Foreign bodies of the gastrointestinal tract, surgical considerations.

Foreign bodies (FBs) of the pharynx are likely to stop at the palatine or lingual tonsils, the cricopharyngeal muscle, or the beginning of the esophagus; they may be removed with direct vision. FBs of the esophagus should be located by esophagram; endoscopy may be diagnostic and therapeutic; sharp objects may cause laceration and vascular injury. In the stomach, the FB may pass through the intestinal tract or stop at the pylorus or duodenum; if after 5-6 days there is no evidence of passage in the duodenum, it should be recovered by gastrotomy or endoscopy. FBs in the small intestine, calculi, or phytobezoar usually stop at the ileocecal valve and should be recovered by enterotomy. They may produce a coloenteric or enteroenteric fistula leading to an inter-intestinal abscess leading to intestinal obstruction. They may pass in the colon and stop at the rectosigmoid junction leading to perforation simulating perforating sigmoid diverticulum. FBs of the rectum may be recovered by sigmoidoscopy. The strategy is exact radiological location and evaluation of whether there is absence or presence of retroperitoneal or perirectal air. Intraperitoneal perforation should be immediately treated by suture of the perforation and temporary sigmoid colostomy. Perforation below the peritoneal reflexion is treated by diverting sigmoid colostomy and extraperitoneal perirectal drainage. Compound lacerations of the rectosigmoid junction may need Hartmann's procedure followed three weeks later by a terminoterminal or terminolateral anastomosis using the EEA stapler.