Swallowing any foreign object is concerning, but ingesting a sharp item like a tack introduces distinct risks within the gastrointestinal tract. A tack, a small metal object with a pointed shaft, is classified as a sharp-pointed foreign body. While the digestive system can process many swallowed items, the tack’s sharp nature means it cannot be managed with simple observation. The immediate risk is the tack becoming lodged or injuring the delicate lining, necessitating prompt medical attention.
The Journey Through the Digestive System
The initial phase of transit involves the esophagus, a muscular tube that pushes the tack toward the stomach through rhythmic contractions called peristalsis. If the tack is not lodged in the esophagus—which would cause immediate discomfort or difficulty swallowing—it proceeds into the stomach. The stomach’s acidic environment and thick lining provide a temporary barrier against injury, often allowing the object to tumble and pass into the small intestine.
Once in the small intestine, the tack must navigate approximately twenty feet of narrow, winding passageway. Most blunt foreign objects pass through the entire digestive tract spontaneously, with an estimated 80% to 90% exiting the body within a week. However, the tack’s pointed design significantly increases the risk of complications, as it can catch on the intestinal wall. Narrow points in the small intestine, such as the duodenal curve and the ileocecal valve, pose particular hazards for impaction.
The sharp point of a tack can potentially pierce the intestinal wall, a severe complication known as perforation. If the tack successfully reaches the large intestine, the path widens, and the object is less likely to cause an issue before excretion. A tack that fails to progress after three days should raise serious concern, though most objects that pass do so within four to six days.
Warning Signs of Complications
If the tack causes a serious issue, the patient will develop specific symptoms that demand immediate emergency medical care. The most concerning potential complication is gastrointestinal perforation, where the tack punctures a hole in the lining of the stomach or intestine. Symptoms of perforation often manifest as severe, sudden abdominal pain that may worsen when the abdomen is touched or when the person moves.
This sharp pain is often accompanied by signs of systemic infection or inflammation, such as a fever and chills. Another serious warning sign is persistent, forceful vomiting, especially if the vomit appears bile-colored. The presence of blood in the stool is also a major red flag, which may appear as bright red bleeding or as dark, tarry stools, indicating bleeding higher up in the digestive tract. Difficulty swallowing or chest pain that begins immediately after ingestion suggests the tack is lodged in the esophagus and requires urgent removal.
These symptoms—severe pain, persistent vomiting, fever, or bloody stool—signal a medical emergency requiring immediate assessment. Such signs indicate that the tack may have caused an obstruction, a perforation, or significant internal bleeding. Ignoring these symptoms can lead to life-threatening conditions like peritonitis, an infection of the abdominal cavity that occurs when gut contents leak out through the perforation.
Clinical Assessment and Treatment
Upon arrival at the hospital, the medical team’s first priority is to locate the tack and assess for any immediate complications. Initial assessment typically involves a physical examination and imaging studies, often starting with X-rays to determine the object’s position, size, and shape. If the clinical picture suggests a perforation or obstruction, a computed tomography (CT) scan may be used to provide more detailed images of the soft tissues and guide potential surgical planning.
For a tack lodged in the esophagus or stomach, the treatment is generally an urgent endoscopic removal. Endoscopy involves inserting a thin, flexible tube with a camera and specialized tools down the throat to visualize and carefully retrieve the object. This procedure is preferred because it is minimally invasive and can prevent the tack from causing injury further down the tract.
If the tack has traveled past the stomach and into the small intestine, the approach shifts to active monitoring, provided the patient remains without symptoms. Radiographs may be taken every few days to confirm the tack continues to move. Surgical intervention is rarely required, but it becomes necessary if the tack fails to progress or causes an obstruction. Surgery is also needed if the tack has led to a confirmed perforation that cannot be managed endoscopically.