swallowed impacted foreign body-gp1
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SWALLOWED IMPACTED FOREIGN BODY
SWALLOWED IMPACTED FOREIGN BODY
AETIOLOGYSENTATION NAME AGE
children often affected.
LOSS OF PROTECTIVE MECHANISMUse of upper denture – prevent tactile
sensation and FB is swallowed undetected.
Loss of consciousnessEpileptic seizuresDeep sleepAlcoholic intoxication
CARELESSNESSPoorly prepared foodImproper mastication, hasty drinking
and eating.
NARROWED ESOPHAGEAL LUMEN.Esophageal stricture or carcinoma.
PSYCHOTICSFB swallowed in suicidal attempt.
SITES OF IMPACTION
Tonsil Base of
tongue/vallecula Pyriform fossa
Esophagus
TONSILSharp fish bone or needle in one of
tonsillar crypts. Easily observed by oropharyngeal
examination and removed.BASE OF TONGUE/VALLECULA
Fish bone/needleCan be observed by mirror examinationCan be removed by curved forceps.
PYRIFORM FOSSAFish bone, chicken bone, needle, denture.
Small FB – removed under LA with curved forceps.
Large FB/children – under GA by endoscopy.
ESOPHAGUSCoin, piece of meat, chicken bone, denture, safety pin, marble
FB can be held up at 4 constrictions
4 CONSTRICTION OF ESOPHAGUSpharyngo –
esophageal junction (C6)-upper esophageal
sphincter(15 cm)
Bronco-aortic constriction (T4)
L main bronchus (T5)
diaphragmatic constriction (T10)-lower esophageal sphincter (40 cm)
At or just below cricopharyngeal sphincter-commonest site.
Flat objects (coins) – held up at sphincter. FB which pass the sphincter can be held
up at the next narrowing at broncho – aortic constriction / at the cardiac end
Sharp or pointed objects lodge anywhere in esophagus
CLINICAL FEATURES
History of initial choking or gagging. Discomfort or pain
Location- depend on site of impacted FB.
Increase on attempts to swallow. Dysphagia
Partial or total obstruction. Partial to total due to edema
Drooling of saliva In total obstruction. Aspirated saliva – pneumonitis.
Respiratory distressimpacted foreign body in upper
esophagus compress post wall trachea.
Substernal or epigastric painEsophageal spasmIncipient perforation.
SIGNS
Tenderness in lower part of neck on R / L of trachea
Pooling of secretion in the pyriform fossa on indirect laryngoscopy
Foreign body may be seen protruding from the oesophageal opening in the postcricoid region
INVESTIGATIONS
1. Plain x-ray -to show presence and location of radio-
opaque foreign bodySoft tissue lateral view of neck PA and lateral view of chest Children- x-ray from nasopharynx to
rectum (multiple foreign body may have been ingested)
A coin in this child esophagus.
This x-ray reveals a butterfly-shaped earring at the cricopharyngeus, the entrance to the oesophagus.
2.Fluoroscopy- cotton soaked in barium/barium filled capsule to swallow Passage observed through esophagusTo see radiolucent FB
MANAGEMENT
1. Esophagoscopic removal Most foreign body can be removed by
esophagoscopy under GA.2. Cervical esophagotomy
For impacted foreign body or sharp hooks (partial dentures located above thoracic inlet)
Removal through an incision in the neck and opening of cervical esophagus
3. Transthoracic esophagotomy For impacted foreign body of thoracic
esophagus Chest is opened at appropriate level.
Foreign body which has reached stomach may pass through GIT without difficulty→carefully examined the stools every day
Take normal diet and no purgatives should be administrated to hasten the passage
Operative interference may required when:
Pt complaint pain and tenderness in abdomen
F. bodies are not showing any progress (Serial x-ray taken at few days interval)
F. body is 5cm/longer in a child below 2 y.o
Presence of pyloric stenosis
COMPLICATIONS
Respiratory obstruction tracheal compression by FB, laryngeal edema
(in infants, children) Periesophageal cellulitis and abscess in
neck Perforation
by sharp objects may perforate esophageal wall (mediastenitis,
pericarditis or empyema), aorta (fatal). Tracheo-esophageal fistula - rare Ulceration and stricture
Overlooked FB
References: Dhingra, Diseases of ENT 5th edition