Which are the common sites for ingested foreign bodies to lodge?
Ingested foreign body can lodge in:
- Tonsil: Usually sharp fish bones,needles etc
- The base of tongue: Fish bone or a needles
- Pyriform fossa: Fish bone, chicken bone, needle or dentures are commonly seen
- Oesophagus: Coins, piece of meat, chicken, bone, denture, safety pin, marble
Many of the foreign bodies are accidently ingested.
What are the common causes of getting a foreign body into the oesophagus?
Common causes of foreign body in the oesophagus:
- Children more prone as they play with coins, marbles and accidently ingest them.
- Loss of protective mechanism: Use of upper denture prevents tactile sensation and a foreign body is swallowed undetected
- Inadequate mastication
- Oesophageal stricture, spasm
What are the common sites of lodgment of foreign body in the oesophagus?
Common sites of lodgement of foreign body in the oesophagus are:
- Just below cricopharyngeal sphincter
- Flat objects like coins are held up at the sphincter while others are held in the upper oesophagus just below sphincter
- At the broncho-aortic constriction
- Sharp or pointed foreign bodies can be impacted anywhere in the oesophagus
What are the symptoms and clinical features in cases of a foreign body in the oesophagus?
Clinical features seen in cases of a foreign body in the oesophagus:
- History of choking
- Discomfort or pain just above the clavicle
- Dysphagia (difficulty in swallowing)
- Drooling of saliva
- Respiratory distress, dyspnoea, cough and wheezing. These symptoms are due to compression overflow or fistulous communication with the air passages
- Substernal or epigastric pain.
What investigations are required in cases of a foreign body in the oesophagus?
- Plain X-ray can diagnose radio-opaque foreign bodies like coins. 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).
- Fluoroscopy to detect hidden foreign bodies and for swallowing function
- CT Scan helps to detect small foreign bodies
How is foreign body in the oesophagus managed?
- Rigid oesophagoscopy under general anaesthesia is usually safest and the best method of removal of Foreign bodies.
- If such foreign bodies cannot be removed by the above, then transthoracic oesophagotomy is done.
What are the possible complications of foreign body in the oesophagus?
- Respiratory obstruction
- Perioesophageal cellulitis
- Perforation of oesophagus
- Tracheo-oesophageal fistula