Which are the common sites for ingested foreign bodies to lodge?
Ingested foreign body can lodge in:
- Tonsil: Usually sharp fish bones,needles etc
- The base of tongue: Fish bone or a needles
- Pyriform fossa: Fish bone, chicken bone, needle or dentures are commonly seen
- Oesophagus: Coins, piece of meat, chicken, bone, denture, safety pin, marble
Many of the foreign bodies are accidently ingested.
What are the common causes of getting a foreign body into the oesophagus?
Common causes of foreign body in the oesophagus:
- Children more prone as they play with coins, marbles and accidently 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
- Psychotics.
What are the common sites of lodgment of foreign body in the oesophagus?
Common sites of lodgement of foreign body in the oesophagus are:
- Just below cricopharyngeal sphincter
- Flat objects like coins are held up at the sphincter while others are held in the upper oesophagus just below sphincter
- At the broncho-aortic constriction
- Sharp or pointed foreign bodies can be impacted anywhere in the oesophagus
What are the symptoms and clinical features in cases of a foreign body in the oesophagus?
Clinical features seen in cases of a foreign body in the oesophagus:
- 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 oesophagus?
- 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 foreign body in the oesophagus managed?
Rigid oesophagoscopy under general anaesthesia 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 foreign body in the oesophagus?
- Respiratory obstruction
- Perioesophageal cellulitis
- Perforation of oesophagus
- Tracheo-oesophageal fistula
