Foreign Body Ingestion Clinical Pathway — Emergency Department, ICU, and Inpatient

Other Foreign Bodies

Bezoar	Trichobezoars Consult General Surgery and GI Large trichobezoars are almost impossible to remove endoscopically Do not use electrocautery to break up hair Phytobezoars Consult GI Soda (Coca-Cola) has been demonstrated to help dissolve these bezoars Endoscopic management depends on size of bezoar and length of expected procedure Endotracheal intubation is required during procedure
Super-absorbent Objects e.g., water orbs, tampons, etc.	Consult GI Consult General Surgery if symptomatic Consider endoscopic removal Objects rapidly expand within the GI tract 30-60 times original volume Cause gastric outlet or bowel obstruction Radiolucent on X-ray
Narcotic Packets	Consult Toxicology and Poison Control Center Do not remove endoscopically
Lead-containing Foreign Bodies or Large Burdens of Lead Paint Chips	Lead-containing FBs may result in significantly elevated blood lead levels within 24 hrs Consult Toxicology and GI Obtain baseline venous lead level Gastric location Consider prompt endoscopic removal Consider proton pump inhibitor and prokinetic therapy Location beyond pylorus Consider whole bowel irrigation with Golytely, especially for large burdens of lead paint chips Endoscopy or surgery are rarely indicated

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Foreign Body Ingestion Clinical Pathway — Emergency Department, ICU, and Inpatient

Other Foreign Bodies

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Foreign Body Ingestion — Other Foreign Bodies — Clinical Pathway: Emergency, ICU and Inpatient

Foreign Body Ingestion Clinical Pathway — Emergency Department, ICU, and Inpatient

Other Foreign Bodies