Specialist ENT FOREIGN BODY OESOPHAGUS

FOREIGN BODY OESOPHAGUS

Ingested foreign bodies can lodge in:

  1. Tonsil: Usually sharp fish bones, needles etc.
  2. The base of tongue: Fish bone or a needles.
  3. Pyriform fossa: Fish bone, chicken bone, needle or dentures are commonly seen.
  4. Oesophagus: Coins, piece of meat, chicken bones, denture, safety pin, marble.

Aetiology:

  1. Age: Children more prone as they play with coins, marbles and accidently ingest them.
  2. Loss of protective mechanism: Use of upper denture prevents tactile sensation and a foreign body is swallowed undetected.
  3. Inadequate mastication.
  4. Oesophageal stricture, spasm.
  5. Psychotics.

Constrictions of Oesophagus:

Specialist ENT Screenshot 2020 11 29 book oesophagus almost final

Sites of lodgment of foreign body in the Oesophagus:

  1. Just below cricopharyngeal sphincter.
  2. Flat objects like coins are held up at the sphincter while others are held in the upper oesophagus just below sphincter.
  3. At the broncho-aortic constriction.
  4. Sharp or pointed foreign bodies can be impacted anywhere in the oesophagus.

Clinical features:

Symptoms:

  1. History of choking.
  2. Discomfort or pain just above the clavicle.
  3. Dysphagia (difficulty in swallowing).
  4. Drooling of saliva.
  5. Respiratory distress, dyspnea, cough and wheezing. These symptoms are due to compression overflow or fistulous communication with the air passages.
  6. Substernal or epigastric pain.

Signs:

  1. Tenderness in the lower part of neck on the right or left side of trachea.
  2. Pooling of saliva in pyriform fossa as seen on indirect laryngoscopy.
  3. Foreign body may be seen protruding from Oesophageal opening in post-cricoid region.

Investigations:

  1. Plain X-ray can diagnose radio-opaque foreign bodies like coins, safety pin etc. Oesophageal foreign bodies like coins present as a radio-opaque shadow on A-P view while the lateral view shows a vertical slit-like shadow (vice-versa is seen in tracheal foreign bodies).
Specialist ENT Screenshot 2020 11 29 book oesophagus almost final1
Specialist ENT Screenshot 2020 11 29 book oesophagus almost final2

2. Fluoroscopy to detect hidden foreign bodies and for swallowing function.

3. CT Scan helps to detect small foreign bodies.

Management

  1. Rigid Oesophagoscopy under general anesthesia is usually safest and the best method of removal of Foreign bodies.
  2. If such foreign bodies cannot be removed by the above, then transthoracic oesophagotomy is done.
  3. Blunt non-impacted foreign bodies can be removed by fibre optic oesophagoscopy especially in high risk patients.

Complications:

  1. Respiratory obstruction.
  2. Perioesophageal cellulitis.
  3. Perforation of oesophagus.
  4. Tracheo-Oesophageal fistula.

Disc batteries:

  1. Ingestion of disc batteries is a common problem.
  2. Batteries contain potassium hydroxide, sodium hydroxide and mercury. These contents leak and causes oesophageal injury like stricture, perforation, tracheo-oesophageal fistula, mediastinitis and death.
  3. Disc battery causes damage to

    ➣ Mucosa in 1 hr

    ➣ Muscle coat in 2–4 hr

    ➣ Perforation of the oesophagus in 8–12 hr

Hence, they should be removed promptly from the oesophagus.

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