Esophageal Foreign Body Obstruction Research Articles

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.

Transdiaphragmatic Gastrotomy for the Extraction of Distal Esophageal Foreign Bodies in 13 Dogs (1997-2016).

The records of 13 dogs with distal esophageal foreign body obstruction not amenable to endoscopic management that had transdiaphragmatic gastrotomy (TG) for the foreign body extraction were reviewed. West Highland white terriers were over-represented. Mean age of the dogs at presentation was 38.6 mo, and mean duration of clinical signs associated with esophageal foreign bodies was 5.8 days. A TG was performed via an eighth or ninth left intercostal thoracotomy, and clinical results were successful in 12 dogs. In 1 dog, gastrotomy failed to retrieve a foreign body and esophagotomy was performed. Foreign bodies that were removed included 3 fishhooks and 10 animal bones. Postoperatively, all dogs developed esophagitis, 1 dog showed esophageal stricture, and 1 dog died of pyothorax associated with esophageal perforation 1 day postsurgery. Overall, 12 dogs survived and were free of clinical signs after a median follow-up time of 17 mo. TG is an effective surgical technique for the retrieval of distal esophageal foreign bodies.

Risk Factors for Death in Dogs Treated for Esophageal Foreign Body Obstruction: A Retrospective Cohort Study of 222 Cases (1998-2017).

BackgroundLimited data exist describing risk factors for death, and long‐term outcomes in dogs with esophageal foreign body (EFB) obstruction.Hypothesis/ObjectivesTo evaluate short‐ and long‐term outcomes, and analyze risk factors for death in dogs with EFB obstruction. We hypothesized duration of entrapment and treatment type would affect outcome.AnimalsA total of 222 dogs were treated for EFB obstruction at an emergency and referral hospital between March 1998 and March 2017.MethodsMedical records for dogs with EFB were retrospectively evaluated.ResultsForeign material most frequently was osseous (180/222 [81%]), with distal esophagus the most common location (110/222 [49.5%]). Duration of clinical signs was not associated with risk of death (OR = 1.08, 95% CI 0.99–1.17; P = 0.2). Entrapment was treated by endoscopy (204/222 [91.8%]), surgery after endoscopic attempt (13/222 [5.9%]), and repeat endoscopy after surgery was recommended but declined (5/222 [2.3%]). In‐hospital case fatality rate was 11/222 (5%). Risk of death was significantly higher with surgery (OR = 20.1, 95% CI 3.59–112.44; P = 0.001), and 5/5 (100%) of dogs died if undergoing endoscopy after surgery was recommended but declined. Increasing numbers of postprocedural complications (OR = 3.44, CI 2.01–5.91; P < 0.001), esophageal perforation (OR = 65.47, CI 4.27–1004.15; P = 0.003), and postprocedure esophageal hemorrhage (OR = 11.81, CI 1.19–116.77; P = 0.04) increased in‐hospital risk of death. Esophageal strictures were reported in 4/189 (2.1%) of survivors available for follow‐up.Conclusions and Clinical ImportanceDeath is uncommon in canine EFB; however, treatment type affects outcome, and these data should be used to guide decision‐making in dogs with EFB.

Update on Foreign Bodies in the Esophagus: Diagnosis and Management

Foreign body impaction in the esophagus is an important emergency that carries significant morbidity and potential mortality. The most common cause of esophageal foreign body obstruction in adults is meat bolus impaction above a pre-existing distal esophageal (mucosal) ring, peptic or malignant esophageal stricture, or eosinophilic esophagitis. Immediate evaluation of the airway, assessment of the urgency of removal, radiological evaluation to localize the object, endoscopic or surgical retrieval, and subsequent monitoring for complications are essential steps in the management.

Use of Glucagon in Relieving Esophageal Food Bolus Impaction in the Era of Eosinophilic Esophageal Infiltration

Esophageal food bolus impaction may require an urgent endoscopy. Glucagon is often administered to promote spontaneous passage of the food bolus. Eosinophilic esophagitis is increasingly recognized as a cause of dysphagia, and food impaction is often the presenting symptom. Our study was aimed at determining the effectiveness of glucagon in relieving esophageal foreign body obstruction in general and in the setting of esophageal eosinophilic infiltration (EEI). A retrospective chart review was performed using the ICD codes and the emergency department database of adult patients presenting with symptoms of esophageal food bolus impaction from July 2004 to October 2010. Response to glucagon was defined as symptomatic relief of obstruction prior to endoscopic intervention. A total of 213 episodes of esophageal food bolus obstruction in 192 patients were identified during the study period. Glucagon was given in 125 cases of which 41 had a response (32.8%). A total of 170 episodes had an Esophagogastroduodenoscopy performed either during the impaction event or at a later date. Of the 60 patients' biopsies, 45 had received glucagon (17 with EEI, 28 without EEI). None of the 17 episodes with EEI as compared to 8 of the 28 without EEI responded to glucagon (0% vs. 28.5%, p=0.017). Glucagon is effective in about one third of patients with esophageal food bolus impaction, which is consistent with historical data. Patients with EEI appear less likely to respond to glucagon.

Use of Glucagon in Relieving Esophageal Food Bolus Impaction in the Era of Eosinophilic Esophagitis

Introduction: Esophageal food bolus impaction has an annual incidence of approximately 13 cases per 100,000 per year. To promote the spontaneous passage of the food bolus glucagon is often administered. Glucagon acts by relaxing the smooth musculature of the lower esophagus, thereby reducing the resting pressure of the lower esophageal sphincter. Studies have reported a response in up to one third of the cases who received glucagon, however conflicting data does exist. Eosinophilic esophagitis (EoE) is increasingly recognized as a cause of dysphagia. Food impaction is quite often the presenting symptom (56-86% of the cases). There is little to no data on the effectiveness of glucagon in relieving the esophageal foreign body obstruction in the setting EoE. Methods: Using the ICD codes and the emergency department database, a retrospective chart review of all the patients (≥ 18 years of age) presenting to the emergency department with symptoms of esophageal food bolus impaction from July 2004 to February 2010 was performed. Data collected included age, sex, food type, whether glucagon was given or not, dose of glucagon, response to glucagon, endoscopic findings, dilatation performed, biopsy results, and follow up. Response to glucagon was defined as symptomatic relief of obstruction after receiving glucagon. Endoscopic and pathology reports were reviewed electronically. Results: A total of 193 episodes of esophageal food bolus obstruction were identified during the study period. Glucagon was given in 107 episodes of which 35 had a response (33%). A total of 158 had an EGD performed either during the impaction event or at a later date. Biopsies were taken in 49 of the cases (25.4%). Out of 49 patients who had biopsies, 35 of them had received glucagon (13 with EoE, 22 without EoE). None of the 13 patients with EoE had responded to the glucagon (0%). Seven of 22 without evidence of EoE had responded to glucagon (31.8%, p-value 0.031). Conclusions: Our study shows that glucagon is effective in about one third of patients with esophageal food bolus impaction, which is consistent with historical data. Compared to patients without eosinophilic esophagitis, those with the condition appear to be even less likely to respond to glucagon.

Allergy Testing in Pediatric Eosinophilic Esophagitis – Identification of IgE and Delayed Hypersensitivity Food Reactions and Its Impact on Management

Introduction: Esophageal food bolus impaction has an annual incidence of approximately 13 cases per 100,000 per year. To promote the spontaneous passage of the food bolus glucagon is often administered. Glucagon acts by relaxing the smooth musculature of the lower esophagus, thereby reducing the resting pressure of the lower esophageal sphincter. Studies have reported a response in up to one third of the cases who received glucagon, however conflicting data does exist. Eosinophilic esophagitis (EoE) is increasingly recognized as a cause of dysphagia. Food impaction is quite often the presenting symptom (56-86% of the cases). There is little to no data on the effectiveness of glucagon in relieving the esophageal foreign body obstruction in the setting EoE. Methods: Using the ICD codes and the emergency department database, a retrospective chart review of all the patients (≥ 18 years of age) presenting to the emergency department with symptoms of esophageal food bolus impaction from July 2004 to February 2010 was performed. Data collected included age, sex, food type, whether glucagon was given or not, dose of glucagon, response to glucagon, endoscopic findings, dilatation performed, biopsy results, and follow up. Response to glucagon was defined as symptomatic relief of obstruction after receiving glucagon. Endoscopic and pathology reports were reviewed electronically. Results: A total of 193 episodes of esophageal food bolus obstruction were identified during the study period. Glucagon was given in 107 episodes of which 35 had a response (33%). A total of 158 had an EGD performed either during the impaction event or at a later date. Biopsies were taken in 49 of the cases (25.4%). Out of 49 patients who had biopsies, 35 of them had received glucagon (13 with EoE, 22 without EoE). None of the 13 patients with EoE had responded to the glucagon (0%). Seven of 22 without evidence of EoE had responded to glucagon (31.8%, p-value 0.031). Conclusions: Our study shows that glucagon is effective in about one third of patients with esophageal food bolus impaction, which is consistent with historical data. Compared to patients without eosinophilic esophagitis, those with the condition appear to be even less likely to respond to glucagon.

Esophageal foreign body obstruction caused by a dental chew treat in 31 dogs (2000–2006)

To evaluate the signalment, clinical signs, diagnosis, treatment, and outcome associated with esophageal obstruction caused by a dental chew treat in dogs. Retrospective case series. 31 dogs. Medical records were contributed from 19 hospitals via responses to a questionnaire that was developed for veterinarians who managed the cases. Esophageal obstructions with the dental chew treat occurred primarily in small dogs (26/31 [83.9%]). The most common clinical signs were gagging, regurgitation, vomiting, anorexia, and lethargy. Diagnosis was usually made via survey thoracic radiography. Obstructions were most commonly located in the distal portion of the esophagus (23/31; 74.2%). Esophageal lesions were moderate or severe in 86.7% (26/30) of the dogs. Orad endoscopic removal of the foreign bodies was uncommon (8/31 [25.8%]); most were pushed into the stomach. Thoracotomy was necessary in 6 dogs. Esophageal strictures developed in 6 of 25 (24%) dogs that survived initial hospitalization. Overall mortality rate was 25.8%. Esophageal obstructions with a dental chew treat were difficult to remove orally via endoscopy, resulted in moderate or severe esophageal damage, frequently were associated with stricture formation, and were associated with a high mortality rate.

Results of Transthoracic Esophagotomy Retrieval of Esophageal Foreign Body Obstructions in Dogs: 14 Cases (2000–2004)

The records of 14 consecutive cases of esophageal foreign body obstruction in dogs that had undergone transthoracic esophagotomy for foreign body retrieval were reviewed. Clinical results were considered successful in 13 of 14 dogs. One dog was euthanized at surgery because of the severity of associated thoracic lesions. Clinical signs resolved in the remaining 13 dogs. Two dogs had postoperative complications. One dog developed a pyothorax, and one dog developed a subcutaneous seroma. The overall recovery rate was 93%.

Esophageal foreign body obstruction after esophageal atresia repair

Background/Purpose: The aim of this study was to determine the incidence and risk factors for esophageal foreign body obstruction (EFBO) after esophageal atresia/tracheoesophageal fistula (EA-TEF) repair. Methods: A Case-control chart review was conducted from 1987 to 1999. Results: EFBO occurred in 14 of 108 patients (13%) with EA-TEF. Mean follow-up was 31 months. Alimentary debris was the most common foreign body. Mean time between operation and EFBO was 25 months. EFBO recurred in 50%. Sixty-one percent of patients required endoscopic FB removal. Esophageal stenosis was present in 57% of EFBO patients, and 80% of stenoses presented initially with EFBO. The incidence of gastroesophageal reflux (GER; 50%), type C anomaly (100%), anastomotic leak (21%), major associated anomalies (50%), and encephalopathy (14%) were not significantly different between the EFBO group and the total EA-TEF population. There was no difference in the need for antireflux surgery (57%) between those with EFBO and GER and the total EA/TEF population with GER. Conclusions: Esophageal foreign body obstruction occurs in at least 13% of patients after EA-TEF repair. Because no reliable risk factors were identified that could predict foreign body obstruction, all families should be warned about this possibility during the first 5 years, particularly once the child begins eating solid foods. J Pediatr Surg 37:776-778. Copyright 2002, Elsevier Science (USA). All rights reserved.