|Year : 2015 | Volume
| Issue : 3 | Page : 382-383
Esophageal foreign bodies
Department of Cardiovascular and Thoracic Surgery, School of Medicine, Bozok University, Yozgat, Turkey
|Date of Web Publication||15-May-2015|
Department of Cardiovascular and Thoracic Surgery, School of Medicine, Bozok University, Yozgat
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ekim H. Esophageal foreign bodies. Med J DY Patil Univ 2015;8:382-3
Foreign body ingestion is a commonly encountered clinical condition in children or adults with psychiatric disorders of mental retardation. Children have a behavior to put any small toys or metallic coins due to their explorative nature. Thus, the majority of patients with suspected foreign body are children. Occasionally these objects can be ingested in the aerodigestive tract; 80% of them will be stuck in the esophageal lumen, and the remaining 20% of them will lodge in the tracheobronchial system.  Although majority of ingested foreign bodies pass through the gastrointestinal system and come out with the stool, 10-20% of the cases require rigid or fiberoptic esophagoscopy and <1% of those will require surgical intervention. 
The main symptoms related to esophageal foreign bodies are acute onset of pain, difficulty in swallowing, dysphagia, choking and excessive salivation. The most common site of impaction is at or above the level of the cricopharyngeus muscle, followed by the other areas of anatomical narrowing or congenital stricture. ,
Besides, medical history and physical examination, both cervical and chest radiographs in posteroanterior and lateral view should be taken to identify the foreign body and its location. In the majority of patients, the plain chest or cervical radiograph is helpful for the diagnosis. If radiographs do not successfully locate a foreign body, an esophagram with barium or gastrografin should not be performed due to the risk of aspiration.  For patients with ingestion histories who had negative radiological finding, computed tomography (CT) should be performed. CT has been shown to be most sensitive for localizing foreign bodies and provides more benefit to other diagnostic modalities in locating additional complications, such as perforation and vascular-esophageal fistulas. 
Although rupture of the esophagus is more likely due to prolonged impaction of the foreign body, it may also occur immediately after a sharp object has embedded the esophageal mucosa. Thus, mediastinitis or other life-threatening complications can occur if not immediately treated. ,
Sharp esophageal foreign bodies can perforate the esophagus leading to mediastinitis and severe hemorrhagic complications. Also, smooth foreign bodies such as coins may become sagittally oriented and can encroach on the trachea, causing biphasic stridor and requiring urgent retrieval.  Smooth foreign bodies may be coin or even button battery. In a patient with suspected esophageal button battery impaction, esophagoscopy should be immediately performed to prevent mucosal injury and migration.  Swallowed button batteries comprise another serious condition regarding as different injury mechanisms. Localized current produced by button battery may be dangerous due to potential voltage burn and mucosal erosion.  Therefore, urgent endoscopic removal should be done within 2 h in patients with digestion of button battery. 
Esophagoscopy may be performed by rigid or fiberoptic esophagoscope with equal advantages. Rigid endoscope has a larger diameter and allows retrieval of the most objects. Furthermore, nonendoscopic procedures for retrieval of smooth esophageal foreign bodies have been reported, such as dislodgement by a Foley catheter  or Fogarty catheter. According to my opinion, sharp esophageal foreign bodies should be removed under direct vision without withdrawn the endoscope by means of a rigid endoscope to prevent complications. For the retrieval of foreign subjects, alligator-jaw forceps or biopsy forceps without a protective hood or sheath are, usually, sufficient. Intratracheal general anesthesia should be performed to minimize the incidence of aspiration during the endoscopic intervention. In addition, muscle relaxation induced by anesthesia may also facilitate to remove the embedded foreign body.
Complications related with esophageal foreign bodies have a high mortality rate (20%). Esophageal wall perforation or migration of an esophageal foreign body through the esophageal wall can result in life-threatening complications such as cervical abscess, mediastinitis, retropharyngeal or parapharyngeal abscesses, esophageal-tracheal fistula and esophageal-vascular fistulas. , If life-threatening hemorrhage or perforation is evident, urgent surgical intervention should be performed to retrieve a foreign body and to repair any vascular-esophageal fistula or esophageal perforation leading to severe complications or even death. 
Clinical sequelae of embedded esophageal foreign bodies depend on the characteristics of the foreign bodies and the duration of impaction. The timely diagnosis and esophagoscopic retrieval should be performed to prevent severe complications leading to death. Although endoscopic retrieval of esophageal foreign bodies in patients presenting early is invariably successful, chronically embedded foreign bodies may necessitate surgical intervention.  Thus, all esophageal foreign bodies should be retrieved as soon as diagnosed to minimize the risk of severe complications.
Rarely, smooth foreign bodies may show uneventful clinical course and may remain without life-threatening complications (mediastinitis, esophageal-tracheal or esophageal-vascular fistulas) for a long time, as reported an article (chronic retained esophageal foreign body masquerading as mediastinal mass) published in this issue of the journal. In addition to its smooth surface, another reason of the uneventful course for the long duration of the aluminum coin may be related with the development of strong granulation tissue due to chemical properties of aluminum. In these cases, embedded esophageal foreign bodies (smooth aluminum coin or similar objects) can be removed successfully without complication by experienced endoscopist. In addition, operating-room should be reserved for a possible risk of complication.
| References|| |
Abdurehim Y, Yasin Y, Yaming Q, Hua Z. Value and efficacy of foley catheter removal of blunt pediatric esophageal foreign bodies. ISRN Otolaryngol 2014;2014:679378.
Berry AC, Draganov PV, Patel BB, Avalos D, Reuther WL 3 rd
, Ravilla A, et al.
Embedded pork bone causing esophageal perforation and an esophagus-innominate artery fistula. Case Rep Gastrointest Med 2014;2014:969862.
Ekim H. Management of esophageal foreign bodies: A report on 26 patients and literature review. East J Med 2010;15:21-5.
Naidoo RR, Reddi AA. Chronic retained foreign bodies in the esophagus. Ann Thorac Surg 2004;77:2218-20.
Panda NK, Sastry KV, Panda NB, Reddy CE. Management of sharp esophageal foreign bodies in young children: A cause for worry. Int J Pediatr Otorhinolaryngol 2002;64:243-6.
Degghani N, Ludemann JP. Ingested foreign bodies in children: BC children hospital emergency room protocol. B C Med J 2008;50:257-62.
Ratcliff KM. Esophageal foreign bodies. Am Fam Physician 1991;44:824-31.
Benmansour N, Ouattassi N, Benmlih A, Elalami MN. Vertebral artery dissection due to an esophageal foreign body migration: A case report. Pan Afr Med J 2014;17:96.