Foreign Bodies In Aerodigestive Tract Research Articles

Retrospective study of upper digestive tract foreign bodies in central India

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.

Incidence of foreign bodies in aerodigestive tract in vindhya region: our experience.

Foreign bodies in aerodigestive tract are frequent occurrence and may lead to life threatening situation due to obstruction caused in respiratory passages. To present foreign body ingestion cases observed in a 5-year period at the S.S. Medical College and G.M. Hospital, Rewa (MP). The present study is a retrospective analysis including 108 patients of foreign bodies of aerodigestive tract of Vindhya region who presented to the S.S. Medical College and G.M. Hospital, Rewa from January 2008 to August 2012. About 92 patients of total 108 patients had evidence of foreign body in food passage with age ranging from 9month to 85years. Most patients 65 (70.65%) belong to <10year age group. Radiological evidence was found in 76 (82.6%) patients. Most common foreign body was found to be coin 75 (81.52%). The commonest site of lodgement was cricopharynx. About 16 patients of total 108 patients had evidence of foreign body in airway with age ranging from 9months to 72years. Most cases 8 (50%) belong to <10year age. Maximum cases showed vegetative foreign body with right bronchus (58.33%) as commonest site of lodgement. Early detection by meticulous history, imaging modality and prompt management remains basis for favourable outcome and prevents future complications.

The Characteristics and Outcomes of Foreign Body Ingestion and Aspiration in Children Due to Lodged Foreign Body in the Aerodigestive Tract

Injury due to foreign body (FB) aspiration and/or ingestion is a common and serious pediatric emergency. Foreign body injury (FBI) most commonly occurs in children younger than 6 years, and the incidence of FBI has increased in recent years. The aim of the present study was to evaluate and compare the characteristics of FBI due to ingestion and aspiration. Data from patients who were hospitalized for FB ingestion and/or aspiration and underwent rigid bronchoscopy and esophagoscopy from 2008 to 2011 were retrospectively evaluated. Foreign body in the upper aerodigestive tract was evaluated with respect to the characteristics of patients, clinical presentation, management strategy, the outcome, and features of FB. A total of 192 patients admitted for FB ingestion or aspiration in the pediatric surgery department were evaluated. The mean age was 40.97 (SD, 35.73) months. The majority of patients were younger than 4 years. Foreign bodies were mainly located in the upper esophagus for ingested FBs (60.8%), whereas for aspiration 43% of FBs were in the main right bronchus. A total of 4 patients died. The hospitalization period of patients admitted for FB aspiration was longer than that of patients with FB ingestion. Surgery was performed in 4 patients. The most commonly ingested FBs were coins, whereas seeds were the most commonly aspirated. Prevention is the key to dealing with FBIs. Because the frequency of foreign bodies is higher in underdeveloped countries, education of parents regarding the dangers and prevention of aspiration and ingestion is important.

Fatal haemorrhage due to a fish bone in the oesophagus; a case report

Case Report Foreign bodies in the upper aero-digestive tract are a common problem. Rupture of the oesophagus is one of the rare yet more dramatic conditions and is an emergency. Studies show that 10% to 20% of foreign body ingestion in the gastrointestinal tract requires endoscopic treatment and its retention in the esophagus may represent risk of severe complications, with rare fatalities. In addition to endoscopic treatment, surgical procedure might be necessary in approximately 1% (1).

Extraluminal Perforation Complicating Foreign Bodies in the Upper Aerodigestive Tract

Ingestion of a foreign body is a common problem in nearly all otolaryngology practices. One of the uncommon complications of ingested foreign bodies is penetration and migration of the object, which may lead to serious morbidity and/or death. This study will evaluate the presentation, complications, and management of different sites of penetration. We present a retrospective study of a series of 11 patients who presented with a penetrating foreign body of the upper aerodigestive tract in the past 10 years. All of the patients had radiologic evidence of a foreign body, but negative findings on rigid endoscopy. A computed tomographic scan was done to confirm the presence of a penetrating foreign body. The foreign body was lodged in the extrapharyngeal tissue in 6 patients, was lodged in the upper thyroid pole in 2 patients, had penetrated a Zenker's diverticulum in 2 patients, and had migrated to the thoracic retroesophageal tissue in 1 patient. All patients underwent extraction of the foreign body by an external approach. Although the occurrence is rare, impacted foreign bodies in the upper digestive tract can perforate and migrate into the soft tissue of the neck. In the presence of negative findings on endoscopy, a computed tomographic scan of the neck is essential for the prompt diagnosis and management of perforating foreign bodies.

Paediatric aerodigestive foreign bodies: remember the nasopharynx

Nasopharyngeal foreign bodies are relatively uncommon, compared with other aerodigestive sites. They may mimic a lower airway location, or may be coughed up into the nasopharynx prior to endoscopic evaluation. To describe our experience with nasopharyngeal foreign bodies mimicking a more distal airway location. Case series from a tertiary referral children's hospital. We present a series of four children who were initially thought to have a lower aerodigestive tract foreign body (three respiratory, one oesophageal), but who were finally diagnosed with nasopharyngeal foreign body. The concept of panendoscopy at all foreign body removals is suggested as a means to avoid a missed nasopharyngeal foreign body. Although nasopharyngeal foreign bodies are uncommon, their rare ability to mimic distal sites mandates a thorough endoscopic approach to ensure that all sites (i.e. larynx, lungs, oesophagus and nasopharynx) are evaluated endoscopically.

Ingested foreign bodies causing complications and requiring hospitalization in European children: Results from the ESFBI study

In young children, particularly those aged 1-3 years, aerodigestive tract foreign bodies (FB) are a common pediatric problem. The aim of the present study was therefore to characterize the risk of complications and prolonged hospitalization due to FB in the upper digestive tract in terms of the characteristics of the injured patients (age, gender), typology and features of the FB, the circumstances of the accident and hospitalization details. A retrospective study was done in 19 hospitals in 19 corresponding European countries of 186 cases of injury due to the presence of an FB in the mouth, esophagus and stomach (ICD935), out of the 2103 overall cases of FB reported in other locations. Complications arose in 14 cases and hospitalization was required in 164 cases. No deaths were observed. A higher incidence of hospitalization in male patients (61%) was observed. Median age for children who experienced complications was 2 years old. The most common FB removal technique was esophagoscopy. In the majority of cases the children were treated by the ENT Department. The most common FB were coins, batteries and fish bones among food. Because batteries, as well as coins and fish bones among food were the most common type of FB encountered, and because recent development of technology has accelerated broad use of disk-type batteries, parents should be aware of this hazard, and an educational campaign for public education for this serious problem is advisable.

Lateral soft tissue neck X-rays: are they useful in management of upper aero-digestive tract foreign bodies?

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Clinical Experience of Removing Dentures From Aerodigestive Tract

A denture as an aerodigestive tract foreign body continues to present challenges to otolaryngologists. Records of patients who presented with a denture as an aerodigestive tract foreign body were retrospectively reviewed. Records of patients treated during the last 8 years were reviewed to gather information on the age, sex, and presenting symptoms of the patient, location of the denture, radiographic findings, and endoscopic procedure required. Our review identified 15 patients, with the mean and median age being 59.6 and 63 years, respectively. One patient presented with a denture in the valleculae, 4 patients with a denture in the airway, and 10 patients with a denture in the hypopharynx/esophagus. Rigid endoscopy was performed to remove the dentures in most patients. An esophagotomy was required in 1 patient. Fixed partial dentures should be advised by dentists, especially in patients who have predisposing factors such as old age, epilepsy, mental retardation, or alcoholism.

Esophageal Foreign Body Presenting As Repiratory Distress

Aerodigestive tract foreign bodies are common place occurrences in paediatric population and impose diagnostic and therapeutic challenge for otolaryngologists. Several mechanisms have been proposed to explain respiratory symptoms secondary to esophageal foreign bodies. Authors are reporting a case of respiratory stridor in a one year old child resulting from sharp penetrating foreign body in cricopharyngeal area.

Autologous embedded foreign body of mobile tongue.

Foreign bodies of upper aerodigestive tract are common otorhinolarygological emergencies. The foreign bodies of mobile tongue are however very rare and there are only limited case reports in literature. The case of a young female with an autologous foreign body mobile tongue with unusual presentation is presented.

Lateral soft tissue neck X-rays: are they useful in management of upper aero-digestive tract foreign bodies?

To assess the value of lateral soft tissue neck X-rays in patients presenting with upper aero-digestive tract foreign bodies. Retrospective study. (1) Patients referred to the ENT team, via either the accident and emergency department or their general practitioner; (2) a history of a non-aspirated, upper airway, aero-digestive tract foreign body; and (3) a lateral soft tissue neck X-ray taken on admission. A total of 62 patients met the inclusion criteria. Twenty-four patients (38.7 per cent) had positive findings on lateral soft tissue neck X-ray. 'Soft' signs, such as widened pre-vertebral shadow and loss of lordosis, were seen in all 24 patients, and foreign bodies were visualised in six patients. Overall, lateral soft tissue neck X-rays were helpful in the management of 32 patients (51.6 per cent). Rather worryingly, doctors in the accident and emergency and ENT departments missed 79.2 and 66.6 per cent of the positive findings, respectively. A lateral soft tissue neck X-ray is a helpful tool in the management of patients presenting with upper aero-digestive tract foreign bodies. Junior doctors need better radiology training.

Management of Aerodigestive Tract Foreign Bodies: Innovative Teaching Concepts

We discuss a method to provide medical education in bronchoesophagology by using high-fidelity patient simulation manikins. A sophisticated, life-sized infant manikin with realistic anatomic, physiologic, and hemodynamic responses to interventions was programmed to simulate endobronchial foreign body lodgment by blocking ventilation of one lung and manifesting audible stridor, asymmetric chest wall motion, and decreased oxygen saturation. Otolaryngology residents participated in simulation exercises incorporating the cognitive and technical skills necessary for successful airway endoscopy, including technical proficiency and teamwork, to learn to coordinate endoscopy and ventilation and manage laryngospasm. Rather than relying on instructor description, the participants responded directly to the manikin. This sense of realism stimulated participants to rehearse to improve provider performance and patient safety. Simulation provided an agenda determined by the needs of the learners, exploration without direct risk to patients, immediate feedback, and objective documentation. Rapidly evolving medical simulation technologies support activated, effective adult learning; they will play an increasing role in medical education.

Tooth Brush In Stomach

Foreign bodies of the upper aero-digestive tract are common problems dealt with by the otolaryngologist. Toothbrush is a rare foreign body of upper gastrointestinal tract and only about 40 cases have been reported so far. It is seen mainly in females affected by bulimia and anorexia nervosa. Because of its unique shape, toothbrush cannot pass the pylorus. Prompt removal is advised to avoid complications. Endoscopic removal is the method of choice. For impacted toothbrush a gastrotomy or duodenotomy may be needed.

Foreign bodies in the aerodigestive tract—a clinical study of cases in the coastal belt of South India

Purpose To investigate the cases of foreign body in the aerodigestive tract and to elucidate the characteristic problems in India. Design and setting Three hundred patients presenting with a history of either aspirating or swallowing a foreign body were analyzed in a tertiary care center. Data were collected by retrospective chart review and statistically analyzed. Results Of the 300 patients studied, 90% (270 cases) did have a retained foreign body, with 233 (86.2%) cases found in the pharyngoesophagus and 37 (13.7%) cases in the tracheobronchial tree. With foreign bodies in the tracheobronchial passages, the most common sign and symptom were rhonchi (50%) and dyspnea (67%), respectively; in pharyngoesophagus, the most common symptom and sign were dysphagia (64%) and odynophagia (45%), respectively. The most common foreign body found was fish bone in 39% (106 cases) and the most common site of lodgment was the cervical esophagus 50.5% (136 cases). Rigid endoscopy with forceps removal under general anesthesia was the main treatment modality. Thirty-three (12.2%) cases had complications secondary to retained foreign body. Conclusion Foreign bodies in the aerodigestive tract continue to be a common problem affecting adults and children alike. Rigid endoscopies with forceps removal under general anesthesia are the preferred management modality. From their experience, the authors recommend that no foreign body in the upper aerodigestive tract should be left alone with the hope that it will come out spontaneously. Delay in diagnosis and management can lead to life-threatening complications.

Unusual presentations of foreign body in aerodigestive tract.

Foreign bodies lodged in aerodigestive tract makes the commonest emergency in the otorhinolaryngology clinics. Diagnosis often becomes difficult with parental ignorance and lack of clear history. Patients with foreign body can have unusual presentations.

An unusual foreign body in the floor of the mouth presenting as a gradually growing mass

Foreign bodies in the upper aerodigestive tract represent one of the most common ENT emergencies, but patients with foreign bodies in the floor of the mouth rarely present to the otolaryngologist. Only a very small number of these foreign bodies are embedded under normal mucosa and can result in lethal complications. In this article, we report the case of a 3-year-old girl with a gradually enlarging mass in the floor of the mouth. On physical examination at admission, there was a 2x3-cm, elastic, tender mass on the left side of the floor of the mouth, with the overlying mucosa intact and normal in color. Taking the palpable lymph nodes into consideration, a congenital lesion or a pediatric malignancy was suspected initially. A blue pen cap with a surrounding pneumatocele was found intraoperatively. After a careful reevaluation of a previous MRI, a check valve mechanism at the possible site of entry was detected, leading to a pneumatocele, thus explaining the constant growth of the mass. This is a unique case of a foreign body in the floor of the mouth, mimicking a congenital lesion or a pediatric malignancy. Thus, the possibility of a foreign body should not be underestimated when evaluating a child with swelling in the floor of the mouth.

An unusual rhino-pharyngeal foreign body

Foreign bodies of the upper aerodigestive tract are commonly seen in the paediatric population; however adult patients with nasal foreign bodies in particular are much less common and when sharp foreign bodies are present there is a great risk of developing complications. This is a case report of a 20-year-old male magician with impacted rhino-pharyngeal foreign body. He intentionally inserted two long sewing needles into the right nasal cavity during a magical act. The impacted foreign bodies were located in his nose/pharynx and removal was achieved per orally under general anaesthesia. Only a minimal evidence of retropharyngeal abscess was noted despite the prolonged stay of the foreign bodies. This case highlights the fact that both a deliberate and an accidental foreign body in an adult nasal cavity can get impacted as well as the significance for its early removal.

Clinical experience of removing aerodigestive tract foreign bodies with rigid endoscopy in children.

This study was undertaken to document the aerodigestive tract foreign body accidents among children, and to investigate the circumstances surrounding these events. A review of the charts of pediatric patients admitted with the definitive or suspicious diagnosis of aerodigestive tract foreign bodies was carried out in the period between January 1, 1998 to December 31, 2002. There were 53 eligible children; 39 boys and 14 girls, with an age range of 7 months to 14 years. Food items were the most common airway foreign bodies and coins were the most common esophageal foreign bodies. Among the 32 patients who underwent bronchoscopy, no foreign body was identified in 9 patients. Among the 21 patients who underwent esophagoscopy, foreign body was removed in 19 patients. In 2 cases, large foreign bodies which we could not extract with forceps were pushed into the stomach. Foreign bodies in the airway and esophagus constitute a constant hazard in all age groups, which demands immediate approach and management. Although the rigid endoscopic removal of aerodigestive foreign bodies was successful in this series, the most effective treatment of foreign body accidents is their prevention.

Retropharyngeal abscess secondary to penetrating foreign bodies

A retrospective study was conducted on patients with upper aerodigestive tract foreign bodies requiring operative intervention over a 12-year period to aid in the recognition and management of foreign body associated complications. Oesophagoscopies were performed for the removal of foreign bodies in 37 patients, age one to 82 years with a male to female ratio of 1.2:1. Retropharyngeal abscesses accounted for eight of 11 foreign body-associated complications. Fish bones were the cause in six cases, chicken bone and a pen refill in one case each. An abscess was already present at the time of initial procedure in six cases and developed in two cases after successful removal of the foreign body. A high level of suspicion for a retropharyngeal abscess should be maintained in cases with perforation, and in patients with immunodeficiency.