Management of ingested sharp and pointed foreign bodies is controversial. Objects longer than 5 cm and wider than 2 cm rarely will pass the stomach. Objects of that size and those with extremely pointed edges, such as open safety pins or razor blades, must be removed before they pass from the stomach because 15 to 35 percent will cause intestinal perforation, usually in the ileocecal valve.
Paul and Jaffe13 recommend the following management for children who have swallowed sharp objects. All patients should have an initial radiograph and physical examination. If the patient is symptomatic or has ingested a sewing needle, surgical consultation for possible endoscopy and laparotomy is indicated. Children who have swallowed a sharp object (other than sewing needles) yet are asymptomatic can be managed on an expectant basis. Progression of the sharp object should be documented with serial radiographs. If progression past the stomach is not seen, a water-soluble contrast film may document gastrointestinal perforation. At the first sign of perforation, the object should be removed even if the patient remains asymptomatic. If the object does not progress through the gastrointestinal tract, surgical retrieval is indicated.
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