Purpose: Ingestion of small foreign bodies rarely results in complications and the presenting symptoms are usually vague abdominal pain and the diagnosis remains a challenge. It is important to identify the risk factors for patients that require admission and intervention. The objective was to look at the incidence of complication of the small foreign bodies found in the distal gastrointestinal tract and to evaluate the risk factors for these complications. Methods: A retrospective chart review was done for data from consecutive patients for the year 2008 with ICD-9 billing code for foreign body. Patients with foreign bodies that have passed the duodenum were included in the case series. Records were reviewed for patient's age, sex, prior abdominal surgeries, co-morbid conditions, foreign body type, initial location, presenting symptoms, intervention required, as well as length of stay, morbidity and mortality. Patients under age 18 were excluded. Results: Of the 24 patients with swallowed foreign body, only seven cases were identified to have passed the duodenum. Foreign bodies identified included fish bones, soda can lid and an orthodontic device. Foreign bodies were located as follows: one in the jejunum, two in proximal and three in terminal ileum, one in the sigmoid diverticulum. Patient's age ranged from 24 to 80 with a mean of 57. 40% (3pts) had prior abdominal surgery. Only one patient had a history of psychiatric disorder that contributed to the ingestion. 60% (4 of 7) were male. Length of stay ranged from 2-12 days, with the mean of 6. Four patients required interventions: two colonoscopies and three surgeries. First patients had perforation of the gastrointestinal tract from the foreign body at the site of diverticulum. Second patient had a fish bone impacting into the wall of jejunum, without perforation. The third patient had surgery as the object could not pass a stricture. The length of stay was longer in the four patients that required intervention. Only 3 patients remembered swallowing the object. Conclusion: Impaction and perforation usually occurs at the site of narrowing, i.e. terminal ileum. Majority of the swallowed distal foreign bodies ultimately will need intervention, although an expectant conservative management may be warranted as 40% of them may pass the object spontaneously.