Discharge Instructions After Swallowed Foreign Body
After successful endoscopic removal of a swallowed foreign body without complications, patients may be discharged home with specific instructions for monitoring complications and follow-up to identify underlying esophageal disorders. 1
Immediate Post-Procedure Discharge Criteria
- Patients can be safely discharged after uncomplicated foreign body removal, meaning no evidence of perforation, significant mucosal injury, or aspiration during the procedure 1
- Monitor for at least 2-4 hours post-procedure to ensure hemodynamic stability and absence of immediate complications 1
Warning Signs Requiring Immediate Return to Emergency Department
Instruct patients to return immediately if they develop:
- Severe chest pain or worsening chest discomfort (may indicate delayed perforation or mediastinitis) 2, 3
- Fever, chills, or signs of infection (can signal esophageal perforation with mediastinal contamination or abscess formation) 2, 4
- Difficulty breathing, shortness of breath, or neck swelling (suggests perforation with air leak into mediastinum) 5, 6
- Persistent or worsening difficulty swallowing (may indicate unrecognized injury or retained foreign body) 3, 4
- Vomiting, especially with blood (suggests mucosal injury or perforation) 2, 3
- Severe abdominal pain (if foreign body passed to stomach, may indicate gastric or intestinal perforation) 7
Dietary Instructions
- Start with clear liquids for the first 24 hours, then advance to soft diet as tolerated 4
- Avoid hard, sharp, or poorly chewed foods for 48-72 hours to allow any mucosal injury to heal 4
- Take small bites and chew food thoroughly, especially if underlying esophageal disorder is suspected 8
Critical Follow-Up Appointment
Schedule mandatory outpatient gastroenterology follow-up within 1-2 weeks before discharge to prevent patients from being lost to follow-up 5, 6, 8. This is essential because:
- Up to 25% of patients with foreign body impaction have an underlying esophageal disorder that requires diagnosis and treatment 5, 6, 8
- Eosinophilic esophagitis is found in up to 46% of patients with food bolus obstruction and requires specific therapy 5, 6, 8
- Other conditions include esophageal stricture, hiatus hernia, Schatzki ring, achalasia, and tumors 5, 6, 8
If Biopsies Were Not Obtained During Initial Endoscopy
- Arrange elective repeat endoscopy to obtain at least 6 biopsies from different esophageal sites to evaluate for underlying pathology 6, 8
- If eosinophilic esophagitis is suspected or diagnosed, withhold proton pump inhibitors for at least 3 weeks before repeat endoscopy if symptoms persist 6, 8
Activity Restrictions
- Avoid strenuous physical activity for 24-48 hours post-procedure 1
- No driving for 24 hours if sedation was used during endoscopy 1
Common Pitfall to Avoid
The most critical error is failing to schedule definitive outpatient follow-up before discharge, which leads to missed diagnoses of treatable esophageal disorders and recurrent foreign body impactions 5, 6, 8. Ensure the appointment is made and documented before the patient leaves the hospital.