The ingested foreign body can lodge in:
● Tonsil: Usually sharp fish bones, needles etc
● The base of tongue: Fishbone or a needles
● Pyriform fossa: Fishbone, chicken bone, needle or dentures are commonly seen
● Esophagus: Coins, a piece of meat, chicken, bone, denture, safety pin, marble
Many of the foreign bodies are accidentally ingested.
What are the common causes of getting a foreign body into the esophagus?
Common causes of a foreign body in the esophagus:Flat objects like coins are held up at the sphincter while others are held in the upper esophagus just below sphincter
● Children more prone as they play with coins, marbles and accidentally 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 a foreign body in the esophagus?
Common sites of lodgement of a foreign body in the esophagus are:
● Just below cricopharyngeal sphincter
● Flat objects like coins are held up at the sphincter while others are held in the upper esophagus just below sphincter
● At the broncho-aortic constriction
● Sharp or pointed foreign bodies can be impacted anywhere in the esophagus
Clinical features are seen in cases of a foreign body in the esophagus:
● 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 esophagus?
● 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 a foreign body in the esophagus managed?
● Rigid oesophagoscopy under general anesthesia 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 a foreign body in the esophagus?
● Respiratory obstruction
● Perioesophageal cellulitis
● Perforation of esophagus
● Tracheo-oesophageal fistula