Section 9. Digestive Disorders

Chapter 123. Hiatus Hernia, Bezoars, and Foreign Bodies

Topics: Introduction | Hiatus Hernia | Bezoars and Foreign Bodies

Bezoars and Foreign Bodies

Bezoars are tightly packed collections of partially digested or undigested material stuck in the stomach or other parts of the digestive tract. Foreign bodies are small ingested objects that can also get stuck in the digestive tract and sometimes perforate (pierce) it.

The stomach is a common collection site for hardened masses of food materials or other objects. This is due in part to the shape of the stomach and to the narrow opening (pyloric sphincter) through which the stomach's contents must empty in order to enter the first segment of the small intestine (duodenum). Undigestible masses (bezoars) or foreign objects (bodies) larger than 2 centimeters (about ¾ of an inch) in diameter are rarely able to pass out of the stomach.

Bezoars consist of partially digested hair or fiber from fruits or vegetables that accumulate most often in the stomach but sometimes elsewhere in the digestive tract. These hairballs or foodballs cannot pass through narrow openings or spaces and thus get stuck in the digestive tract. Even hardened blocks of drugs, such as antacids, can accumulate and become stuck.

Foreign bodies are sometimes swallowed by children and even adults, especially intoxicated adults. If these undigestible objects are small, they pass through the digestive system until they are excreted with stool. However, larger objects or sharp ones, such as fish bones, may get stuck in the esophagus or stomach or, less often, in other parts of the digestive tract. Sometimes foreign bodies are swallowed purposely, such as when smugglers swallow balloons filled with illegal drugs to get through customs; the foreign bodies may become stuck in the stomach.

Food or other materials can collect in anyone but do so more often under certain circumstances. People who have undergone surgery to their digestive tract, particularly if they have had part of their stomach or intestines removed, are particularly prone to bezoars and foreign bodies becoming stuck. People with diabetes sometimes develop a condition in which the stomach does not empty properly, resulting in problematic collections of food.

Symptoms and Diagnosis

Most bezoars and foreign bodies cause no symptoms.

A small blunt object that is swallowed may produce the sensation of something being stuck in the esophagus. This feeling may persist for a short time even after the object has passed into the stomach. A small sharp object that is swallowed may become lodged in the esophagus and cause pain, even though the person is able to swallow normally. When the esophagus is completely blocked, the person is unable to swallow anything, even saliva, and drools and spits constantly. The person may try to vomit, but nothing comes up.

Sometimes bezoars or foreign bodies lead to blood in the stool. If they are partially or completely obstructing the stomach, the small intestine, or, rarely, the large intestine, they cause cramps, bloating, loss of appetite, vomiting, and sometimes fever. If a sharp object has pierced the stomach or intestines, stool spills into the area around the intestines, causing severe abdominal pain, fever, fainting, and sometimes shock. Such a leakage is a medical emergency because it can cause peritonitis (see Section 9, Chapter 132). If a person has swallowed a drug-filled balloon, the balloon may rupture, which can then lead to an overdose of the drug.

Often an obstructing object can be seen on x-rays of the abdomen. Sometimes endoscopy (a visual examination of the digestive tract using a flexible tube (see Section 9, Chapter 119)) is performed to determine the nature of the obstructing object and to exclude a tumor as the cause. Rarely, computed tomography (CT) and ultrasound scans are used to identify the problem.

Treatment

Most bezoars and foreign bodies require no treatment. Even a small coin is likely to pass without problem. A doctor advises the person to check the stool to see when the object is excreted. Sometimes a doctor recommends that the person consume a liquid diet to help excrete the object.

To help break down a bezoar, a doctor may prescribe a regimen of dissolved cellulase, which is taken by mouth for several days. When a doctor suspects that a blunt foreign body is stuck in the esophagus, the drug glucagon may be given intravenously to relax the esophagus and allow the object to pass through the digestive tract. Other drugs such as metoclopramide taken by mouth can help bezoars or blunt foreign objects pass through the digestive tract by causing muscles to contract.

Doctors can remove some objects that are stuck in the esophagus by passing a small tube (catheter) with a balloon on the end of it through the mouth and below the object. The balloon is inflated and the catheter is pulled out, removing the object.

Sharp objects may pierce the wall of the esophagus, with serious consequences. Therefore, they must be removed, either by endoscopy or surgery. Batteries are also removed because they can cause internal burns. When an object suspected of being a drug-filled balloon is detected, it is removed to prevent the drug overdose that can occur if the object ruptures.