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Ingested Foreign Body

This document discusses ingested foreign bodies in the esophagus. It notes that coins are the most common foreign body found in children in Western literature, while fish bones are common in parts of Asia. Meat is most common in adults. Symptoms may include dysphagia, vomiting, or respiratory symptoms like cough or stridor. Complications can include perforation, infection, fistula formation or death. Diagnosis involves x-rays to locate the object. Rigid esophagoscopy under general anesthesia is the gold standard treatment for removal, while alternative methods carry risks.

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Teuku Faisal
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150 views18 pages

Ingested Foreign Body

This document discusses ingested foreign bodies in the esophagus. It notes that coins are the most common foreign body found in children in Western literature, while fish bones are common in parts of Asia. Meat is most common in adults. Symptoms may include dysphagia, vomiting, or respiratory symptoms like cough or stridor. Complications can include perforation, infection, fistula formation or death. Diagnosis involves x-rays to locate the object. Rigid esophagoscopy under general anesthesia is the gold standard treatment for removal, while alternative methods carry risks.

Uploaded by

Teuku Faisal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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INGESTED FOREIGN BODY

Etiology
Foreign Bodies Many foreign bodies pass uneventfully
through the digestive system, but some become lodged in
the esophagus and require surgical removal
In Western literature, meat is the most common
esophageal foreign body found in adults and coins are the
most common in children
Fish bones in the pharynx are commonly encountered in
the Far East and in Greece.
In Turkey watermelon seeds are the most frequently
aspirated objects.
Coins are a universal danger particularly for pharyngooesophageal impaction and nuts for tracheobronchial
aspiration.

Etiology
Nonspherical objects equal to or less
than 1.5 inches (38.10 mm), and
particularly spherical objects equal to
or less than 1. 75 inches (44.50 mm)
in diameter, are especially
dangerous.

Sign and symptom


Patients may be asymptomatic, or they
may have dysphagia or emesis or develop
stridor, fever, or a cough aggravated by
eating
Hawkins reported that 50% of children
with ingested coins had them lodged for
longer than 3 days, and every patient with
coins lodged for longer than 7 days had
respiratory symptoms, and some were
febrile or had respiratory infections.

Even coins can cause stridor,


esophageal erosion, aortoesophageal
or tracheoesophageal fistula,
mediastinitis, or paraesophageal
abscess

Coin in the oesophagus

Coin in the oesophagus

Complication
Major complications include
retropharyngeal and mediastinal abscess,
migration of the foreign body into deep
structures, oesophageal perforation (from
either the foreign body or endoscopic
procedure) and luminal stenosis.
Alkaline batteries are particularly
dangerous because the tissue necrosis
can be devastating and fatalities have
been described.

Complication

Oesophageal edema
laceration or erosion
hematoma
granulation tissue
mediastinitis
arterial-esophageal fistula with massive hemorrhage
respiratory problems
strictures
and proximal esophageal dilation
fatalities have been reported.

Identification
Two-view neck and chest radiographs are often
useful in identifying both the location and shape of
a foreign body or its sequela, such as an
esophageal air-fluid level.
Barium is sometimes indicated to define a foreign
body or to elucidate an underlying anatomic
condition predisposing to foreign-body lodgment.
Radiologic signs suggestive of perforation include
retropharyngeal air, widening of the
retropharyngeal soft tissue, leakage of contrast, or
an extraluminal foreign body.

Management
Compared rigid esophagoscopy to fiber-optic
esophagoscopy with conscious sedation
Foley catheter technique under fluoroscopy
(usually without sedation)
Blind bougienage with Maloney dilators
Passage of a nasogastric tube to force the
object into the stomach
Administration of intravenous glucagon or
nifedipine.

Management
Although some foreign bodies can be
safely removed using a fiber-optic
esophagoscope, rigid
esophagoscopes with Hopkins rod
telescopes remain the gold standard
for evaluation and removal of
esophageal foreign bodies.

Management
Alternative methods of removal, such
as dislodging with a Foley catheter,
are contraindicated if the foreign
body has an unfavorable shape or if
the patient has symptoms of airway
involvement or any other
complication.

Management
Reported complications of Foley
catheter removal include fatal airway
obstruction, transient apnea, coin
displacement to a main bronchus,
esophageal perforation, esophageal
tear, pneumomediastinum, bleeding,
missed second coin, foreign body lost in
the nasopharynx, aspiration pneumonia,
and an inability to remove the coin.

Management
Blind bougienage with Maloney
dilators and insertion of nasogastric
tubes to push the object into the
stomach are occasionally used, but
current opinion favors abandoning
these methods as lacking safety and
efficacy.

Management
Pharmacologic agents such as
nifedipine have been used with
varying degrees of success to
facilitate the passage of an impacted
foreign body by manipulating
esophageal muscular tone; glucagon
does not appear to be effective in the
dislodgment of esophageal coins in
children

Management
Rigid endoscopy gives a much better
view of the hypopharynx,
cricopharyngeus and the first few
centimetres of the cervical
oesophagus, whereas a flexible
endoscope gives an excellent view in
the thoracic oesophagus and
oesophago-gastric junction

Management
The use of rigid angled
nasendoscopes and curved forceps
designed for fish bone removal
has greatly facilitated fish bone
removal from the oropharynx under
local anaesthetic in adults, but
general anaesthesia is more likely to
be needed in a child.

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