Esophageal Foreign Body Research Articles

Food bolus and oesophageal foreign body: a summary of the evidence and proposed management process

Food bolus and oesophageal foreign bodies are a common presentation that may be managed by otolaryngologists, gastroenterologists, acute medicine physicians and accident and emergency. The condition is highly variable with presentations ranging from well patients whose obstruction spontaneously passes to peri-arrest with severe aspiration or impending airway compromise. Management of this condition is heterogeneous and often depends on the specialty the patient is originally admitted under. There exist European and American guidelines from the perspective of gastroenterology, but there are no UK-based guidelines and limited consideration of the role of the otolaryngologists and rigid oesophagoscopy. An extensive literature search was carried out to generate conclusions on key management questions for food bolus and oesophageal foreign bodies. This was then summarised into both a written summary of the evidence and a graphical decision tree. This paper is a review article and presents conclusions regarding management options for food bolus and oesophageal foreign bodies. This article considers the current evidence surrounding investigation and management of oesophageal food bolus and foreign body. It draws conclusions regarding presentation, investigation and subsequent operative treatment. As part of this process, we propose a graphical decision tree to assist in management decisions.

One case of removal of complex esophageal foreign body guided by ultrasound gastroscope

One case of removal of complex esophageal foreign body guided by ultrasound gastroscope

Foreign bodies in the ear, nose, and throat of children - A 10 years' experiences at a tertiary care teaching hospital

Background: Foreign bodies (FBs) in the ear, nose, and throat are frequently encountered clinical entities among the children. These ear, nose, and throat FBs are often seen by pediatricians, primary care physicians, and otolaryngologists. Aim of the Study: The objective of this study is to analyze various types of FBs in the ear, nose, and throat among children and its clinical profile with its treatment in the pediatric age group. Materials and Methods: This descriptive retrospective study was carried out at a tertiary care teaching hospital. During 10-year period from April 2010 to May 2020, 452 pediatric patients with FB in the ear, nose, and throat were managed. The clinical profile and management of these children were analyzed. The clinical data were collected from the admission charts and clinic tickets. Results: In this study, the majority of the FBs were found in the nasal cavity, which constitutes 30.53%, whereas 28.31% found in the external auditory canal, 11.72% in the pharynx, 13.49% in the esophagus and 15.72% in laryngotracheobronchial (LTB) tract. The age ranges from 0 to 16 years, with a mean age was 7.21 years. The majority of the ear, nose, and throat FBs were found in the age group of 0–5 years. Out of the 452 cases, 243 (53.76%) were removed under general anesthesia. Vegetable seed was the most common FB in the nose. Coin was the most common FB in the esophagus, whereas vegetable seeds were the most common FB found in the bronchus. The open safety pin is a hazardous LTB FB. Conclusion: FBs in the ear, nose, and throat of children are common. The accurate diagnosis and treatment of the FBs in the pediatric age is often challenging. These FBs can be associated with significant morbidity and complications if not removed immediately.

An impacted coin in the esophagus: a cause of dysphagia in a child.

A 4-year-old female with no previous medical history presented to the Emergency Department complaining of difficulty in swallowing especially solid food for a duration of 4 days. This was accompanied by some painful swallowing whenever she attempted taking solid foods. She preferred taking liquids in all the four days. She had no cough, difficulty in breathing, chest pain, stridor, drooling or fever. Physical examination revealed relatively normal oral, neck, abdominal, respiratory and neurological examination. An anteroposterior chest X-rays (A) revealed a round opaque object and a lateral neck X-ray(B) showed a thin opaque object, presenting in a coronal plane, on the same level of the child’s esophagus. Our patient was taken to the emergency operating theatre for endoscopic removal of an esophageal foreign body under anesthesia. A coin was removed without any complications. Initial use of X-ray investigations is important for children with dysphagia before opting for invasive procedures. A coin in the esophagus lies in the coronal view, whereas when situated in the trachea it lies in the sagittal view.

Rare Upper Esophageal Foreign Body and a Simple Trick to remove it

This is a case report of a 7 year old male child who presented with an unusual foreign body a glass marble in upper esophagus. The child was a case of global developmental delay, seizure disorder, patent ductus arteriosus, congenital hydrocephalus with VP shunt in situ. The case was a challenging one to the entire team of surgeons, anesthesiologist and pediatricians. Under general anesthesia the foreign body was removed using a foley’s catheter. Spherical foreign bodies like glass marbles are always challenging as the usual instruments cannot grasp such foreign bodies and there is always a chance of pushing the foreign body downwards during the attempt to remove. In this case foley’s catheter was used to retrieve the foreign body which is cheap, easily available and non-traumatic.

Button batteries and typical swallowed foreign bodies can be differentiated in high-resolution X-Rays

BackgroundButton battery ingestions have emerged as an increasing medical issue in recent years, especially for children. The frequent use of these energy sources in small appliances and toys is responsible for their ubiquitous occurrence in households. In addition to other possible foreign bodies, button batteries are particularly dangerous as they can cause severe complications in the aerodigestive tract. ObjectiveThe study aimed for a detailed analysis of specific radiographic identifiers of button batteries and similarly configured potential esophageal foreign bodies in high-resolution X-ray scans. MethodsA selection of potentially hazardous button batteries - in cases of ingestion (CR2032) or aspiration (LR44, LR1130) - was made. Other clinically relevant radio-opaque objects of similar size and shape have been selected accordingly. High-resolution X-ray scans (33.3 lp/mm) were made using an in vitro model in porcine esophageal preparations. A systematic, comparative analysis was carried out with the digital radiographic images. FindingsIn the study described, the selected foreign bodies were scanned at distinct angles in high image quality. Using button batteries, radiographically details of their internal structures were shown that have not yet been described. The known markers, as well as new detailed characteristics, were found in the experimental setting. The differentiation from other typical esophageal foreign bodies was possible by analyzing four relevant identification features: the edge properties, internal structures, the size, and differences in 0°/90° scans. ConclusionsThe study results reveal that specific features of potential esophageal foreign bodies can be identified by improved radiographic resolution, contrast, and dynamics. Thus, the diagnostic reliability in distinguishing 'high-risk foreign bodies' from less dangerous ones could be increased. In the future, button batteries could be detected more reliably with intelligent digital image analysis and enhanced radiographic technology. This may further support clinical triage algorithms and help reduce medical complications in cases of foreign body ingestions.

Never fish your brother: a case of plastic fish hook in the oesophagus

Foreign body ingestion is a common, yet sometimes dangerous entity encountered in paediatric population. Depending on the type, size and location of a foreign body, it can present with variety of symptoms. The purpose of this report is to present an unexpected radiolucent oesophageal foreign body impaction in a 4-year-old boy missed by imaging, but successfully removed using rigid esophagoscopy without any complications.

Gastric Physaloptera Infection in 27 Dogs (1997-2019).

Infection with the stomach worm Physaloptera spp. in dogs can cause chronic vomiting, although the diagnosis is often difficult owing to a low worm burden, single-sex infections, a failure to produce ova, or ova that are of greater density than solutions routinely used for qualitative fecal flotation. A retrospective evaluation was performed of 27 dogs that had gastric Physaloptera spp. infection confirmed endoscopically. In 23 of 27 dogs (85.2%), chronic vomiting was the chief complaint, and Physaloptera was an incidental finding in 3 dogs with esophageal or gastric foreign bodies. The worm burden was low (1-3 worms) in 21 dogs (77.8%), but 2 dogs were infected with large numbers (>50 worms). Prior therapy with routine doses of anthelmintics was ineffective in eight dogs prior to endoscopy. A higher dose and longer duration of fenbendazole in combination with pyrantel pamoate is recommended for treatment of suspected or confirmed infections. Reinfection is common in some dogs and should not be viewed as treatment failure.

Management of deep neck infections from cervical esophageal perforation caused by foreign body: A case series study

PurposeEsophageal perforation caused by foreign body is common in Chinese medical institutions, and resultant deep neck infections (DNI) is quite different from typical DNI. The purpose of this article was to share our experience on management of this particular type of DNI. Material and methodsA retrospective review was conducted on a consecutive sample of such patients at Capital Medical University Beijing Friendship Hospital from 2015 to 2019. ResultsIn total, 24 cases were recorded. CT scan of the neck and upper thorax was the most useful tool for early diagnosis. Gas formation was not predictive of a worse clinical course. Eleven patients with minor DNI were treated with antibiotics and foreign body removal; while 13 patients with major DNI were treated with neck incision and drainage, ICU observation, and prolonged usage of antibiotics. Outcome was generally good, but major complications, including sepsis and lingual artery rupture, could occur. ConclusionsConservative management, focusing on prompt extraction of esophageal foreign body and adequate antibiotic coverage, can lead to good outcome for mild cases; while in addition to these measures, neck incision, cervical and superior mediastinal exploration, and high negative pressure drainage, should be performed for severe cases.

Oesophagal foreign Bodies Ingestion: Experience of 109 Cases

Esophageal foreign bodies ingestion is a worldwide surgical issue in pediatric age group while less likely in adults. We estimate endoscopic, clinical and therapeutic sides of this situation in the surgical department in Al-Hussein Teaching Hospital, Karbala city, Iraq and in Al-Sader Medical City, Najaf city, Iraq. The study made to revise our experience for all patients admitted to our hospitals with a diagnosis of oesophagal foreign bodies and their treatments and outcome. The medical registrations resolved concerning demographic information, symptoms presented, investigation and treatments. We revised 109 (61 males and 48 females) patients ranged from 4 months to 65 years with (median age of 2 years). Coins most repeatedly ingested objects (27.5%), miscellaneous metal objects (17.4%), batteries (13.8%) and food (9.2%). The clinical features we encountered vomiting (27.5%), dysphagia (22.9%), asymptomatic (15.6%), drooling and food refusal (12.8 %) and foreign body sensation (8.3%). Usually X-ray screen finding the foreign body in 89(81%) patients. Magill forceps and rigid oesophagoscope performed within six hours from admission under general anaesthesia and from 12-48 from time of ingestion. Foreign body Impaction in the hypopharynx and the upper part of the oesophagus (68.8%) middle part (23%) and the lower part (8.2 %).100(91.7%) patients recovered completely without any complications,9 (18.3%) patient get bleeding, mucosal ulceration and infection which treated successfully.

Study of the Esophageal Foreign Bodies

Study of the Esophageal Foreign Bodies

Characteristics Of Patient With Foreign Body Ingestion In Palembang

Abstract
 Introduction. Foreign body ingestion is a common diagnosis that presents in emergency departments—coins as the oesophagal foreign body most commonly found in infants and children. Coins retained in the oesophagus require intervention to prevent complications. This study aimed to determine oesophagal coin foreign body patient's characteristic at Mohammad Hoesin General Hospital Palembang.
 Method. This study design was retrospective descriptive. Samples were all patient diagnosed with oesophagal coin foreign bodies which underwent Extraction with esophagoscopy guidance that was performed at Mohammad Hoesin General Hospital Palembang during January 2013 – August 2017.
 Result. Forty-three patients had diagnosed with oesophageal coin foreign bodies consist of 22 males and 21 females. The most frequent age was 4fouryears old. The most presenting symptoms are Globus sensation on the throat (79%) and odynophagia (51,1%). Radiologist confirmation was done in every patient with foreign coin bodies in oesophagus. All patients underwent oesophagoscopy. 65,1% of cases of foreign coin bodies were found in the second constriction of throat. Duration of stay in hospital was the range from 1- 4 days, with the most frequent, was two days. There was no complication found in all patients.
 Conclusion. Oesophagal coin foreign body is most commonly ingested in children. The most presenting symptom is globus sensation on the throat. There is no complication found in this study.

Removal of Cervical Esophageal Complete Denture Foreign Body by Cervical Incision

Removal of Cervical Esophageal Complete Denture Foreign Body by Cervical Incision

Removal of a chronically impacted cylindrical esophageal foreign body by innovative fiberoptic endoscopy with a team approach.

Removal of a chronically impacted cylindrical esophageal foreign body by innovative fiberoptic endoscopy with a team approach.

Suspension Microesophagoscopy for Foreign Body Removal in Children.

View Video S1 Laryngoscope, 131:E2066–E2068, 2021

Chicken Bone Perforation “The Missing Link” in a Bemused Breathless Octogenarian-A Case Report of Endoscopic Revivification

Esophageal perforation is a rare complication of foreign body ingestion. The most common foreign bodies causing esophageal perforation in adults are fish and chicken bones. We present the case of an octogenarian man with mild cognitive impairment presenting with respiratory complaints of dyspnoea and orthopnoea in the emergency room. He had hyponatremia induced confusion in addition to his mild cognitive impairment. The diagnosis for his clinical condition was not evident. Evaluation by imaging detected the missing link chicken bone as the cause of esophageal double perforation with mediastinitis and bilateral pleural effusion. Following multidisciplinary discussion, the minimally invasive endoscopic approach was decided as the definitive therapy. After medical stabilization in ICU, he underwent endoscopic retrieval of the foreign body followed by fully covered self-expandable metallic stenting. He recovered well and the stent removed after three weeks. Six months down the lane he is doing well and under neurology follow up for mild cognitive impairment. This clinical case shows the atypical, delayed perplexing presentation of esophageal foreign body in the elderly and the need for individualized treatment decision making for a successful outcome.

Esophageal Foreign Body Management in Children: Can It Wait?

Introduction: Pediatric foreign body ingestion remains a common reason for emergency department (ED) visits. Button battery ingestion is an established surgical emergency, requiring immediate removal. Timing of removal for other foreign bodies remains controversial. We hypothesize that there is no difference in complication rate or successful removal of esophageal foreign bodies that wait until the following morning for removal. Materials and Methods: A retrospective review for cases involving esophageal foreign body removal by pediatric surgery or pediatric gastroenterology from November 2015 to November 2019 was performed. Patients were divided into two groups based on ED arrival-daytime (05:00-16:59); nighttime (17:00-04:59). Imaging confirmed an esophageal foreign body. Data collected included basic demographics, time of presentation, time of procedure, symptoms, location of the foreign body, and complications within 30 days. Statistical analysis was performed. Results: After excluding button batteries, 273 children underwent esophageal foreign body removal. Two-thirds presented at night. A significant difference was identified in the median time from ED to the operating room when comparing daytime (194.8 minutes; interquartile range [IQR]: 108.5-347) versus nighttime groups (643 minutes; IQR: 471.5-745; P < .001). Nine children had a complication or readmission within 30 days of their procedure and 25 patients had migration of their foreign body into the stomach, both with no significant difference (P = .94; P = .98, respectively). Conclusion: We found that waiting until the following morning had minimal impact on complications or success rate when removing esophageal foreign bodies. By waiting, institutions with limited personnel can keep resources and staff available for more pressing emergencies.

Esophageal foreign body perforation presenting as chronic thoracic pain

Foreign body ingestion occurs frequently in children and may lead to severe complications and mortality.

Aortic penetration due to a fish bone: a case report

BackgroundAortoesophageal fistula (AEF) caused by an esophageal foreign body is a life-threatening crisis, with rapid progress and high mortality. The first case of AEF was reported in 1818, but the first successfully managed case was not until 1980. Although there have been some reports on this condition, in most cases, the aorta was invaded and corroded due to its adjacent relationship with the esophagus and subsequent mediastinitis. To date, few reports have described an aortic wall directly penetrated by a sharp foreign body, likely because this type of injury is extremely rare and most patients cannot receive timely treatment. Here, we present a rare case of a fish bone that directly pierced the aorta via the esophagus.Case presentationA 31-year-old female experienced poststernum swallowing pain after eating a meal of fish. Gastroscope showed a fishbone-like foreign body had penetrated the esophagus wall. Computed tomography revealed that the foreign body had directly pierced the aorta to form an AEF. Surgery was successfully performed to repair the aorta and esophagus. The postoperation and follow-up was uneventful.ConclusionsFor the treatment of foreign bodies in the esophagus, we should be alert of the possibility of AEFs. The effective management of AEFs requires early diagnosis and intervention, as well as long-term treatment and follow-up, which still has a long way to go.

S0574 Analysis of All-Inclusive Upper Gastrointestinal Foreign Body Findings and Management

INTRODUCTION: Esophageal and gastric foreign bodies classically involve food in adults and coins, toys, batteries, magnets, marbles, and other small objects in children. However, limited studies have been published regarding the removal of iatrogenic foreign bodies. We aimed to catalog and analyze a comprehensive spectrum of foreign bodies removed by EGD. We accomplished this by comparing the findings and management of the foreign bodies by dividing them into three major groups: food based, iatrogenic, and “others” (intentional and unintentional non-food ingestions) to detect if there were significant differences. METHODS: We conducted a retrospective review of all foreign bodies removed via EGD over a 3-year period. Our study was IRB approved and conducted at a tertiary medical center. We collected demographic variables, medical history, objects removed, removal method, and outcomes. All of these cases were analyzed with descriptive statistics. Categorical data was analyzed using the Chi-Square test while quantitative data was analyzed by ANOVA. A P-value < 0.05 was considered significant. RESULTS: Over a 3-year period, there were 401 encounters for foreign body removed by EGD. Iatrogenic made up the majority of the encounters with 232 patients, followed by food at 136, and “others” (intentional and unintentional non-food ingestions) at 33. As presented in Table 1, when comparing the three groups, we found significant differences in age (P < 0.05), gender (P < 0.001), insurance status (P = 0.002), PCP status (P = 0.002), if follow up was scheduled (P < 0.001), and if the patient presented to follow-up (P = 0.032). In addition, there were significant differences in the removal method between groups when comparing single vs. multiple modalities and graspers vs. non-graspers (P < 0.001). When combining all 3 groups together, utilizing a single device compared to multiple devices was more common and successful (79.8% vs 20.2%, P < 0.001). The top object removed was food in 132 cases followed by staples in 98 patients. CONCLUSION: We aimed to study differences between the complete spectrum of upper GI foreign bodies. Dividing the data between 3 major categories, we found multiple differences between demographics and successful removal methods. We were also able to list the objects removed. Inclusion of all objects including iatrogenic should shed light on what is being removed along with removal method for a typical GI department at tertiary medical center.Table 1.: *Intentional and unintentional non-food ingestions. DemographicsFigure 1.: *Intentional and unintentional non-food ingestions. Extraction Device or Method as a Total and Divided between Groups.Figure 2.: Objects Extracted.