Surgical management of an impacted sharp metallic foreign body in esophagus

Impacted sharp foreign bodies in the esophagus can be very difficult to manage. When attempts are made to remove such objects inappropriately, life-threatening complications such as perforation can occur. The aim of this study was to evaluate the safety and efficacy of endoscopic removal of impacted sharp foreign bodies in the esophagus using proximal dilatation with an oral side balloon or transparent cap. A total of 22 patients (10 men, 12 women) with impacted sharp foreign bodies in the esophagus underwent endoscopic extraction. The following technique was successfully performed at our hospital. An oral side balloon (Top Co., Japan) for esophageal variceal sclerotherapy was attached to the distal part of the endoscope. With the patient under local anesthesia, the endoscope was inserted as far as the proximal part of the esophageal foreign body. The oral side balloon was then gradually inflated. Dilatation of the proximal part of the esophagus made it possible to release the impacted sharp foreign body from the esophageal wall. A transparent cap was used for foreign bodies in the upper esophagus when there were difficulties with the oral side balloon. The types of foreign body removed were fish bones (n = 9), press-through packages (n = 8), chicken bones (n =3), dentures (n = 1), and a wrist watch (n = 1). Endoscopic removal was successful in all but one of the cases, in which a fish bone had to be extracted surgically. The proximal dilatation method using an oral side balloon or transparent cap is safe and effective in removing sharp foreign bodies from the esophagus, avoiding surgery and possible perforation.

Swallowed Foreign Bodies in Children: Aspects of Management

Analysis of Risk Factors of Esophageal Perforation in Patients with Esophageal Foreign Bodies

BackgroundForeign body in the esophagus is most commonly observed at the cervical esophagus level and is often detected in pediatric patients. Esophagoscopy is the definitive diagnosis and treatment instrument in foreign body ingestion, and the procedure should not be delayed to avoid serious complications such as late tracheoesophageal fistula and perforation. While sore throat, difficulty in swallowing, and hypersalivation are the main complaints in almost all patients, respiratory symptoms due to tracheal compression can also be observed.Case presentationWe present our 5-year-old patient who presented with the complaint of foreign body ingestion, dysphagia, and hypersalivation due to foreign body in the cervical esophagus, and isolated central awake apnea, which is not seen in the literature. The patient, who had central awake apnea in the supine position, was completely normal after the removal of the foreign body.ConclusionsForeign bodies in the esophagus, which are not more urgent than foreign bodies in the respiratory tract, can sometimes threaten life through central apnea in the acute process, and one should be alert.

Background: Esophageal foreign body is a common otolaryngological emergency encountered in clinical practice. The cases with esophageal foreign body need prompt medical attention and appropriate endoscopic or surgical intervention. The type of foreign body varies in different age groups and the level of impaction also varies accordingly. The foreign body in upper esophagus can be removed with safer and easier non-surgical techniques.Objectives: The objective of this study was to determine the demography, management approach and outcome of esophageal foreign body cases presented to Kathmandu Medical College Teaching Hospital.Methodology: This is a prospective study conducted in Kathmandu Medical College Teaching Hospital. The data was collected from the medical records of cases that presented to Kathmandu Medical College Teaching Hospital with clinical diagnosis of esophageal foreign body from July 2013 to July 2017.Results: Out of 101 cases of esophageal foreign body, there were 57% cases of chicken bone, followed by 17% mutton bone and 12% meat bolus. Among all, 71% cases had endoscopic removal of foreign body within six hours of presentation and 29% had endoscopic removal of foreign body between six to twelve hours. The most common age group was fifth decade of life. One patient had post-operative mediastinitis.Conclusion: The endoscopic approach is the mainstay of management in foreign body esophagus and timely management leads to successful outcome.Journal of Kathmandu Medical College, Vol. 6, No. 4, Issue 22, Oct.-Dec., 2017, Page: 136-139

Objective: To explore clinical features, diagnosis, localization, and therapeutic strategy of migratory pharyngeal and cervical esophageal foreign bodies. Methods: A total 23 cases of pharyngeal and cervical esophageal migratory foreign bodies were admitted between January 2015 and December 2021. There were 14 females and 9 males with the age ranged from 35 to 82 (55.0±12.7)years. In all the cases, esophageal CT was taken to confirm the esophageal foreign body. Multiplanar reconstruction (MPR) was performed to locate the foreign body from the horizontal, coronal and sagittal dimensions as well as the corrected reconstructed MPR. According to the location of the foreign body, appropriate surgical method was selected.The symptoms, complications, types of foreign body, positioning, surgical methods, and relevant information were recorded.Data were analyzed using the descriptive method and SPSS 25.0 software. Results: The clinical symptoms of 23 migrating esophageal foreign bodies included pharyngodynia (20/23), foreign body sensation (6/23), hoarsenss (1/23), difficulty in turning neck(1/23), difficulty in opening mouth (1/23), fever (7/23), poor appetite (1/23), and abdominal pain (1/23). The foreign bodies included 19 fish bones, 2 wires, 1 embroidery needle and 1 chicken bone. There were 9 cases (39.1%) of foreign bodies located in extraluminal cervical esophagus, 2 cases (8.7%) of foreign bodies located in the muscular layer of the cervical esophagus and 12 cases (52.2%) of foreign bodies located in pharynx. Twenty-one cases of foreign bodies were removed by cervical lateral incision, in which 11 were removed by cervical lateral incision directly, 10 by the second lateral cervical incision after the foreign bodies were accurately located by MPR and/or corrected MPR, 1 foreign body was removed by incision of the pharyngeal mucosa under suspension laryngoscope, 1 foreign body was removed by tracheoscopy. Compared with patients with intraluminal foreign bodies (n=308) treated in the same period, intake of fishbone [19 (19/23) vs. 133 (82.6% (43.2%, 133/308), OR=7.31] and first visit was more than 24 hours [20(87.0%, 20/23) vs. 77(25.0%, 77/308),OR=17.2] were the significant risk factors of migratory esophageal foreign bodies. Conclusions: MPR and the corrected MPR can accurately locate the migrating pharyngeal and cervical esophageal foreign bodies, by providing more intuitive imaging evidence for doctors, which provide imaging basis for formulation of surgical programs. Foreign bodies in pharyngeal and cervical esophagus need to be treated as soon as possible, otherwise they are easy to migrate, leading lead to serious complications.

Foreign Bodies of the Esophagus: A Two-Year Prospective Study

<p class="abstract"><strong>Background:</strong> The presence of a foreign body in the esophagus is a challenging problem. Perforations may result in death. Impaction mandates immediate extraction.</p><p class="abstract"><strong>Methods:</strong> A retrospective chart review was made of all patients hospitalized in Department of ENT, SMGS Hospital with a diagnosis of foreign bodies in the gastrointestinal tract between July 2017 to February 2018. Forty patients were identified. The charts were reviewed for the following: patient demographics, preoperative diagnosis, kind and location of the foreign body, timing of the procedure and the length of hospitalization. </p><p class="abstract"><strong>Results:</strong> The youngest patient in our study was 8 months old while the oldest was 60 years old. The male: female ratio of 2.3:1. The most common site of impaction was cricopharynx (55%) followed by thoracic esophagus (40%) and lower end of esophagus (5%). The most common foreign body was coin (50%) and all were seen in children upto 7 years of age. 25 (62.5%) patients were children of age less than 10 years. 20 children showed coin ingestion, 1 child of 8 months presented with impaction of fruit seed and 4 children with battery button ingestion. The length of retention of foreign body ranged from 2 hours to 6 days. All the patients were managed with rigid esophagoscopy under general anesthesia all within 12 hours of admission.</p><p class="abstract"><strong>Conclusions:</strong> Rigid endoscope as the instrument of choice for extracting foreign bodies from the esophagus as delay in extracting foreign bodies from the esophagus may lead to retention of foreign body and hence perforation.</p>

Introduction. Infants learn the world while playing through the taste of objects. If the parents neglect it, the object in the mouth can be swallowed. Foreign bodies in the esophagus are easily diagnosed, as a rule, since immediately after getting stuck they are manifested by salivation, choking, difficulty in passing food. If a foreign body passed into the esophagus being unnoticed, in 20% various complications develop, such as esophagitis, stenosis, organ perforation, esophageal-tracheobronchial fistula, mediastinitis, aortoesophageal fistula, cervical spondylitis.Material and methods. The article presents a clinical case of the long time presence of a large foreign body in the esophagus of an infant which was simulating respiratory disorders. The child was admitted to a surgical hospital with suspected congenital tracheoesophageal fistula because when swallowing liquid food he did not manifested any complaints typical for foreign bodies in the esophagus: pain in the neck and sternum with irradiation to the interscapular region, difficulty or inability to swallow, urge to vomit, hypersalivation. Mom and doctors were inclined to find other reasons for cough and wheezing which were intensified when the child was eating. The authors discuss features of extraesophageal manifestations of a foreign body in the esophagus as well as diagnostic and therapeutic tactics in such cases.Conclusion. Even small children can swallow large foreign bodies. While taking anamnesis, especially in children of the first year of life, a doctor should think not only about the syndrome of bronchial obstruction, but also about possible presence of a foreign body in the esophagus if wheezing and coughing attacks appear during meal. Diagnostic algorithm should include X-ray and endoscopic examinations which are effective and minimally invasive and which allow to remove a foreign body, even if it is in the esophagus for a long time.

Statistical observation on the cases of foreign bodies handled in our clinic during the period from 1956 through 1965 was performed.The results were as follows.1. 1, 043 cases (approximately 1%) out of 108, 760 patients treated in our ear, nose and throat clinic during last 10 years, were recognized as the foreign bodies.2. The locations of the foreign bodies were as follows: 507 cases in esophagus (50% of all foreign bodies), 177 cases in pharynx (17%), 170 cases in gastrointestinal tracts (16%), 63 cases in larynx, trachea and bronchus (6%), 87 cases in ear (8%), 41 cases in nose (4%) and 2 cases in maxillary sinus.3, More than 50% of the foreign bodies were found in infants and were found to be coins in esophagus.It is important to discuss about the cases of coins in esophagus as well as beans in bronchus of the infants.4. 365 cases (72%) of 507 cases in esophagus were coins which were lodged at the entrance of esophagus. Fish bones, artificial dentures and pieces of meat were seen in the second strictures as much as in the first strictures.124 (90%) of 138 foreign bodies found in mesopharynx were fish bones and more than 50% of them were found within the palatine tonsil.Foreign bodies in bronchus were seen in 48 cases, which were almost lodged at the area of carina.Insects were most common among the foreign bodies of ear canals and often cause otitis media.5. The removal of foreign bodies in about 75% of total cases was performed by means of Endoscopy. Foreign bodies were removed via the external esophagotomy approach in 5 cases and via the tracheotomy approach in 13 cases.6. The complications of foreign bodies in esophagus were periesophageal abscess in 6 cases and in death in 2 cases. Especially in infant, there were 11 cases diagnosed as other respiratory diseases than foreign bodies by the pediatrist and 3 cases suffocated to death. The foreign bodies in these cases were found by the bronchoesopha-gologist.7. The authors reported the statistics of foreign bodies, treated in our clinic during the period of 1936-1965.

Summary Foreign bodies in esophagus are avoidable accidents that occur most often in children younger than 3 years. The most common presenting symptoms are dysphagia, drooling, and vomiting. Revelation by respiratory distress is a rare and unusual condition. Objective We describe and discuss the case of an esophageal foreign body, in which the patient presented with respiratory distress. Case report A two-year-old child was admitted to the emergency department for acute respiratory distress. He had no history of choking episodes or dysphagia. Nevertheless, he was brought by his parents several times for a persistent cough and wheezing that was treated as asthma for a month. Pulmonary examination had revealed polypnea, suprasternal recession, scattered snoring, and diffuse wheeze. As part of his assessment, a chest X-ray was demanded. It had shown, as unexpected, a nonmetallic foreign body in the upper thoracic esophagus. A clothing button was removed by hypopharyngoscopy under sedation without any incident. Subsequent follow-up had not shown any complications related to this episode. Conclusion Large esophageal foreign bodies can impinge on the trachea causing upper respiratory tract signs. We alert clinicians on variation in the presentation of foreign body ingestion, and we emphasize the importance of an early diagnosis and management.

An Unusual Presentation of a Retained Esophageal Foreign Body

Introduction: A Foreign body ingestion and ofreign body aspiration commonly affect children between 6 months and 6 years. Items that are commonly swallowed by children are small and shiny object, such button batteries and magnets that have increased rapidly over the last decade. Botton battery ingestion an established surgical emergency, requiring immediate removal. Delay in diagnosis can lead possible complication such as inflammation, necrosis of esophageal mucosa and esophageal perforation. Rigid esophagoscopy is mainstay procedure of management foreign body in esophagus. Case Report: A case of foreign body battery in esophagus was reported in a 4 year old girl with chief complain felt something stuck at the throat since 3 days before admission and patient performed thoracal x-ray. Esophagoscopy was performed to remove battery foreign body in esophagus. At the time of evaluation, necrosis and excoriation was found in the esophagus as high as 18 cm from the incisivus. Conclusions: Delay in diagnosis and management of foreign battery in the esophagus could lead in to severe clinical manifestations and could cause the complication. Esophagoscopy remains the mainstay management of foreign body in esophagus because of its good visualization.

Introduction: Current ASGE guidelines recommend emergent removal of esophageal food bolus impactions and foreign bodies though this is two star (low quality evidence) guideline and further research has been recommended in this area. We aim to study the differences in outcomes based on early versus late esophagogastroduodenoscopy (EGD) among patients presenting with a foreign body in esophagus using a large national inpatient sample database. Methods: The National Inpatient Sample (NIS) databases (2002-2011) is the largest all payer inpatient care database, containing around 5 to 8 million hospitalizations from approximately 1000 hospitals in the USA. The patients presented with foreign body in esophagus and EGDs were identified using the ICD-9 codes. Early EGD was defined as being performed on the day of admission. Various outcomes such as inpatient mortality, acute respiratory failure (ARF)/aspiration pneumonia (AP), iatrogenic pneumothorax, endotracheal intubation, length of stay (LOS), and total hospitalization cost were evaluated. Multivariate logistic regression analysis adjusted for age, sex, race, complications and Elixhauser comorbidities was used to identify independent predictors of inpatient mortality. Results: Our study included 21,475 hospitalizations related to a foreign body in esophagus. The mean age of the study population was 51.2 years with 71.8% white and 54.9% male. Overall 55.8% of hospitalizations had an early EGD. There was a significantly lower rate of ARF and AP requiring endotracheal intubation >96 hours among hospitalizations with early EGD (ARF/AP: 9.2% vs 12.6%, p < .001; intubation: 0.7% vs 1.3%, p < .001). Hospitalizations with early EGD had a significantly lower rate of inpatient mortality. (0.6% vs 1.9%, p < .001). Multivariate logistic model identified age, delay in EGD, requiring endotracheal intubation, ARF/AP and having multiple comorbid conditions as independent risk factors associated with inpatient mortality (Table 1). Overall hospitalization mean LOS and financial charges were significantly lower among hospitalizations with early EGD. (LOS: 2.0 vs 4.2 days, p < .001; financial cost: $16,634 vs $24,390, p < .001).Table 1: Independent risk factors associated with inpatient mortality among hospitalizations with foreign body in esophagusConclusion: Our study showed significantly reduced finalcial burden, and lower rates of complications and inpatient mortality related to foreign body in esophagus among individuals who undergo early EGD. Our study adds high quality evidence to current ASGE guideline by utilizing a large nationally representative hospitalization sample.

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Foreign bodies in esophagus come as an emergency to otolaryngologist and needs to be removed at the earliest to prevent complications. The objective was to share our experience with esophageal foreign bodies removal in Sapthagiri Institute of Medical Science and Research Centre, Bangalore, India.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Study of 84 patients admitted with the final diagnosis of esophageal foreign body during September 2011 – September 2018, for sex, age, diagnosis on admission, estimated duration and site of impaction, type and number of foreign body removed. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Over 7 years period, 84 patients (48 males and 36 females) of different ages, youngest being 02 years and oldest being 92 years were admitted with the diagnosis of esophageal foreign body. Fifty percent of patients were five years or less in age at the time of admission. 32.1% were between 5 to 14 years and 17.9% were between the age range of 60-92 years. Seven patients (2.9%) had a history of esophageal anomalies requiring operation. Different types of foreign bodies ingested most common being coin. Majority of foreign bodies (75/84, 89.2%) were located in the post cricoid and upper esophagus followed by the mid-esophagus, and only 3 cases involved the lower esophagus.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The most common foreign bodies in children are coin and toys. Sharp foreign bodies are difficult remove but need to be removed carefully at the earliest to prevent dreaded complications like - retropharyngeal abscess and mediastinitis. Loose fitting dentures are common foreign body in elderly patients.&lt;/p&gt;