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Which are the common sites for ingested foreign bodies to lodge?
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
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What are the symptoms and clinical features in cases of a foreign body 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