Retrospective study of upper digestive tract foreign bodies in central India

Abstract

Background: Variety of foreign bodies may enter the digestive tract accidentally. Many pass spontaneously, but some become impacted, causing symptoms of obstruction. The cricopharynx and esophagus are the most common site of impaction. Nearly, all impacted objects can be removed endoscopically but, occasionally open surgery may be required. Objectives: This study was conducted on 228 patients with the aim to describe age-sex incidence, socioeconomic and geographical distribution, types of foreign body ingested and management strategy. Methods: Retrospective study was conducted in tertiary care hospital of Central India on 228 patients who had undergone rigid endoscopic removal of digestive tract foreign body from January 2007 to January 2014. Results: Foreign body ingestion was found most commonly in the age group of 1-3 year. (133; 58.33%) with male predominance. 180 patients (78.94%) belonged to lower socioeconomic status. Out of them 160 patients came from rural areas. Definitive history was found in (212; 92.98%) patients with dysphagia to solid as the most common presenting symptom. Most of the foreign bodies were detected by plain X-rays (203; 89.03%). Coin was found to be the most commonly ingested foreign body (67.54%). Cricopharynx was the most common site of impaction (86.4%). Rigid endoscopic removal under general anesthesia was successful in all 228 patients. Conclusions: Higher incidence of ingestion of foreign body is in toddlers. The most common site of lodgement was at the cricopharynx and upper third of esophagus. Early detection and rigid endoscopic removal can prevent from morbidity associated with the complications of foreign body impaction. 1. Webb WA. Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc. 1995;41:39-51. 2. G. Paul Digoy. Diagnosis and management of upper aerodigestive tract foreign bodies. OCNA. 2008;41:485-96. 3. Prakash Adhikari, Bikesh Lal Shrestha, Dharma K. Baskota, Bimal K. Sinha. Accidental foreign body ingestion: analysis of 163 cases. Arch Otolaryngol. 2007;11(3):267-70. 4. Palta R, Sahota A, Bemarki A, Salama P, Simpson N, Laine L. Foreign-body ingestion: characteristics and outcomes in lower socioeconomic population with predominantly intentional ingestion. Gastrointest Endosc. 2009;69:426-33. 5. Litivitz EL, Schmitz BF. Ingestions of cylindrical and button batteries: an analysis of 2382 cases. Pediatrics. 1992;89:747-57. 6. Hachimi-Idrissi S, Come L, Vandenpias Y. Management of ingested foreign bodies in childhood: our experience and review of literature. Eur J Emerg Med. 1998;5:319-23. 7. Naid Dehghani. Ingested foreign bodies in children: BC children’s hospital emergency room protocol. BC Med J. 2008 June;5(5):257-62. 8. ASGE Standards of Practice Committee, Steven O. Ikenberry, Terry L. Jue, M. Anderson, V. Appalaneni, S. Banerjee, et al. Management of ingested foreign bodies and food impactions. Gastrointestin Endosc. 2011;73(6):1085-91. 9. Faigel DO, Stotland BR, Kochman ML, Hoops T, Judge T, Kroser J, et al. Device choice and experience level in endoscopic foreign object retrieval: an in vivo study. Gastrointestin Endosc. 1997;45:490-2. 10. Nixon GW. Foley catheter method of esophageal foreign body removal: extension of applications. Am J Radiol. 1979;132:441-2. 11. Bonadio WA, Jona JZ, Glicklich M, Cohen R. Esophageal Bougie technique for coin ingestion in children. J Pediatr Surg. 1988;23:917-8. 12. Chu KM, Choi HK, Tuen HH, Law SY, Branicki FJ, Wong J. A Prospective randomized trial comparing the use of the flexible gastroscope versus the broncoscope in the management of foreign body ingestion. Gastrointest Endosc. 1998;47:23-7. 13. Ferruci TJ, Long JA. Radiographic treatment of esophageal food impaction using intravenous glucagon. Radiology. 1977;125:25-8. 14. Trenkner SW, Maglinte D, Lehman GA, Chernish SM, Miller RE, Johnson CW. Esophageal food impaction treatment with glucagon. Radiology. 1983;149:40. 15. Schunk JE, Harrison AM, Corneli HM, Nixon GW. Fluoroscopic Foley catheter removal of esophageal foreign bodies in children: experience in 415 episodes. Pediatrics. 1994;94:709-14. 16. Gaigel DO, Fennerty MB. Miscellaneous disease of the esophagus. In: Gaigel DO, Fennerty MB, eds. Textbook of Gastroenterology. 1st ed. Philadelphia: Lippincott Williams and Wilkins; 1999: 1304-1325. 17. Cheng W, Tam PKH. Foreign body ingestion in children: Experience with 1265 cases. J Paediatr Surg. 1999;34:1472-6. 18. Schunk JE. Foreign body ingestion/aspiration. In: Schunk JE, eds. Textbook of Pediatric Medicine. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2006: 307-314.