Esophageal foreign bodies: 177 cases

Abstract

The aim of this study is to assess patients treated for esophageal foreign bodies. The charts of patients (n=177), between January 1994 and April 2009, were investigated retrospectively. Patients' age and gender, locations and types of foreign bodies (FBs) and interventions were taken into consideration. Fifty-seven percent of the patients were male. The youngest patient was 6 months, whereas the oldest was 83 years old. The median age was 9 years. Half of the patients were in their first decade. Treatment took place 11 h (ranging from 1 to 120 h) after impaction of the FB. One hundred fifty-two FBs were removed in 177 patients. Our negative esophagoscopy (n=25) rate was 14%. The FBs were radiopaque in 75% (n=114) and were commonly (71%; n=109) located in the cervical esophagus. Metallic coins (n=81-53%) were the most commonly observed inorganic FB while bones and/or meat impaction (n=54-35%) were the most frequent organic FB. A total of 182 endoscopic interventions were performed on these patients. One hundred eleven of them were esophagoscopy and the remaining 71 were direct laryngoscopy. The FB was pushed into the stomach in 11 patients. Our morbidity rate was 1.6% (n=3). Iatrogenic perforation occurred in two patients. There was no mortality. Esophageal FBs may vary in type: sharp or round objects, metallic, plastic or organic material. FBs are commonly found at pharyngoesophageal junction and usually removed by McGill forceps. Rigid esophagoscopy is used for children and adults because of its large working channel. Rigid instruments are considered reliable and safe for extracting foreign bodies.

Esophageal perforations due to foreign body impaction in children

“…The role of clinical history and presenting symptoms for early recognition of FBI has been repeatedly emphasized. Positive history of FB ingestion may be seen in up to 84% of the cases, however the numbers are much less in cases of FB impaction [4,5]. Only 3 parents in our patients recalled the ingestion of FB.…”

“…In impacted FBs, there is a complication rate of 18% and these are more common in adults (37.1%) as compared to children (8.8%) [6]. Most objects were located within the cricopharyngeal sphincter, however, in complicated cases; the thoracic esophagus is involved more commonly [2,5].…”

“…Open surgical treatment may be unavoidable in cases of failure of the endoscopy or in the presence of esophageal perforation [4]. The treatment of FBI associated with esophageal perforation is complex and there is scarcity of the literature available on the management protocols [5]. This report describes the management and outcome of esophageal FBI with perforations.…”

The Prolonged Presence of a Fish Bone in the Neck

“…Although the largest case series to date (a worldwide review of studies from 1818 to 1983; Remsen et al 1983) indicated that penetrating foreign bodies are associated with an overall mortality rate of 45%, most previous deaths have been attributed to their occurrence during the preantibiotic era. Recently, several studies (Loh et al 2000;Athanassiadi et al 2002;Nadir et al 2011) have shown that the major complication rate of foreign bodies in the esophagus was 1.6-7.3%, and that the mortality rate was 0-0.73%. Reported lethal causes included mediastinitis, subclavian esophageal fistula (Loh et al 2000), and aortoesophageal fistula (Athanassiadi et al 2002).…”

Rigid Esophagoscopy; A Teaching Institution Experience

“…Rigid instruments are considered reliable and safe for extracting foreign bodies. 5,6,7 In this study it has been observed that foreign body esophagus is the most common indication for rigid endoscopy as 51.95% of the cases undergoing rigid esophagoscopy were due to ingestion of foreign body. Hariga et al 8 showed that most common indication for rigid endoscopy was foreign body in 87.7 % of their patients in contrast to our study where foreign body was the major indication but our percentage was low 62.85%.…”