Clinical presentation, diagnosis and management of aerodigestive tract foreign bodies in the adult population: Part 1.

Rishi P. Mathew,Gavin Low,Sreekutty Sarasamma,Vinayak Jayaram,Vimal Patel,Merin Jose,Ajith Toms

doi:10.4102/sajr.v25i1.2022

Abstract

In the adult population, foreign bodies may be accidentally or intentionally ingested or even inserted into a body cavity. The majority of accidentally ingested foreign bodies pass through the alimentary tract without any complications and rarely require intervention. Accidentally ingested foreign bodies are usually fish bones, bones of other animals, and dentures. Oesophageal food impaction is the commonest cause of oesophageal foreign bodies in the Western hemisphere. Intentionally ingested foreign bodies may be organic or inorganic, and often require intervention; these patients have either underlying psychological or mental disease or are involved in illegal activities such as body packing, which involves trafficking narcotics. Imaging plays a crucial role in not only identifying the type, number and location of the foreign body but also in excluding any complications. In this comprehensive pictorial review, we provide an overview of the spectrum of foreign bodies ingested in adults, emphasising the role of various imaging modalities, their limitations and common foreign body mimickers on imaging.

Highlights

Foreign body ingestion is a common clinical presentation with approximately 80% – 90% of all ingested foreign bodies passing through the digestive tract without need for intervention
The intention of this article is to inform readers of the risk factors, the common locations where foreign bodies become lodged in the aerodigestive tract, useful imaging modalities and how to protocol them to aid in the diagnosis, how to identify the complications when present and the common foreign body mimickers on imaging
Rigid bronchoscopy may be required in adults in certain circumstances such as failed flexible bronchoscopy attempt(s) to retrieve a foreign body, foreign bodies that are impacted in extensive granulation tissue or excessive tissue scarring, a large foreign body that cannot be gripped with flexible forceps, asphyxiating foreign bodies, foreign bodies with a smooth margin and sharp foreign bodies.[46]

Summary

Introduction

Foreign body ingestion is a common clinical presentation with approximately 80% – 90% of all ingested foreign bodies passing through the digestive tract without need for intervention. About 10% – 20% require endoscopic removal and hardly 1% need surgery. The statistics change when it comes to intentionally ingested foreign bodies, with nearly 76% of the cases requiring non-surgical intervention and 28% needing surgery.[1]. Clinical symptoms may be acute, including epigastric pain, vomiting, dysphagia, pharyngeal discomfort and chest pain. The intention of this article is to inform readers of the risk factors, the common locations where foreign bodies become lodged in the aerodigestive tract, useful imaging modalities and how to protocol them to aid in the diagnosis, how to identify the complications when present and the common foreign body mimickers on imaging

Discussion

Findings

Conclusion