Swallowed a Screw? Immediate Steps, Risks, and Medical Management

Ingesting a screw is a foreign body emergency. Seek medical attention immediately—do not wait for symptoms.

Risk Factors

• Size: >2.5 cm length or >1.5 cm diameter → higher obstruction risk.
• Shape: Sharp threads, pointed ends → perforation risk.
• Location: Esophagus (highest risk), pylorus, ileocecal valve, appendix.

Potential Complications

1. Esophageal impaction: Drooling, dysphagia, chest pain, airway compression.
2. Mucosal injury: Abrasion, laceration, perforation → mediastinitis, peritonitis.
3. Obstruction: Small bowel (most common site), colon.
4. Bleeding: Erosion into vessels.
5. Sepsis: From perforation or translocation.

Management

• Esophagus: Urgent endoscopy (within 2 hr if symptomatic, 24 hr if asymptomatic).
• Stomach: If <2.5 cm, blunt, asymptomatic → observe with serial X-rays; most pass in 3–5 days. If sharp, >2.5 cm, or symptomatic → endoscopy.
• Beyond pylorus: Observe if asymptomatic; surgery if obstruction/perforation signs.

Do NOT

• Induce vomiting (aspiration, esophageal injury).
• Eat/drink to "push it down" (worsens impaction).
• Use laxatives (increases motility → perforation risk).

Outcome is excellent with timely intervention.