Known or
suspected
ingestion of
sharp object

Radio-opaque

Radiolucent

Esophageal:
Urgent
endoscopic
removal

Gastric

Consider
endoscopic
removal
unless short
object with
heavier blunt
end

Small bowel (distal to
ligament of Treitz)

Symptomatic

Asymptomatic

Enteroscopy
or surgical
removal

Follow
clinically with
serial x-ray
Enteroscopy or
surgical
removal
considered if
develops
symptoms or
>3 days without
passage

Symptomatic
self-reported
or witnessed
ingestion:
Urgent
endoscopic
evaluation
and removal

Asymptomatic:
Consider CT,
ultrasound,
MRI, or
esophagram
for further
assessment

Evidence of
FB:
Endoscopic
removal

No evidence
of FB:
Clinical
observation,
close follow-
up, reassess if
develops
symptoms