Foreign Bodies of the Esophagus: A Two-Year Prospective Study

Abstract

Foreign body (FB) impaction of the upper digestive tract is a common problem in both children and adults. The estimated annual incidence of foreign body ingestion in the United States is about 120 per million population, with approximately 1500 deaths each year.1 Typically, two types of FBs are encountered-true FB (e.g., coins, buttons) and food-related FB. The three common areas for esophageal FB impaction are just below the cricopharyngeal muscle (70%), the site where the aortic arch crosses the anteromedial wall of the esophagus (20%), and at the gastroesophageal junction (10%). In most cases, an impacted esophageal FB is an urgent medical situation, but not a life-threatening one. 2,3 This study was aimed at establishing the pattern of ingested FBs, their symptomatologies, presentation, techniques of removal and the possible associated complications. Subjects and MethodsA prospective study for suspected impacted esophageal FB was carried out in the ENT Department at King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia, from January 1995 to August 1997. The study involved 26 patients admitted to the ENT ward with a history of impacted FB. They comprised 23 adults (88%) and three children (12%). Four other children were excluded from the study because the FB had passed spontaneously down the esophagus during the observation period.The age of the patients ranged from 2 to 71 years (mean 35 years), and the male to female ratio was 14:12. Fourteen patients (54%) were Saudis and 12 (46%) were non-Saudis. Twenty-five of the patients (96%) were admitted through the Emergency Department for urgent esophagoscopy, while the other one was admitted through the Outpatient Department-an Indian female who presented with dysphagia and odynophagia after a meal of chicken three days prior to presentation. The details of the patients, including age, sex, nationality, source of admission, urgency of the procedure, types of FB found, the status of the esophagus if no FB were found, complications, and the duration of the hospital stay, were analyzed, and are discussed below. ResultsThe summary of the presenting symptoms of the disease (Table 1) shows that dysphagia (22 cases) and odynophagia (21 cases) were the most common presenting symptoms. X-ray findings were positive in only seven cases (27%), in which the foreign bodies involved were three coins, two fish bones, a meat bone and a chicken bone. The clinical history and patients' symptoms were found to be the most accurate indicators of impacted esophageal FB. All the patients were admitted to the hospital, and the removal of the FB was accomplished under general anesthesia with endotracheal intubation, using the rigid esophagoscopy technique. The types of FB found were fish bone (seven cases, 27%); meat bone (six cases, 23%); coins (three cases, 12%); chicken bone (one case, 4%); meat bolus (one case, 4%); and pigeon bone (one case, 4%).All three children in our study had coins lodged in the cervical esophagus. These were removed by the use of grasping forceps...

Endoscopic esophageal foreign body removal among children at Lubaga Hospital, Kampala, Uganda

“…We removed a crucifix that was swallowed by a 6-year-old girl safely without complications figure1 . The most frequent lodgment site described in literature is the upper esophageal sphincter found around the region of the cricopharyngeus muscle 9 , 13 , 14 , a similar finding in our study that revealed most objects lodged at the cricopharyngeal region.…”

“…With regard to foreign body types, fish bones, metal objects such as batteries and coins, and broken tooth fragments are the most frequently ingested foreign bodies according to scientific literature 9 , 11 , 12 . In our study, coins were by far the most frequent foreign body ingested.…”

Removal of Foreign Body (Glass of Mirror) in Esophagus with Direct Laryngoscope

“…1,11 The diameter of the esophagus is reduced at four points: the cricopharyngeus, the crossing of the aorta at 25 to 30 cm from the incisors, the crossing of the left bronchus, and the hiatus at the diaphragm. 12 Ashoor 15 described The three common areas for esophageal foreign body impaction are just below the cricopharyngeal muscle (70%), the site where the aortic arch crosses the anteromedial wall of the esophagus (20%), and at the gastroesophageal junction (10%). The other author recorded that the entrapment of the foreign body was in the cervical esophagus in 57% of cases, in the thoracic one in 26%…”

“…Weissberg 16 Those with foreign bodies impacted for more than 24 hours were 14.1 times more likely than those with foreign bodies impacted for less than 24 hours to have a major complication. 15 In this case glass mirror extraction was performed in more than 24 hours after impacted. 16 Complication of rigid esophagoscope can minimilize when extraction performed in 24 hours after impaction.…”