Esophageal Foreign Body Research Articles

Abnormal calcification misdiagnosed as esophageal foreign body in children: report of two cases

食道异物是儿童急症的常见疾病之一。儿童食道异物多为硬币等金属异物或动物骨骼等骨性异物，而临近组织的异常钙化较易误诊为外源性的食道异物。本文报告了儿童茎突舌骨韧带和杓状软骨的异常钙化误诊为食道异物的2例病例，通过对儿童食道异物病史及影像学资料进行分析并复习相关文献，总结其误诊原因及诊治特点，有助于降低儿童食道异物的误诊率。.

Esophageal discoid foreign body detection and classification using artificial intelligence.

Early and accurate radiographic diagnosis is required for the management of children with radio-opaque esophageal foreign bodies. Button batteries are some of the most dangerous esophageal foreign bodies and coins are among the most common. We hypothesized that artificial intelligence could be used to triage radiographs with esophageal button batteries and coins. Our primary objective was to train an object detector to detect esophageal foreign bodies, whether button battery or coin. Our secondary objective was to train an image classifier to classify the detected foreign body as either a button battery or a coin. We trained an object detector to detect button batteries and coins. The training data set for the object detector was 57 radiographs, consisting of 3 groups of 19 images each with either an esophageal button battery, esophageal coin or no foreign body. The foreign bodies were endoscopically confirmed, and the groups were age and gender matched. We then trained an image classifier to classify the detected foreign body as either a button battery or a coin. The training data set for the image classifier consisted of 19 radiographs of button batteries and 19 of coins, cropped from the object detector training data set. The object detector and image classifier were then tested on 103 radiographs with an esophageal foreign body, and 103 radiographs without a foreign body. The object detector was 100% sensitive and specific for detecting an esophageal foreign body. The image classifier accurately classified all 6/6 (100%) button batteries in the testing data set and 93/95 (97.9%) of the coins. The remaining two coins were incorrectly classified as button batteries. In addition to these images with a single button battery or coin, there were two unique cases in the testing data set: a stacked button battery and coin, and two stacked coins, both of which were classified as coins. Artificial intelligence models show promise in detecting and classifying esophageal discoid foreign bodies and could potentially be used to triage radiographs for radiologist interpretation.

Application of esophageal CT to establish the evaluation model of foreign body position in rigid esophagoscopic surgery

Objective:Establish a correlation model with the true position of the foreign body in the esophageal foreign body surgery using the relevant diameter of the esophageal foreign body computed tomography（CT）. Methods:Thirty-three patients who were diagnosed with esophageal foreign bodies by esophageal CT in the emergency department of the Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, were selected to measure the CT-related diameters of the esophageal tube（airway length, hyoid anterior edge-mandibular distance, incisor extension line-Posterior nasal ridge, distance from foreign body to hard jaw, distance from foreign body to incisor, front and back nasal crest line-spine line included angle, front and back nasal crest line and airway length line included angle, the lowest point of mandible-highest point of hyoid bone-and Spine angle）, record the height and weight of the patient and calculate the body mass index（BMI）. During the operation, the patient's head is fully tilted back, and the rigid esophagus is inserted through the mouth, and the front end of the esophagus is recorded when it touches a foreign body. The method of multivariate linear analysis was used to calculate the CT diameter that correlated with the distance between the foreign body and the incisor during the operation. Results:The most common foreign body in the esophagus is jujube pit（14 cases）, followed by fish bones（13 cases）; the distance between the foreign body and the hard jaw, the incisor teeth measured by CT of the esophagus is less than the actual distance between the foreign body and the incisor during the operation（P<0.001）, the difference was statistically significant. Multiple linear regression analysis found that the patient's BMI（P=0.037） and the distance of the foreign body from the hard jaw（P<0.001） were correlated with the actual distance of the foreign body from the incisor during the operation. LR=3.708+0.130×BMI+0.857×Lct（cm）, R²=0.736, adjusted R²=0.719. Conclusion:The distance between the foreign body and the hard jaw measured by esophageal CT combined with the patient's BMI can predict the distance of the foreign body during rigid esophagoscopic surgery under general anesthesia and provide a certain reference value for the detection of foreign body during the operation.

Surgical management of choke due to trichobezoars in a cow: A case report

Choke or esophageal foreign body obstruction is common condition in cow due to indiscriminate feeding habits. The most common site of obstruction is caudal cervical esophagus. A 7 year old, crossbred cow was presented with a history of sudden onset of ptyalism, bloated abdomen, respiratory distress, restlessness and swollen caudo-ventral cervical part. Physical examination of cervical region revealed partially movable, two round hard masses. Survey radiography showed two spherical (ball) like structures (6.83⁎6.11cm) at the level of C3-C4 and C5-C6 verterbral junction with an outer radiopaque wall and inner radiolucent part. The manual method of pushing foreign body into abdomen using probang and removal through oral cavity was failed due to complete intraluminal obstruction. Left cervical esophagotomy was performed and two trichobezoars (balls) were retrieved. This surgery proved excellent resolution of clinical signs.

A Rare Complication of Foreign Body Removal from the Oesophagus Using Foley Catheter: Esophageal Rupture

Delay in diagnosis and treatment of esophageal foreign bodies (FBs) increases morbidity and mortality. Anamnesis, radiological imaging and endoscopy are important in this diagnosis. A nine-month-old male patient was admitted to the hospital an hour after swallowing a coin. Pulmonary radiographic images detected the FB in the 2nd narrowing of the oesophagus and the FB was removed using a foley catheter. Six hours after removal of the FB, the patient was re-admitted by the emergency service upon development of puffiness in the neck and chest area. Physical examination revealed subcutaneous crepitation on the anterior wall of the thorax. Esophagography revealed that the contrast agent leaked from the right lateral of the oesophagus into the chest cavity. The nasogastric tube was inserted, the oral nutrition was stopped and antibiotherapy was started. Primary oesophagus repair was performed via thoracotomy on the 7th day of conservative follow-up upon the deterioration of the general condition and continuing leakage of contrast agent as observed in the fluoroscopy. In conclusion, The use of foley catheter in the removal of esophageal FBs can lead to serious complications.

The practice of foreign body removal from the ear, nose, and upper esophageal in children in Ethiopia: A retrospective descriptive study.

BackgroundEar, nose, and upper esophageal foreign body (FB) impaction in children is a common emergency in‐hospital service. There are no clear guidelines regarding the management of ingested FBs. This study aimed to determine the FB in terms of type, anatomic site, management outcome, and associated complications.MethodsRetrospective study of children with ear, nose, and upper esophageal FB managed under general anesthesia (GA) at operating room of Wolkite Hospital in the southern part of Ethiopia between January 2019 and February 2021. Data were collected from the medical chart of the patients using a prepared checklist. The parameters included were age, sex, FB anatomic site, type, management outcome, and associated complications related to FB or procedure modalities.ResultsA total of 169 (31.4%) study subjects were required GA for the removal of FBs. The mean age was 4.45 ± 3.20 years. Under 5 years old children comprises 61.5% of total cases. The most common anatomic site of FB impaction was in the ear 97 (57.4%). The most commonly found type of FB was cereals or seeds, which constituted 102 (60.35%). The complication rate was 18.35%. Epistaxis was the commonest complication (6.51%) from the nose while canal abrasion (5.92%) was common from the ear.ConclusionEar, nose, and upper esophageal FBs were found more frequently in younger children. The ear was the most common anatomic site of FB impaction followed by the nose and upper esophageal. The most common type of FB was cereals or seeds.Level of Evidence4.

CT imaging of esophageal foreign bodies in children: a pictorial essay.

Foreign body (FB) ingestion is common in children, particularly from 6months to 3years of age. As young children may be unable to provide a clinical history and the ingestion is often unwitnessed, imaging plays an important role in diagnosis, predicting outcomes and detecting complications that require surgical intervention. Since 2015, our institution's diagnostic algorithm for suspected airway foreign bodies has included a noncontrast airway FB CT (FB-CT) with the z-axis coverage spanning from the larynx to the proximal segmental bronchi of the lower lung zones. The effective dose of radiation from this FB-CT airway protocol is typically less than 1mSv, compared to an effective dose of just under 1mSv to up to 3mSv for a fluoroscopic esophagram in children under 10years of age and 1-3mSv for a routine pediatric CT chest. In using the FB-CT airway protocol at our institution, we observed that esophageal rather than airway FBs were sometimes encountered on these exams. However, the confidence among radiologists for definitively diagnosing an esophageal foreign body on noncontrast CT was variable. Consequently, we created a teaching module of positive cases for our group of 21 pediatric body radiologists to increase their diagnostic confidence. This pictorial essay illustrates our institutional experience and can help others to confidently diagnose esophageal foreign bodies using a dedicated CT foreign body imaging protocol. At a similar radiation dose to a fluoroscopic esophagram, CT provides the additional advantage of an expedited diagnosis without the need for a radiologist on site.

Practical tips for paediatricians: Esophageal button battery impaction in children.

Foreign body ingestion is a common reason for presentation to both outpatient paediatric as well as emergency medical care (1). Although the majority of esophageal foreign bodies are harmless, esophageal button batteries represent a special case where prompt recognition and removal is critical to avoid devastating complications and even death. Paediatricians and emergency room physicians play a central role in the timely management of button battery ingestion as most ingestions (70%) occur in children aged <6 years (2). The incidence of button battery ingestion associated with severe, life-altering injuries is on the rise (2). Over half of these ingestions are unwitnessed, and diagnosis is often delayed. Clinicians should have a high index of suspicion for a potential button battery if there is history of a ‘coin’ ingestion upon presentation. Although some children are initially asymptomatic, others may present with symptoms that mimic a viral infection including fever, decreased oral intake, vomiting, dysphagia, and cough (2). Clinicians must also watch for presenting symptoms of esophageal obstruction, including drooling and intraoral pooling of saliva (1). Potential complications of ingestion include esophageal perforation, tracheoesophageal fistula, major vessel injury, including aorto-esophageal fistula, vocal cord paralysis, and spondylodiscitis (3). An understanding of how to diagnose button battery ingestion and prevent or mitigate injury is critical to avoid these tragic consequences.

Use of a dissected intravenous giving set to assist large metal oesophageal foreign body removal in rigid oesophagoscopy.

Oesophageal foreign body removal may be challenging. If a foreign body is sufficiently high risk and cannot be retrieved via oesophagoscopy, laparotomy may be required as the foreign body migrates distally. This paper presents the use of the plastic tubing from an intravenous giving set, combined with rigid oesophagoscopy grasping forceps, in order to improve purchase and obtain sufficient traction on a large, smooth, metallic distal oesophageal foreign body (knife). This method offers an option for removal of oesophageal foreign bodies that may be rendered challenging with traditional metal grasping forceps given the lack of purchase and traction afforded by a 'metal on metal' grip, potentially avoiding the need for open surgery.

Impact of COVID-19 lockdown on a tertiary center pediatric otolaryngology emergency department.

To assess the quantitative and qualitative impact of the COVID-19 lockdown on pediatric otolaryngology emergency activity. A retrospective study was conducted in a pediatric otolaryngology tertiary care center. Emergency activity during the lockdown period from March 17 to May 11, 2020, was compared to the 2019 and 2018 averages for the same period. Study data included a number of emergency consultations and the number and type of surgical procedures: infection management, endoscopic airway procedure, and post-tonsillectomy hemorrhage. Only 350 children were referred to the pediatric otolaryngology emergencies in our center during the lockdown, compared to 761 on the same period the year before (− 54%); 62 emergency surgeries were performed, compared to 93 (− 33%). The ratio between emergency surgeries and consultations was 18% in 2020, versus 12% previously (p = 0.014). The number of surgical procedures for infectious diseases decreased (− 68%), at 16% of surgical emergencies in 2020 compared to 33% previously (p = 0.017). In 2020, 52 emergency endoscopies were performed, versus 59 previously (− 12%), 27% being performed for suspected tracheobronchial or esophageal foreign bodies, compared to 66% in previous years (p < 0.0001). No post-tonsillectomy hemorrhages were managed in 2020.Conclusion: The COVID-19 lockdown changed pediatric ENT emergency activity quantitatively and also qualitatively. What is Known:• SARS-CoV-2 pandemic impacted pediatric ENT emergency activity quantitatively and qualitatively.What is New:• here was a 54% decrease in pediatric ENT emergency consultation and 33% decrease in emergency ENT surgeries.• Rates of surgery for infection of whatever type decreased by 68%.

Surgical removal of esophageal fish hook foreign body in a fancy Aseel chicken

One year old fancy Aseel female chicken was presented with a history of fish hook ingestion accidently in a confusion of meat piece. The bird ingested one fish hook was stucked at oesophagus before reach the crop. Based on the physical examination eye of the fish hook was felt at the caudal part of oesophagus and nylon protruding from its oral cavity. Under local anaesthetic procedure esophatomy was performed and undigested meat piece along with fish hook were removed. Bird recovered completely and post-operative care procedure was followed until complete recovery.

Delayed Endoscopic Management of Esophageal Sharp-Pointed Food Impaction: An Analysis of 829 Cases in China.

Esophageal foreign body impaction is the most common cause of endoscopic emergency. However, there are limited available data on delayed endoscopic management of esophageal sharp-pointed food impaction. To investigate cases of esophageal sharp-pointed food impaction with endoscopic removal findings. This single-center retrospective study collected medical records to identify patients with esophageal sharp-pointed food impaction who underwent endoscopic removal between April 2018 and April 2020. The patients were divided into the early (endoscopic removal <12h) and delayed intervention (>12h) cohorts. Overall, 133 and 696 patients received early and delayed intervention, respectively. The success rate of endoscopic foreign body removal was 96.45%. The most common foreign body was fish bone (66.90%), and the most common shape was "I" (56.26%). Patients from the delayed intervention cohort received general anesthesia with a higher risk for perforation, and no foreign body was identified. The duration of endoscopy, distance between the foreign body/wound and the incisor, and longest diameter of the foreign body were not different between the groups. In multivariate analysis, male sex (odds ratio = 1.792 [1.159, 2.771]; P = 0.009), longer duration of impaction (odds ratio = 2.212 [1.121, 4.365]; P = 0.022) and endoscopy (odds ratio = 1.502 [1.253, 1.800]; P < 0.001), and longest diameter of the foreign body (odds ratio = 1.632 [1.329, 2.003]; P < 0.001) were associated with a higher incidence of perforation in patients with foreign body impaction. Endoscopic removal is a safe and effective treatment method for sharp-pointed food impaction. Delayed endoscopic removal can increase the risk of esophageal perforation.

Unusual esophageal foreign body in neonates: A case report

Introduction and importanceEsophageal foreign body mostly occurs in children aged 6 months to 5 years old. In neonates (babies less than 28 days old), such report is extremely rare. In this case, we report the first esophageal foreign body in neonates without any symptoms.Case presentationA 28-day-old baby boy, with normal body weight, from a low socio-economic status family, came to us with a history of ingested foreign body. No sign of unconsciousness, excessive saliva, dysphagia, and respiratory distress. The chest X-ray revealed a radiopaque foreign body in the upper third of the esophagus. The patient underwent extraction of the foreign body using a flexible endoscope under general anesthesia. We found a 1.9 cm in diameter pendant with no sign of bleeding nor inflammation in the esophageal lumen. After the foreign body removal, the patient is in good condition and recovered uneventfully.Clinical discussionForeign body in children under 6 months old is very rare. A high index of suspicion for foreign body ingestion must be considered in unattended children from lower socio-economic status, primarily if witness statements are present and confirmed with radiological examination. Most common impaction site is at the level of the cricopharyngeus muscle. Currently, flexible endoscopy is the standard for foreign body removal in children.ConclusionHigh index suspiciousness, witness statements and radiological examination are the important points in diagnosing ingested foreign body in neonates. Clinicians are required to provide education to parents to supervise their children when playing together.

Real Time Fluoroscopy Guided Extraction of an Impacted Oesophageal Foreign Body: A Case Report

Real Time Fluoroscopy Guided Extraction of an Impacted Oesophageal Foreign Body: A Case Report

How we do it: impacted oesophageal foreign body removal using a dilatation balloon.

Ingested foreign bodies are a common presentation to paediatric ENT services. Depending on the site, these are usually managed with flexible or rigid oesophagoscopy and retrieval. This paper presents a novel technique for removing a hollow foreign body that could not be removed using conventional means. After rigid and flexible approaches failed, a guidewire was passed through the foreign body under fluoroscopic guidance and a dilatation balloon passed through the lumen of the object. Inflating the balloon allowed dilatation of the inflamed mucosa above and below the object, facilitating straightforward removal under traction. This is a novel and reproducible technique that uses equipment readily available in tertiary referral centres. Employed in this context, the technique enabled removal of an impacted object surrounded by granulation tissue, and would be appropriate for other objects with a lumen.

Unusual Esophageal Foreign Bodies in a Schizophrenic Patient: A Case Report

Introduction: The possibility of foreign body ingestion should be considered in psychiatric patients. In some complicated cases, foreign bodies become problematic and require immediate surgical intervention. Case presentation: A 45-year-old man with schizophrenia swallowed razor blades and pieces of glass resulting in esophageal perforation, pneumothorax, pneumomediastinum and urgent need for surgery. He was presented in shock state but successfully passed post-operative period in the intensive care unit and surgical ward and was ultimately transferred to the psychiatric ward. Conclusion: Management of asymptomatic patients depends on the demographic factors of patients as well as the site affected in the gastrointestinal tract.

Oesophagoscopy in a Treated Oral Cavity Carcinoma Patient: A Case Report and Review.

Vegetable matter, especially fruit seed impaction, is uncommon in Otolaryngology practice. If it happens, there should be a possibility of abnormality in the oesophagus like stricture, web, malignancy, trauma or diverticulum. Here we present a case of seed as a foreign body oesophagus in a patient who was a known case of carcinoma left buccal mucosa status post left hemimandibulectomy with flap reconstruction Radiotherapy 20years ago. We explained the practical and logistic issues while intubation and doing oesophagoscopy in this patient.

Survey of Instruments and Techniques for Endoscopic Retrieval of Esophageal and Gastric Foreign Bodies in Cats and Dogs

Esophageal and gastric foreign bodies (EFB and GFB) are a common occurrence in cats and dogs. The objective of this study is to evaluate the endoscopic instruments and techniques used for foreign body retrieval by internists or criticalists based on type and location of the foreign body. An online, anonymous survey was created using a commercial software. The survey was distributed to diplomates of the ACVIM (SAIM) and ACVECC through each college's listserv. Data obtained included specialty, years in practice, practice type, available instruments, and preferred instrument for various foreign bodies by location and type. Two hundred sixty-eight surveys were completed with 74% from private referral practice and 21% from academic practice. For EFB, laparoscopic or endoscopic grasping forceps were used most commonly. For GFB, grasping forceps or loop snares were used most commonly. Fifty percent of respondents reported attempting duodenal FB removal. In practices with limited financial resources, endoscopic grasping forceps and loop snares may be prioritized for purchase as these instruments may have the most application for foreign body retrieval from the esophagus and stomach.

Management of oesophageal foreign bodies in pediatric patients: our experience

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Amongst pediatric patients, oesophageal foreign bodies (OFBs) are relatively common clinical problem. Majority pass harmlessly through gastrointestinal tract, some can cause complications or morbidities. Our study considered and reviewed our experience in managing OFBs in pediatric patients, with emphasis on the management and outcomes of complicated cases.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 77 cases of OFBs (diagnosis established), upto 12 years of age admitted at our tertiary hospital between January 2015 to December 2020 (duration of 6 years) were reviewed and analysed. On the basis of our analysis accounting demographic data, presenting symptoms, workup investigation, management, complications and outcomes, results and conclusions were derived.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Amongst cases, 43 were male and 34 female. Mean age for our cases was 5.4 years. 56 cases (72.7%) cases presented in the hospital within first 24 hours. Commonest foreign body found in 64 cases (83.1%) was coin. Most cases had history of witnessed ingestion. Commonest presentation was asymptomatic (with history of witnessed ingestion), followed by complaint of vomiting and drooling of saliva. Most patients were discharged within 48 hours post-operatively except for 2 patients who presented intra-operatively with edematous inflamed mucosa with slight charring on oesophagoscopy where foreign body was button battery (cell). Follow-up period ranged from 2 to 8 months and all patients had complete recovery without any sequelae.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our experience of 6 years with 77 pediatric patients with OFBs having various presentations have been reviewed, analysed and concluded here. All the patients had complete recovery without any sequelae.&lt;/p&gt;

CERVICAL OESOPHAGOTOMY IN A CAT FOR FOREIGN BODY REMOVAL - CASE REPORT

Oesophageal foreign bodies are a significant cause of morbidity and mortality in small animals, especially in carnivores. Due to the possibility of complications such as perforation or tracheal compression, the patient may present an upper airway obstruction, which might become a medical emergency. Here, we describe a rare case of a large cervical foreign object in a cat and review the diagnostic and therapeutic approach of this condition. A 4-year-old female cat was referred to our clinic with signs of dyspnoea, dysphagia and regurgitation. The history and clinical exam suggested an oesophageal foreign body, subsequently radiographically confirmed. Because its shape and position did not allow endoscopic extraction, the foreign body was removed via ventral cervical oesophagostomy. Due to its location and large size, it was necessary to fragment the foreign body into two pieces for complete extraction without injuring the oesophageal walls. The patient had no postoperative complications and was discharged 7 days after surgery. In this condition, an early diagnosis, followed by an immediate surgical repair and a rigorous postoperative care, correlates with patient recovery and survival, being crucial in reducing the high morbidity and mortality rates that are usually associated.