Esophageal Foreign Body Research Articles

Salvaged, Staged, and Safer Management of Aortoesophageal Fistula and Mediastinitis After Removing a Pork Bone: A Case Report

Aortoesophageal fistula (AEF) caused by esophageal foreign body (EFB) ingestion is a life-threatening condition with a very low survival rate. However, the optimal management strategy remains undetermined. Here, we describe our successful management of a patient with AEF and mediastinitis. A 36-year-old man developed persistent chest and back pain and vomited fresh blood three days after removal of a pork bone in the esophagus under endoscopy in a local hospital. Computed tomography (CT) confirmed bilateral pulmonary infections, mediastinitis, and fistula of the aortic arch. After a multidiscipline discussion, a comprehensive staged strategy was made including salvaged thoracic endovascular aortic repair (TEVAR) to control fatal bleeding, adequate mediastinal debridement, drainage with cervical incision, and video-assisted thoracoscopic surgery, as well as jejunostomy to prevent nasal or gastrostomy reflux from aggravating the mediastinal infection. Furthermore, systematic personalized nutrition support and antibiotics were provided. The patient recovered well and has survived for 50 months until now. Careful assessment should be made with CT to ascertain the risk of AEF before and after the removal of EFB. A salvaged staged strategy of TEVAR with adequate mediastinal debridement and drainage in a less invasive approach may be a safer alternative for AEF patients with infections caused by EFB.

Proposed Management Protocol for Ingested Oesophageal Foreign Bodies - A Case Series And Review of Literature

Foreign body impaction in the esophagus is an important emergency that carries significant morbidity and potential mortality. Essential steps in the management include: immediate assessment of the airway.

A Case of Migrated Esophageal Foreign Body Removal Through Cervical Approach Under C-Arm Fluoroscopic Guidance

Foreign bodies in the upper airway and the esophagus are common and often removed in the outpatient setting using the rigid or flexible laryngoscope. Although most esophageal foreign bodies are removed from the digestive tract, in some cases, surgical intervention is required due to its difficult location. Esophageal foreign bodies often removed by esophagogastroduodenoscopy, but when they penetrate the esophagus and move to deep neck spaces, other approaches should be taken into consideration. We report a rare case of a 13-year-old patient whose esophageal foreign body moved to a deep neck compartment, which was embedded in the anterior vertebral muscle. We decided to perform neck exploration under C-arm guidance, successfully targeted and removed the foreign body.

A Case of Foreign Body Esophagus in a Six Year Old Child Previosly Operated for Esopageal Atresia: The Anesthetic Management

Foreign body ingestion is quite common in the pediatric age group. A six year old boy was brought by his parents to the hospital with history of foreign body (marble) ingestion. The child had been previously operated for the esophageal atresia. Imaging revealed a foreign body of 1.5cm size in the esophagus at the atretic part. The foreign body removal was initially attempted via rigid esophagoscopy but could not succeed. Hence, the procedure was changed to right thoracotomy for foreign body retrieval in the same sitting. Patient also had intraoperative itragenic trachea-esophageal fistula formation. General anesthesia was planned using single lumen cuffed ETT of 5.0mm ID for ventilation. Caudal catheter was inserted for postoperative pain management and early recovery following thoracotomy. Such cases of foreign body ingestion in an atretic esophagus should always be planned considering the unexpected extend of surgical procedure and peri-operative complications.

Complications associated with and outcome of surgical intervention for treatment of esophageal foreign bodies in dogs.

To identify complications associated with and short- and long-term outcomes of surgical intervention for treatment of esophageal foreign bodies (EFBs) in dogs. 63 client-owned dogs. Patient records from 9 veterinary hospitals were reviewed to identify dogs that underwent surgery for removal of an EFB or treatment or an associated esophageal perforation between 2007 and 2019. Long-term follow-up data were obtained via a client questionnaire. 54 of the 63 (85.7%) dogs underwent surgery after an unsuccessful minimally invasive procedure or subsequent evidence of esophageal perforation was identified. Esophageal perforation was present at the time of surgery in 42 (66.7%) dogs. Most dogs underwent a left intercostal thoracotomy (37/63 [58.7%]). Intraoperative complications occurred in 18 (28.6%) dogs, and 28 (50%) dogs had a postoperative complication. Postoperative complications were minor in 14 of the 28 (50%) dogs. Dehiscence of the esophagotomy occurred in 3 dogs. Forty-seven (74.6%) dogs survived to discharge. Presence of esophageal perforation preoperatively, undergoing a thoracotomy, and whether a gastrostomy tube was placed were significantly associated with not surviving to discharge. Follow-up information was available for 38 of 47 dogs (80.9%; mean follow-up time, 46.5 months). Infrequent vomiting or regurgitation was reported by 5 of 20 (25%) owners, with 1 dog receiving medication. Results suggested that surgical management of EFBs can be associated with a high success rate. Surgery should be considered when an EFB cannot be removed safely with minimally invasive methods or esophageal perforation is present.

Choking by Esophageal Foreign Body Impaction

Esophageal foreign body impaction may be fatal secondary to occlusion of the glottis or external compression of the membranous portion of the trachea. A 14-year-old adolescent female was admitted to the emergency department for evaluation of sudden dyspnea and cyanosis after she swallowed a food bolus (a part of bachelor radish kimchi) without chewing. Unfortunately, the patient died despite cardiopulmonary resuscitation. Autopsy findings showed an ovoid, firm foreign body (3.5×2.5×2 cm) impacted in the proximal esophagus, with focal narrowing of the tracheal lumen secondary to external compression by esophageal foreign body impaction. Death was attributed to choking caused by an esophageal foreign body.

A novel approach to button battery removal in a two-and-half year-old patient\u2019s esophagus after ingestion: a case report

BackgroundAccidental swallowing of a foreign body occurs more frequently in children than in adults. Among these cases, button battery impaction in the esophagus may cause severe complications. While prevention is always ideal, if button battery impaction is suspected, immediate diagnosis and retrieval are important.Case presentationWe introduce a novel method for retrieval of a button battery after ingestion by a 2.5-year-old child. When the patient arrived at our center, the battery was incarcerated in the upper esophagus. The battery could not be removed, despite the use of several methods such as alligator forceps under endoscopy and net retrieval. We decided to use a novel method that combined endoscopic balloon extraction and forceps retrieval. This resulted in a push-and-pull effect, creating synergy and easy removal of the battery. There were no long term complications based on the follow-up endoscopy examination.ConclusionsThis new procedure was very effective for removing the esophageal foreign body. When button battery in esophagus was too tight to be removed by the traditional retrieval methods, this procedure was suggested to use. It could be performed at medical institutions. If it fails or esophageal perforation (iatrogenic or spontaneous) occurs, pediatric surgeons could take over immediately.

Outcomes of esophageal and gastric bone foreign bodies in dogs.

BackgroundBone foreign bodies are commonly encountered in small animal practice. Esophageal bone foreign bodies (E‐bFBs) warrant removal, whereas gastric bone foreign bodies might not.ObjectivesDescribe management and outcomes for dogs with esophageal or gastric bone foreign bodies.AnimalsOne hundred twenty‐nine dogs with esophageal (n = 45) or gastric (n = 84) bone foreign bodies.MethodsRetrospective review of medical records.ResultsDogs with E‐bFBs were younger than dogs with gastric bone foreign bodies (median age esophageal, 4 years [IQR 2‐8]; median age gastric, 6 years [IQR 3‐10]; P = .03), and had a higher bone cross‐sectional area relative to body weight (median esophageal, 98.21 mm2/kg [IQR 48.25‐142.6]; median gastric, 28.6 mm2/kg [IQR 17.25‐64.28]; P < .001). Forty‐two of 45 esophageal foreign bodies were resolved non‐surgically and 3 by esophagotomy. Esophageal erosions were more likely with distal entrapment (OR 12.88, [95% CI 31.95‐129.29], P = .01) and longer duration (OR 18.82 [95% CI 2.22‐273.97], P = .01). Sixty‐two of 84 bone gastric foreign bodies were left in situ. Endoscopic removal was successful in 20 of 22 (91%; 95% CI 70‐99) attempts.Conclusions and Clinical ImportanceWhile all E‐bFBs were dislodged either by advancement into the stomach, endoscopic removal, or esophagotomy, the majority of gastric bone foreign bodies were left in situ for dissolution, with no reported complications. Gastric advancement of E‐bFBs should be considered when oral removal is not feasible, and dissolution can be considered even with large bones.

Emergent Endoscopy for Esophageal Foreign Body Removal: The Impact of Location.

BackgroundTimely intervention is essential for the successful removal of ingested foreign bodies. Emergent endoscopy (EGD) is usually performed in the emergency department (ED), operating room (OR), intensive care unit (ICU), or endoscopy suite. However, because the endoscopy suite is not always available, this study investigated the impact of location outside of the endoscopy suite on the successful removal of ingested foreign bodies and other patient outcomes.MethodologyWe reviewed charts of patients who underwent EGD for foreign body removal at an academic quaternary center between January 01, 2012, and December 31, 2020. We defined successful EGD as retrieval of the foreign body at the first attempt and not requiring subsequent endoscopy or surgical intervention. We performed descriptive and inferential statistical analyses and conducted classification and regression trees to compare endoscopy procedure length (EPL) and hospital length of stay (HLOS) between different locations.ResultsWe analyzed 77 patients, of whom 13 (17%) underwent endoscopy in the ICU, 46 (60%) in the OR, and 18 (23%) in the ED. Endoscopic removal failed in four (5%) patients. Endoscopy length was significantly shorter in the OR (67 (48-122) minutes) versus the ICU (158 (95-166) minutes, P = 0.004) and the ED (111 (92-155) minutes, P = 0.009). Time to procedure was similar if the procedure was performed in the ED (278 minutes), the ICU (331 minutes), or the OR (378 minutes). The median (interquartile range) of HLOS for the OR group (0.87 (0.54-2.03) days) was significantly shorter than the ICU group (2.26 (1.47-6.91) days, P = 0.007).ConclusionsWhile performing endoscopy for esophageal foreign body removal in the OR may be associated with a shorter EPL and HLOS, no location was inferior for overall outcomes. Further prospective and randomized studies are needed to confirm our findings.

The Role of Tunnel Endoscopy in a Hidden Esophageal Foreign Body.

The Role of Tunnel Endoscopy in a Hidden Esophageal Foreign Body.

A Retrospective Study of Oesophageal Foreign Bodies using Rigid Oesophagoscopy from Mandya, Karnataka, India

Introduction: Foreign bodies in the oesophagus is one of the commonly seen conditions in the Department of OItorhinolaryngology. Aim: To describe the clinical features and time delay of patients presenting with oesophageal foreign bodies. Materials and Methods: Present study was a retrospective study of case records of 60 patients who underwent rigid oesophagoscopy for foreign body removal at Mandya Institute of Medical Sciences Mandya, Karnataka, India, from January 2017 to December 2019. Details like age and sex of the patient, presenting symptoms, time delay in presentation to the hospital, the type of foreign body ingested, location of the foreign body in oesophagus, any complications were noted in a detailed case proforma. Preoperative X-ray of neck and chest was done in all patients. Descriptive statistical tests like percentage and mean were used to analyse the data. Results: Out of 60 patients, 36 (60%) were children and 24 (40%) patients were adults. Coin was the most common foreign body seen in children (n=32/60, i.e., 53.3%) whereas meat bone was the most common foreign body in adults (n=16/60, i.e., 26.6%). Forty two patients out of 60 presented within 24 hours of foreign body ingestion. Two patients presented after 72 hours of foreign body ingestion. Thirty one patients presented with foreign body sensation in throat, dysphagia was present in 21 patients and two patients presented with fever. Two patients who presented more than 72 hours after foreign body ingestion had mucosal oedema on rigid oesophagoscopy. There was mucosal injury in four patients intraoperatively, two were with dentures, one was with button battery and the other was with a sharp metal locket. Conclusion: Coin was the most commonly seen foreign body in children whereas meat bolus with or without bone was most commonly seen in adults. Timely diagnosis and early removal of the foreign body should be done to prevent complications.

Cap-assisted endoscopic treatment of esophageal food bolus impaction and/or foreign body ingestion: a systematic review and meta-analysis.

Esophageal food bolus and/or foreign body (FB) impaction is a common gastrointestinal emergency. This meta-analysis reports on the pooled outcomes of cap-assisted endoscopic removal of esophageal FB. We conducted a comprehensive search of several databases (inception to February 2022) to identify studies reporting on the use of a cap in the endoscopic treatment of esophageal FB ingestion. A random effects model was used to calculate the pooled odds ratio (OR) and mean difference (MD), and I2 values were used to assess the heterogeneity. Six studies were analyzed that included 677 patients treated with cap-assisted and 694 with conventional endoscopy. The cap-assisted method demonstrated statistically significant superiority regarding technical success (pooled OR 7.1, 95% confidence interval [CI] 1.9-26.9; P=0.004), en bloc removal (pooled OR 26.6, 95%CI 17.6-40.2; P<0.001), as well as a significantly shorter procedure time (4.6 min, 95%CI -6.5 to -2.8; P<0.001), compared to conventional methods. Better technical success was achieved with the cap-assisted method performed under anesthesia (OR 8.7, 95%CI 1.6-47.7; P=0.01); however, a shorter procedure time was noted for the cap-assisted method without anesthesia (MD -1.5, 95%CI -2.7 to -0.4; P=0.01). Pooled adverse events were comparable. Pooled OR for mucosal tear was significantly lower with cap in food bolus impaction (OR 0.07, 95%CI 0.01-0.38; P=0.02). Cap-assisted endoscopic removal of esophageal FB is associated with better technical success and en bloc removal, and a shorter procedure time compared to conventional methods, with comparable adverse events.

Safety and Efficacy of Nonoperative Treatment in Esophageal Perforation Caused by Foreign Bodies.

INTRODUCTION:Esophageal foreign bodies are often treated by endoscopy, but the treatment of esophageal perforation caused by foreign bodies remains controversial. The purpose of this study was to investigate the safety and efficacy of nonoperative treatment of esophageal perforation caused by foreign bodies.METHODS:We retrospectively analyzed 270 patients admitted to our hospital for esophageal perforation caused by foreign bodies from January 2012 to December 2020, all of whom received nonoperative treatment.RESULTS:The mean age of the patients was 56 ± 17 years, and fish bones were the most common type of foreign body. A total of 61.2% of the perforations were in the cervical esophagus. All patients received nonoperative treatment initially, and the foreign body removal rate using endoscopy reached 97%. The perforation healing rate reached 94.8%, whereas 3 patients (1.1%) died during hospitalization. The median (range) duration of hospitalization was 4 days (3–6). Multivariable analysis showed age ≥ 66 years (odds ratio [OR]: 2.196; 95% confidence interval [CI]: 1.232–3.916; P = 0.008), men (OR: 1.934; 95% CI: 1.152–3.246; P = 0.013), and time to treatment (OR: 1.126; 95% CI: 1.027–1.233; P = 0.011) were independent risk factors for infection, whereas the risk of infection was lower when the foreign body type was fish bone (OR: 0.557; 95% CI: 0.330–0.940; P = 0.028).DISCUSSION:Nonoperative treatment is safe and effective for esophageal perforation caused by foreign bodies. Even if perforation is combined with infection, active nonoperative treatment can still achieve a good effect. Early intervention can effectively reduce the risk of infection and improve patient outcomes.

A pregnant woman died of sudden cardiac death: Should esophageal foreign body be considered an inductive factor? A case report and literature review

A pregnant woman died of sudden cardiac death: Should esophageal foreign body be considered an inductive factor? A case report and literature review

Abstracts for the 40th emergencies in medicine conference

Abstracts for the 40^th emergencies in medicine conference

A rare case of esophageal foreign bodies.

A rare case of esophageal foreign bodies.

Complication of an Adult Oesophageal Foreign Body: Place of Cervicotomy

<i>Objectives</i>: Our work was aimed at exposing the methods of extraction of a foreign body enclosed in the cervical esophagus and specifying the place of cervicotomy in its management. <i>Observation:</i> We report the case of a 76-year-old patient admitted to the ENT emergency department for sudden onset dysphagia following the ingestion of a foreign body of dental prosthesis type (two teeth). The face and profile cervicothoracic radiography revealed a thickening of the oesophageal lumen associated with a prevertebral hyperclarity at the height of the C8 and D1 vertebrae. After two endoscopic extraction attempts to the rigid tube we performed a cervicothoracic CT that showed the dental prosthesis at the height of C8-D1 associated with a peripheral hyperclarity and a left pneumothorax. The hemoglobin level was 14 g/dl, the prothrombin rate was 84%, the activated partial thromboplastin time was 35 seconds. The cervicotomy allowed us to note a perforation of the esophagus at the height of C8-D1. We made an oesophagofissure that allowed us to extract the prosthesis. The reconstruction of the oesophageal lesion was done in two planes. <i>Conclusion:</i> Denture type foreign bodies carry a risk of perforation, especially when endoscopic extraction is difficult. This risk is all the more important when the extraction time is long, when there is a pre-existing oesophageal pathology and by forced extraction maneuvers. Standard surgery is the best way to prevent perforation and septic complications.

Successful retrieval of cervical oesophageal foreign body in two cross bred cows

Successful retrieval of cervical oesophageal foreign body in two cross bred cows

Unusual radiological finding in foreign bodies ingestion: three esophageal coins

Case description: A 5-year-old girl presented to the emergency department with a history of foreign body ingestion. A cervico-thoracoabdominal radiograph demonstrate a foreign body in the esophagus, which seemed to show a double rim sign suspecting a button battery. After an emetic episode and expelling a coin, the child became asymptomatic. Close inspection of the X-ray demonstrated that the image was formed by superimposition of 3 circumferential objects of different sizes. Another X-ray observed the persistence of two superimposed objects. Clinical findings: The girl presented with sialorrhea, odynophagia, and nausea. Vital signs and physical examination were normal. There was no significant medical history. Treatment and Outcome: With the suspicion of multiple impacted esophageal objects, the patient was then taken to the operating room. During the flexible esophagoscopy 2 coins were found in the esophagus, both were removed without difficulty. The patient had an uneventful postoperative recovery and there have been no long-term complications. Clinical relevance: Unusual radiographic findings regarding esophageal foreign bodies have been reported, however, we describe the first case of a child with 3 coins impacted in the esophagus and a new radiological finding in foreign bodies ingestions that allow to avoid misdiagnosis and improve outcomes.

Incidence and evolution of foreign body impaction in the upper gastrointestinal tract and its relationship with eosionophilic oesophagitis

BackgroundForeign body impaction is a frequent indication of urgent endoscopy. One of the reasons for impaction is eosinophilic oesophagitis (EE). To analyze characteristics of oesophageal foreign body impactions and their relationship with eosinophilic oesophagitis. MethodsIn this retrospective study, urgent endoscopies in a tertiary care centre were analyzed. We included all urgent endoscopies due to bolus and foreign body impactions performed between September 1st 2018 and September 1st 2020. We reviewed clinical data of all patients who were diagnosed with EE and compared it to impactions that were due to other motives. The mean follow-up time was 18.7 months. Results693 urgent endoscopy procedures were performed. 239 (34%) of these were due to foreign body ingestion. Mean age of the patients was 63 years old and 135 (63%) were men. EE was diagnosed in 36 (17%) patients. The factors associated with EE were age, to be younger than 50 years (OR, 7.3; 95% CI, 1.1–48.4; p=0.04), asthma/rhinitis/atopic dermatitis (OR, 8.9; 95% CI, 2.3–35.3; p=0.002), findings in the endoscopy as trachealization (OR, 9.7; 95% CI, 1.3–70.9; p=0.03) and psychotropic/calcium channel blocker drugs (OR, 0.09; 95% CI, 0.009–0.9; p=0.04). 15 (7%) patients died. In 6 of them death was impaction-related. None patients with EE died. ConclusionsForeign body impaction in the upper gastrointestinal tract due to EE is a frequent cause of urgent endoscopy. Being under 50 years of age, having asthma/rhinitis/atopic dermatitis, trachealization on the oesophagus and not taking psychotropic/calcium channel blocker drugs are factors associated with the diagnosis of EE. Mortality in the follow-up of patients without EE is important.