THROAT - Foreign Body Oesophagus

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
  • Psychotics.

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

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