Foreign Body Removal

• April 15, 2022
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Patients with skin and soft tissue wounds commonly present to the emergency department (ED) for evaluation and treatment. Essential in the evaluation of these wounds is a careful assessment for retained foreign bodies (FB), as they are frequently missed on initial evaluation. Identification of a foreign body can be difficult, depending on the type and location of the wound and the timing and mechanism of injury. Soft tissue foreign bodies most commonly occur secondary to penetrating or abrasive trauma, and they can result in patient discomfort, deformity, delayed wound healing, localized and systemic infection, and further trauma during attempts at removal. Foreign bodies in the ear, nose, and throat are occasionally seen in family medicine, usually in children. The most common foreign bodies are food, plastic toys, and small household items. Diagnosis is often delayed because the causative event is usually unobserved, the symptoms are nonspecific, and patients often are misdiagnosed initially. Most ear and nose foreign bodies can be removed by a skilled physician in the office with minimal risk of complications. Common removal methods include use of forceps, water irrigation, and suction catheter. Pharyngeal or tracheal foreign bodies are medical emergencies requiring surgical consultation. Radiography results are often normal. Flexible or rigid endoscopy usually is required to confirm the diagnosis and to remove the foreign body. Physicians need to have a high index of suspicion for foreign bodies in children with unexplained upper airway symptoms. It is important to understand the anatomy and the indications for subspecialist referral. The evidence is inadequate to make strong recommendations for specific removal techniques.

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