Impacted Esophageal Foreign Body Research Articles

Endoscopic esophageal foreign body removal among children at Lubaga Hospital, Kampala, Uganda.

Diagnostic upper gastrointestinal endoscopy involves examination of the lining of the esophagus, stomach and part of the duodenum. Interventional endoscopy in addition to evaluating the upper gastrointestinal tract to make a diagnosis, also offers a treatment benefit. Traditionally, esophageal foreign bodies (FBs) in Uganda were removed using rigid endoscopy. We therefore report an emerging trend of using flexible endoscopy to remove these FBs. To describe participant characteristics and endoscopic findings among children who underwent esophageal FB removal in Lubaga Hospital in Kampala. This was a retrospective review of endoscopy reports for children who underwent endoscopic esophageal FB removal at Lubaga Hospital from December 2014 to March 2022. Overall, 61 symptomatic children underwent this procedure. The majority of the FBs were removed by flexible endoscopy (n=55, 90.16%). The mean age of the participants was 7.88 (SD=2.12) years old. The majority of the children were females (72.13%) and coins were the most ingested FBs (84%), others included steel crucifix, nails etc. The upper esophageal sphincter was the commonest site for FB impaction (74%). We report high success rates of 90.16% for endoscopic removal of impacted esophageal foreign bodies among Ugandan children using the now widely available flexible endoscopy.

FLEXIBLE VERSUS RIGID ESOPHAGOSCOPY IN THE MANAGEMENT OF ESOPHAGEAL FOREIGN BODY IMPACTION

Background: Foreign body(FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy(FE) is a recommended therapeutic option because it can be performed under local anesthesia, it is cost effective and is well tolerated. Rigid endoscopy (RG) under general anesthesia is another option and is advantageous in some circumstances. The aim of the study is to compare efcacy and safety of exible and rigid esophagoscopy in esophageal foreign body removal. Methods: It is a prospective study done in E.N.T department in KIMS MEDICAL COLLEGE, Amalapuram, which includes 50 patients with impacted foreign body esophagus. Parameters like type of foreign body, location of impacted foreign body are included. The study analyzies the type of procedure the patient have undergone, the intra operative and post operative complications. Results: This prospective cohort study includes 50 patients who have undergone surgical procedure for removal of impacted foreign body. Flexible esophagoscopy is performed in 30 patients and rigid esophagoscopy is performed in 20 patients . The most frequent complications are mucosal erosion, mucosal edema, and ulceration. Conclusion: Flexible esophagoscopy and rigid esophagoscopy are equally safe and effective for removal of impacted esophageal foreign body.

Impacted esophageal foreign bodies in children

Foreign body (FB) ingestion in children has varied presentation. When unwitnessed, it poses therapeutic and diagnostic challenges especially in the presence of pre-existing anatomical pathology. We aim to analyze the clinical course, management, and outcome of children with impacted esophageal FBs. Retrospective chart review (Jan 2000-Feb 2018) recruiting children with impacted esophageal FBs. FBs in cricopharynx and those that moved to stomach were excluded. Investigations/management were based on underlying anatomical pathology, duration of impaction, and difficult FBs. Clinical details, management, and outcomes were collated. Of 86 children, N1 = 31 had identifiable predisposing anatomic pathology and N2 = 55 had impactions in normal esophagus or difficult FBs. N1 group presented early (42months), had recurrent impactions (1-6), and needed multiple dilatations (0-8) and longer follow-up (avg 35months). Food matter was commonest impaction. Many had persistent symptoms. N2 group had commonly coin impactions and strictures developed in long standing or corrosive FBs. Most were asymptomatic. Abnormal esophageal anatomy predisposes to impaction with organic food bolus. Age of presentation is earlier with recurrent impactions requiring multiple dilatations/surgery and longer follow-up. Metallic FBs commonly impact in normal esophagus and are often innocuous. Atypical/multiple FBs may mirror an underlying psychiatric illness.

Body stuffing during apprehension resulting in distal esophageal impaction: a case report and review of the literature

BackgroundBody stuffing and body packing are two methods of concealing illicit drugs. Body stuffing is defined as the oral ingestion of illicit drugs, typically to avoid law enforcement detection or other consequences of possession, and may present a serious medical emergency in patients. Most commonly, body stuffers ingest possibly large or unknown quantities of illicit substances to avoid detection of the drugs during apprehension. This ingestion is typically hasty or impulsive, and therefore the substances ingested are rarely packaged in a way that would be considered safe for ingestion.Case presentationThis case highlights a series of rare complications of impacted esophageal foreign body including esophageal edema, pericarditis, and hydro-pneumothorax for a 16-year-old Hispanic male who was booked into a county juvenile detention and rehabilitation facility. He complained of persistent intractable epigastric pain, along with pleuritic chest pain with multiple episodes of vomiting over the previous 4 days. He denied swallowing any foreign body. He underwent esophagogastroduodenoscopy, and a plastic bag with content suspicious for marijuana was discovered in the distal esophagus and removed.ConclusionsFailure to consider body stuffing and foreign body impaction in individuals during medical evaluation in detention centers with complaints of chest pain, abdominal pain, dysphagia, and/or certain toxidromes can delay diagnosis and lead to a variety of medical complications.

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.

Esophageal Stricture Complicated by a Foreign Body Successfully Removed with the Endoscopically-Guided Foley Catheter Technique

Esophageal foreign bodies require prompt recognition and targeted intervention. Foreign bodies have great variation in size, shape and consistency posing a unique clinical challenge for gastroenterologists. We report a rare case of an esophageal stricture complicated by an impacted esophageal foreign body refractory to retrieval with conventional interventional modalities. The endoscopic-Foley catheter technique is a well-documented and viable technique that can be applied to these extenuating circumstances in which traditional endoscopic methods have failed.

Galvanic Esophageal Injury

AbstractForeign body ingestion is a common clinical problem met in paediatric practice. Though an expectant line of management is indicated in most instances, ingested button batteries warrant emergency endoscopy and retrieval. When impacted, they can result in mucosal damage as a consequence of mechanical, chemical and electrical injury as well as systemic heavy-metal toxicity. Here we report the case of a three-year-old child who presented with features suggestive of impacted oesophageal foreign body. X ray neck revealed the characteristic features, confirming the diagnosis of an impacted button battery. The battery was successfully retrieved endoscopically with fluoroscopic assistance.

Missed diagnosis of an unusual case of impacted esophageal foreign body

AbstractAccidental foreign body or food particle impaction in the esophagus causing partial or complete obstruction of the esophageal lumen is not uncommon. Most of this presents with remarkable history and acute or related symptoms that lead to diagnosis. Here, we present an unusual clinically misleading case of impacted food object in the esophageal lumen causing partial obstruction that mimic the diagnosis of esophageal and other associated pathologies.

Condoms used to assist difficult endoscopic removal of impacted upper esophageal foreign bodies

Summary The use of a homemade balloon dilator and protector hood composed of condoms for assisting the removal of sharp foreign bodies lodged in the upper esophagus in difficult cases is reported. A conventional endoscopic method failed to remove two sharp bones and two press-through packages became impacted in the upper esophagus. A condom was used to make a balloon dilator that was attached to a flexible endoscope in an attempt to dilate the upper esophageal sphincter to dislodge the impacted sharp bones. This handmade condom balloon dilator succeeded in dislodging the two tightly impacted sharp bones and assisted in removing the impacted objects in the upper esophagus. Additionally, a condom was tied to the distal end of the scope to act as a protector hood to protect the esophageal mucosa when removing the sharp packages. The two impacted press-through packages were pushed into the lower esophagus or stomach and removed uneventfully using the condom protector hood. Subsequent endoscopy disclosed no relevant mucosal damage after the successful removal and the patients did well after discharge from the emergency department. In conclusion, condom-based endoscopic balloon dilatation is a simple and accessible method for assisting the endoscopic removal of tightly impacted, sharp foreign bodies in the upper esophagus. A condom can also be used as a protector hood to avoid mucosal injury when removing impacted, sharp press-through packages when a commercial protector hood is not available.

Removal of impacted esophageal foreign bodies with a dual-channel endoscope: 19 cases

There have been few reports concerning the endoscopic removal of impacted esophageal foreign bodies from patients. The objective of this study was to evaluate the effectiveness of dual-channel endoscopy in managing foreign-body ingestions in patients. A total of 19 patients with foreign-body ingestions between September 2008 and July 2011 were selected from the Digestive Endoscope Center in Lishui, a typical middle-sized city in China. The patients underwent endoscopy following admission. The impacted foreign bodies were successfully removed from 18 patients without complications using a dual-channel endoscope. One patient underwent surgery for an ingested denture following the failure of the endoscopic removal method. This study demonstrates that dual-channel endoscopic management may be a useful option for removing ingested foreign bodies from the esophagus.

An impacted oesophageal foreign body in a physically abused child

Physicians under-report cases of child abuse or child maltreatment. We present a case of an impacted oesophageal foreign body in a physically abused child. S.H. is a 7-year-old male child who accidentally ingested metal clip while being assaulted by his paternal uncle whom he resides with. He presented with dysphagia, odynophagia and drooling of saliva and urgent x-ray soft tissue neck revealing the presence of the metallic foreign body in the prevertebral region. He had emergency oesophagoscopy with the removal of foreign body, did well and was discharged home 4th day postoperatively after parental counselling. It remains the responsibility of paediatric healthcare providers to consider child maltreatment as a differential diagnosis of any unexplained injury or medical problems, including oesophageal foreign body impaction.

Fat Bolus Impaction; a Rare Case Report

An impacted esophageal foreign body is most often an urgent, rather than a life-threatening, medical situation. Typically, two types of foreign bodies are encountered: true foreign bodies (buttons, coins, pieces of balloon etc) and food-related foreign bodies. Ingestion of true foreign bodies generally occurs in persons less than 40 years old, with the vast majority being children. The incidence of true foreign body ingestion is also high in incarcerated individuals and in persons with psychiatric disorders. Food-related foreign bodies are more prevalent in persons who are over 60 years of age, who have esophageal disease, anatomic narrowing, motility disorders or who have recently consumed central nervous system depressants, especially ethanol. This article describes the clinical presentation, radiological findings and management of impacted mutton fat bolus as foreign body in an adult male patient.

Endoscopic management of impacted esophageal foreign bodies

There are many reports on the endoscopic management of ingested foreign bodies in the upper gastrointestinal tract, however, little is known about the management of a specific subset of esophageal foreign bodies - impacted esophageal foreign bodies (IEFBs), especially perforating esophageal foreign bodies (PEFBs). The aim of this retrospective study on 78 cases was to report experience and outcome in the endoscopic management of the IEFBs in Chinese patients. From January 2006 to July 2011, a total of 750 patients with suspected upper gastrointestinal foreign bodies were admitted to the endoscopy center. Among these 750 patients, 78 cases that met the defined criteria of IEFBs were retrospectively enrolled in the present study, including 12 cases (12/78, 15.4%) with PEFBs. The major types of IEFBs were poultry bones (35.9%) and fish bones (17.9%). Most of the IEFBs (80.8%) were located in the upper esophagus, as were two thirds (66.7%) of the PEFBs. Foreign-body retrieval forceps were the most frequently used accessory devices. Extraction of IEFBs failed in eight patients (10.3%) during the endoscopic procedure. The difficult points in endoscopic management were PEFBs, IEFBs with sharp points, and those with impaction for more than 24 hours. IEFBs should be treated as early as possible, and their endoscopic management is safe and effective. Endoscopic management is the first choice for PEFBs when the duration of impaction is less than 24 hours and there are no abscesses outside of the esophageal tract as determined by a computed tomography scan.

Atypical presentation of an impacted radiolucent esophageal foreign body

Patients with impacted esophageal foreign bodies usually present with gastrointestinal and rarely with respiratory symptoms. Impacted esophageal foreign bodies may be identified by radiologic studies. Ingested radiolucent foreign bodies may be more difficult to diagnose, especially if the patient presents with minimal symptoms. We report a rare case of a child who presented with stridor and obstructive sleep apnea. The cause of respiratory symptoms was thought to be due to enlarged tonsils and adenoids, and the patient was scheduled for tonsillectomy and adenoidectomy. On re-evaluation by the surgeon on the day of surgery, the procedure was changed to diagnostic microlaryngoscopy and bronchoscopy to rule out any other cause. The patient's respiratory symptoms were resolved when an incidental discovery and retrieval of the radiolucent esophageal foreign body was made. The diagnosis of radiolucent esophageal foreign body can be difficult and can be easily missed without reasonable clinical suspicion.

An unusual case of impacted oesophageal foreign body

Impacted sharp foreign bodies in the oesophagus can be very difficult to manage. When attempts are made to remove such objects inappropriately, life-threatening complications such as oesophageal perforation can occur. We hare reported a rare case of impacted denture in the oesophagus where endoscopic removal was not possible due to the perforation already caused by the denture, sinee this would have caused an oesophageal laceration, which could have proved fatal. Hence surgical removal had to be performed with repair of the oesophageal perforation.

3482 Endoscopic removal of impacted sharp foreign body in esophagus.

Background/Aims: Sharp impacted esophageal foreign bodies can be very difficult to manage. When attempting to remove such objects inappropriately, life threatening complications, such as perforation can occur. Therefore, surgical intervention generally affords a safer approach. The aim of this study is to evaluate the safety and efficacy of endoscopic removal of impacted sharp esophageal foreign bodies using dilation method with oral side balloon. Methods: Total of 17 patients(Male 6, Female 11) with impacted sharp esophageal foreign bodies underwent endoscopic extraction. The following technique was successfully performed at our hospital(Figure A,B). Oral side balloon(Top Co. Japan) for esophageal variceal sclerotherapy was attached on the distal part of endoscope. Under local anesthesia, endoscope was inserted near the proximal part of the esophageal foreign body. Then, oral side balloon was gradually dilated. Dilataion of proximal part of esophagus made it possible to release the impacted sharp foreign body from the esophageal wall. Results: The types of foreign bodies were fish bones(10 case), and press-through packages(7 cases). Endoscopic removal was successful in all 17 cases without complications such as perforation. Conclusion: This method using oral side balloon is safe and effective in removing impacted sharp esophageal foreign bodies avoiding surgery and possible perforation.

Esophageal Foreign Body Presenting with Stridor: Report of One Case

We report a case of a 12-month-old infant who developed acute respiratory distress with stridor from an impacted proximal esophageal foreign body. She was treated inappropriately as upper respiratory infections prior to the validation of the presenting complaint. Difficulties in diagnosis of esophageal foreign bodies arise, when the patient presents with atypical symptoms. Clinical suspicion remains the most important aid to diagnosis and endoscopic examination is essential for the diagnosis and successful management of foreign bodies in the esophagus.

Esophageal foreign bodies.

A retrospective review was performed on 180 patients from 1975 to 1997 to evaluate the diagnosis, and management of esophageal foreign bodies. All patients except two were symptomatic and 145 of them were younger than 14 years of age. Plain films were performed in every patient with a suspected esophageal foreign body (EFB). In all patients, rigid esophagoscopy was done under general anesthesia once the diagnosis of impacted EFB is made. Fifty-five percent of the foreign bodies were coins. In children, the majority of impacted esophageal foreign bodies were located at the level of the cricopharyngeus muscle while in adults the site of impaction was the lower esophageal sphincter. The most common symptoms were vomiting and or regurgitation. Of the 180 EFBs encountered, 169 were extracted endoscopically, five were pushed into the stomach, five were not found, and one patient needed cervicotomy. There were no deaths in this series. Predisposing factors were found in 15 patients. Fifteen patients (8.3%) had benign strictures. In ten patients (5.5%), minor complications were encountered, none of which were esophagoscopically related. Alternative diagnostic and therapeutic modalities are discussed. All patients with a history of suspected foreign body ingestion should have direct endoscopic examination. If the EFB is not detected a thorough radiographic examination, including CT scan, should be performed to detect a possible intra- or extraluminal object. Preservation of the airway is regarded to be the most important consideration in esophageal foreign body management.

Successful salvage of an 8-month-old child with an aortoesophageal fistula

Aortoesophageal fistula (AEF) from an impacted esophageal foreign body was first described in 1818 and has been a uniformly fatal condition to this date. We report the salvage of an 8-month-old child with an AEF from ingesting a straight pin. She survived a massive gastrointestinal (GI) bleed and primary esophageal and aortic repairs performed in conjunction with aortic shunting, interposed pleural flap, and a diverting cervical esophagostomy. This represents the first successful outcome of an AEF from a foreign body, many of which have been described in infants and children. History of esophageal foreign body and signal upper GI hemorrhage should mandate aggressive diagnosis and surgical intervention.