THROAT – Foreign Body Oesophagus

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

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