Intra-digestive foreign bodies can occur either accidentally or intentionally. They vary in nature, shape, and number . These situations are common, particularly in emergency departments, and the pediatric population is most frequently affected [2] . The outcome can be favorable with spontaneous evacuation of the foreign body or bodies via natural routes . However, emergencies may arise due to complications such as perforation and superinfection [3] . Abdominal X-rays without preparation provide a simple means of detecting intra-digestive foreign bodies, their localization, and potential complications, and they offer therapeutic guidance and monitoring.

This is a single-center retrospective descriptive study conducted over a two-year period, from April 2021 to April 2023, within the Radiology Department of the Eaubonne Montmorency Hospital Group in Paris, France.

We included all patients who underwent an abdominal X-ray without preparation following the ingestion or insertion of foreign bodies. We excluded inhaled foreign bodies, incomplete records, and extra-digestive intra-abdominal foreign bodies such as Cristalenet® or Pacs®. Data were entered using Microsoft Excel software.

During this period, we recorded 62 cases of AXR showing radiopaque foreign bodies projected in the digestive tract out of a total of 1,977 AXRs, corresponding to a rate of 3.14%. There was a male predominance, with a sex ratio of 2. The pediatric population under 10 years old was the most represented, with age extremes ranging from 9 months to 82 years ( Table 1 ).

Most incidents occurred accidentally in patients without known psychiatric disorders. A history of psychosis was noted in 4.8% of cases ( Figure 1 ). In more than 98% of cases, the entry route was ingestion. We report one case of rectal insertion in a psychotic patient. The months of July and June saw the highest number of diagnosed cases.

Reported symptoms included abdominal pain (11.2%), vomiting (9.6%), and odynophagia (4.8%), cessation of feces and gases (3.2%) in conscious patients. In 72% of cases, a complementary chest X-ray was performed, and two patients underwent a CT scan. All identified foreign bodies were radiopaque, measuring between 5 mm and 10 cm, with an average size of 22.58 mm.

In more than 96% of cases, a single foreign body was found; there was one case with two foreign bodies and another with multiple. Radiographically, the most common shape was rounded ( Table 2 ), typically resembling a coin in 53.2% of cases ( Figure 2 , Figure 3 ). The umbilical region was the most frequent location of the foreign body on initial Abdominal X-ray ( Figure 4 ).

Only minor complications were noted: fecal stasis (69.2%) and aerocolia (69.7%). Daily radiological monitoring was performed, and spontaneous evacuation occurred in 93.5% of patients. One case required surgical treatment, and three underwent endoscopic extraction.

We collected 62 cases of foreign bodies in the digestive tract using conventional radiography. The number of cases depended both on the study duration and diagnostic methods [4] - [6] .

Our study found a predominance of the pediatric population, with a mean age of 8.04 years. Vignon similarly reported a pediatric predominance of 84.4% [7] . In Jgounni’s study, the mean age was 24.4 years due to a different patient demographic.

Males predominated in our study (sex ratio = 2), consistent with the literature [6] [7] . This may be explained by a higher incidence of accident among males.

Like our findings, Jgounni and Lahlou also reported accidental causes in most digestive foreign body cases [6] . Unfortunately, we were not able to study other risk factors such as alcohol/tobacco use or incarceration.

Abdominal pain was the most common symptom in our study. This contrasts with Vignon and Bakri, who reported more upper digestive symptoms due to esophageal locations, whereas in our study, foreign bodies were mostly peri-umbilical [7] [8] .

Diagnosis in our study relied on conventional radiography, including AXR and, in some cases, chest X-rays. In Togo’s study, a chest X-ray was systematically added, and fibroscopy played a major diagnostic role [5] . This difference may reflect the foreign body location or variations in protocols across institutions.

CT played a limited role in our study, similar to Togo’s findings, as it is a second-line diagnostic tool.

Most identified objects were under 10 cm and radiopaque [5] [6] . Radiotransparent objects represent a limitation of conventional radiography, necessitating other diagnostic modalities.

Multiple foreign bodies in the digestive tract are rare, as also shown in Jgounni’s study [6] .

Metal coins were the most common foreign body in our series, as in other literature [5] [6] , likely due to the pediatric age group, an age characterized by oral exploration. Pointed metallic objects were mostly found in cases of intentional insertion.

According to the literature, most foreign bodies are located in the stomach at diagnosis [6] . Since conventional radiography is two-dimensional, exact localization within the digestive tract cannot be confirmed. However, in our study, most opacities were found in the umbilical region, suggesting gastric localization. We only observed minor complications.

In our study, 93.5% of foreign bodies passed naturally within 2 to 3 days. Upper digestive endoscopy was the preferred diagnostic and therapeutic tool for esophageal foreign bodies. Surgery was indicated in cases of halted progression or endoscopic failure, or when complications such as perforation-induced peritonitis occurred [5 ] [ 7] .

Digestive tract foreign bodies are common, particularly among children, and twice as frequent in boys than girls. Clinical manifestations depend on the object’s location within the tract, and complications vary according to the shape, size, or number of foreign bodies. Conventional radiography still plays an important role in their management by identifying location, describing morphology, and guiding treatment, be it endoscopic, surgical, or natural evacuation.