Foreign Body Ingestion — ORE Part 1 MCQ

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EasyOral SurgeryForeign Body IngestionORE Part 1

During root canal treatment, a patient accidentally swallows a small endodontic file. They have no respiratory or abdominal symptoms. Chest and abdominal radiographs confirm that the file is in the stomach. What is the most appropriate management?

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Correct answer: C — Arrange urgent endoscopic retrieval within 24 hours

Explanation lettering: E = shown as B · B = shown as C · C = shown as E

B is correct. An endodontic file is a sharp-pointed foreign body. Despite the absence of symptoms, it should be referred for urgent therapeutic upper-GI endoscopy, within 24 hours, while it remains accessible in the stomach. Observation is appropriate for many small blunt objects but not for a sharp file, which may perforate the gastrointestinal tract if allowed to progress. Laparotomy is not indicated unless there is perforation, obstruction, peritonitis, or endoscopic management is unsuccessful or impossible. Vomiting should not be induced because the file could injure the oesophagus on regurgitation and aspiration may occur. Laxatives do not remove the risk associated with onward passage of a sharp object.

Reference: European Society of Gastrointestinal Endoscopy. Removal of foreign bodies in the upper gastrointestinal tract in adults: ESGE Clinical Guideline, 2016. Recommendation 10 advises urgent (within 24 hours) therapeutic oesophagogastroduodenoscopy for sharp-pointed objects in the stomach. https://pubmed.ncbi.nlm.nih.gov/26862844/