Foreign Bodies in the Esophagus: Causes, Symptoms, and Treatments
Foreign Bodies in the Esophagus: Causes, Symptoms, and Treatments
Foreign bodies in the esophagus are a common medical emergency, especially among children. Each year, more than 100,000 cases of ingested foreign bodies are reported in the pediatric population. Although most of these incidents are accidental, intentional ingestion starts to occur more frequently in adolescence. Understanding the causes, symptoms, and treatment options is crucial for managing this condition effectively.
Causes of Foreign Body Ingestion
Children under the age of five are particularly prone to swallowing random household objects. Coins are the most common foreign bodies ingested by young children, accounting for up to 76% of cases in one large study. Other common objects include toy parts, batteries, sharp objects (such as needles, pins, and bones), metal objects, seeds, plastic materials, magnets, buttons, nuts, hard candy, and jewelry.
In adults, food, particularly meat, is the most frequently swallowed foreign body, comprising 33% of cases. Hasty eating can lead to the accidental swallowing of chicken or fish bones. Adults may also swallow objects such as tacks, pins, and nails held between the lips, which can attach to the esophageal wall or descend into the stomach and beyond.
Symptoms of Foreign Body Ingestion
The symptoms caused by foreign bodies lodged in the esophagus depend on the object’s size, shape, consistency, and location. Approximately 50% of patients experience symptoms at the time of ingestion, including:
- Retrosternal pain
- Choking
- Gagging
- Cyanosis
- Drooling
- Dysphagia (difficulty swallowing)
- Vomiting
- Odynophagia (painful swallowing)
- Chest pain
- Intrascapular pain (pain between the shoulder blades)
Children or adults with long-standing esophageal foreign bodies may show signs of weight loss, aspiration pneumonia, and fever. Esophageal perforation can lead to more severe symptoms such as crepitus, pneumomediastinum, or gastrointestinal bleeding.
Diagnosis of Foreign Body Ingestion
Radiopaque substances like metallic objects and bones can be easily recognized on x-ray films. Therefore, anteroposterior and lateral x-rays of the neck, chest, and abdomen should be performed. Nonradiopaque objects, such as cartilaginous and thin fish bones, may require computed tomography (CT) or esophagoscopy for diagnosis if other modalities are not effective.
Treatment and Management
The treatment of foreign bodies in the esophagus depends on the type of object, its location, and the patient’s age and size. Emergent removal may be necessary due to the risk of respiratory complications and esophageal erosion or perforation.
Objects that are long and sharp, magnets, and those containing superabsorbent polymers or disk batteries should always be removed due to their potential to cause caustic injury and perforation. Esophageal obstruction, tracheal compromise, or symptoms such as fever, abdominal pain, or vomiting indicate the need for urgent removal.
In many cases, small, smooth objects and those that have passed beyond the duodenal sweep can be managed conservatively with radiographic surveillance and stool inspection. Spontaneous passage of coins and other small objects occurs in 25% to 50% of cases without complications.
When foreign bodies are trapped in the upper esophagus or hypopharynx, rigid endoscopy or Magill forceps can be used for extraction. Esophagoscopy is effective for removing objects from the middle to lower esophagus and is both diagnostic and therapeutic. Newer techniques, such as loop baskets, suction retrieval, and specialized forceps, may be necessary for more difficult cases.
Complications and Surgical Intervention
Blunt objects generally have a complication rate of less than 1%, while sharp objects have a complication rate of 15% to 35%. Batteries lodged in the esophagus require urgent endoscopic removal due to the high risk of burns and potential fatality. Patients are often anesthetized for these procedures, with most tolerating conscious sedation.
Surgical intervention is necessary for approximately 1% of patients when objects cannot be retrieved endoscopically. This often involves the cervical esophagus and may require procedures such as cervical mediastinotomy or thoracotomy.
Conclusion
Foreign body ingestion in the esophagus is a serious condition that requires prompt diagnosis and appropriate management. Awareness of the causes, symptoms, and treatment options can help mitigate risks and improve outcomes for both children and adults. If you suspect that someone has ingested a foreign body, seek immediate medical attention to ensure proper care and treatment.
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