis to identify position, shape, size, location, and possible pneumoperitoneum 1
• In hemodynamically stable patients with suspected perforation, obtain contrast-enhanced CT scan of the abdomen 1
• Do not delay surgical treatment for imaging in hemodynamically unstable patients 1
• Collect complete blood count, serum creatinine, and inflammatory markers (C-reactive protein, procalcitonin, lactates) if perforation suspected 1

Treatment Algorithm Based on Clinical Presentation

Low-Lying Foreign Body Without Perforation

• Attempt bedside extraction as first-line therapy 1
• If bedside extraction fails, use pudendal nerve block, spinal anesthesia, intravenous conscious sedation, or general anesthesia to improve transanal retrieval chances 1
• Perform proctoscopy or flexible sigmoidoscopy after removal to evaluate bowel wall status 1

High-Lying Foreign Body (Above Rectosigmoid Junction)

• Attempt endoscopic extraction as first-line therapy 1

Suspected Drug Concealment

• Avoid any maneuver that can disrupt the drug package, including endoscopic retrieval 1

Signs of Perforation or Hemodynamic Instability

• Do not attempt transanal extraction 1
• Perform emergent laparotomy with damage control surgery approach 1
• Administer broad-spectrum antibiotic therapy according to intra-abdominal infection guidelines 1

Surgical Indications

• Surgical approach indicated if transanal extraction fails 1
• Use "step-up" surgical approach: start with downward milking, proceed to colotomy only when milking/transanal extraction fails 1
• Consider laparoscopic approach if skills and instrumentation available 1

Perforation Management

• Primary suture only for small, recent perforation with healthy, well-vascularized colonic tissues and tension-free approximation 1
• Resection with primary anastomosis (with or without diverting stoma) in clinically stable patients without anastomotic leakage risk factors when primary suture not feasible 1
• Hartmann's procedure for critically ill patients or those with extensive peritoneal contamination and anastomotic leakage risk factors 1

Antibiotic Therapy

• Do not routinely use antimicrobial therapy in uncomplicated cases 1
• Administer broad-spectrum antibiotics for hemodynamic instability or perforation 1

Airway Foreign Bodies

Recognition and Initial Response

• Identify ineffective cough as indication for intervention 1
• Bystanders should undertake interventions immediately after recognition 1

Treatment Sequence for Adults and Children >1 Year

• Use back slaps initially 1
• Use abdominal thrusts when back slaps are ineffective 1
• Consider manual extraction of visible items in the mouth 1
• Do not perform blind finger sweeps 1

Unconscious Patients

• Use chest thrusts in unconscious adults and children 1
• Immediately call emergency medical services when victim becomes unconscious 4
• Initiate chest compressions 4

Healthcare Provider Interventions

• Appropriately skilled healthcare providers should use Magill forceps to remove foreign body in out-of-hospital cardiac arrest from airway obstruction 1
• Routine use of suction-based airway clearance devices is not recommended 1

Ingested Foreign Bodies (Gastrointestinal)

Risk Stratification

• Eighty percent of ingested foreign bodies reaching the stomach pass uneventfully 5
• Increased complication risk with long sharp metal objects, animal bones, prior abdominal surgery with adhesions, pre-existing intestinal disease (Crohn's, stenosis) 5

Management Approach

• Early endoscopic retrieval recommended for patients at increased risk for complications 5
• Use of overtubes has made endoscopic removal of sharp objects safer 5

Skin Foreign Bodies

Indications for Removal

• Foreign body sensation 6
• Presence of wood, vegetative material, graphite, or other pigmenting materials 6
• Pain 6

Removal Technique

• Use radiography to locate foreign bodies 6
• Use ultrasonography for radiolucent foreign bodies 6
• Set a time limit for exploration with a plan for further evaluation or referral 6

Wound Management

• Irrigate high-risk wounds (organic foreign bodies, dirty wounds) with plain water 6
• Ensure complete removal of retained fragments 6
• Antibiotic prophylaxis is not indicated in most cases 6
• Consider retained foreign body if patient presents with infected wound 6
• Provide tetanus prophylaxis if no documentation of immunization within 10 years 6