Management Of Esophageal Foreign Bodies Research Articles

Management of esophageal foreign bodies: a retrospective review of 400 cases.

A retrospective study was conducted in 400 patients with esophageal foreign bodies (EFB) to assess characteristics of EFB and methods of treatment. From 1962 through 1998, 400 patients with EFB were treated in our department on an emergency basis. There were 202 men (50%) and 198 women (49.6%) ranging in age from 1.5 to 95 years. The main symptoms patients complained of were difficulty in swallowing and pain. Detailed anamnesis, oropharynx and hypopharynx examination and finally radiological examination were the diagnostic tools. The location of the FB was in the cervical esophagus in 57% of cases, in the thoracic one in 26% and at the cardioesophageal junction in 17%. The most common objects found were bones, morsels, coins and needles. The treatment consisted of rigid esophagoscopy under general anesthesia in 343 (85.7%) of our cases. In 57 cases (14.3%) other means such as flexible esophagoscopy, Fogarty or Foley catheters and bougienage turned to be very useful. Only 12 patients (3%) were led to surgery because either extraction was impossible or perforation was present. No major complications occurred in the surgical group, whereas in the group of rigid esophagoscopy, there was one iatrogenous esophageal perforation that presented with empyema thoracis successfully treated. Finally, there was a case of an aortoesophageal fistula with mortal outcome perioperatively. (1) Esophagoscopy is a reliable method in the treatment of EFB impaction. (2) Alternative methods such as bougienage, etc., can be used only in selected cases with smooth foreign bodies. (3) Surgical treatment is unavoidable in cases of irretrievable EFB or esophageal perforation.

Mediastinitis associated with foreign body erosion of the esophagus in children

Objective: Timely and experienced intervention for esophageal foreign bodies generally allows for removal with minimal morbidity. However, esophageal foreign bodies present a risk for esophageal perforation and subsequent mediastinitis, especially if the diagnosis of the foreign body is delayed. Although much has been written about the management of esophageal foreign bodies and their complications, little has been mentioned in recent literature about the specific complication of mediastinitis. This review was performed to examine our experience with this uncommon complication of esophageal foreign bodies. Methods: A retrospective review of the esophageal foreign body database at Children's Hospital of Wisconsin from 1987 to 1997 was performed to identify patients with esophageal foreign bodies and subsequent mediastinitis. Results: Four patients with esophageal perforation with associated mediastinitis secondary to retained esophageal foreign bodies were identified. Three of the four patients were treated with conservative measures consisting of foreign body removal, intravenous antibiotics and discontinuing of oral nutrition. These patients all achieved resolution of their mediastinitis and esophageal perforation with subsequent return to normal diets and no significant morbidity. One patient, with vascular erosion, required aggressive, invasive therapy. Conclusion: From review of this limited number of patients, in the absence of major vascular erosion, conservative methods of treating children with foreign body esophageal perforation and subsequent mediastinitis appears to be effective.

Foreign Bodies of the Esophagus: A Two-Year Prospective Study

Foreign Bodies of the Esophagus: A Two-Year Prospective Study

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.

Swallowed Foreign Bodies in Children: Aspects of Management

Swallowed Foreign Bodies in Children: Aspects of Management

Radiologic Management of Esophageal Foreign Bodies

Radiologic Management of Esophageal Foreign Bodies

Esophageal Foreign Bodies in Adults

We present our 1-year experience in the management of esophageal foreign bodies in 31 adult patients, and we analyze the predisposing and risk factors, the diagnostic procedures, the removal techniques and the postoperative control and treatment.

Esophageal Foreign Bodies

Over 80 per cent of ingested foreign bodies pass through the gastrointestinal tract without incident. Sharp (bones, pins, needles, wire) or long (greater than 6.5 cm) foreign bodies are most commonly implicated in perforation. Food boluses are most common in obstruction seen in adult patients and associated esophageal pathology is common in patients aged 60 years and older. Adults with nonfood foreign bodies have a high incidence of psychiatric, social, or chemical derangements. Pediatric patients most commonly ingest coins. Ingestions tend to occur during nonschool months or in high-risk situations, and repeat ingestions are not uncommon. Fatalities and other major complications are linked to type of foreign body, location, and duration of the impaction. Deaths have also occurred with endoscopic and enzymatic modalities of treatment. Glucagon and Foley catheter removal are safe techniques in selected patients, provided resuscitative skill and equipment are available. Based on these data, an algorithmic approach to the management of esophageal foreign bodies by the emergency physician is recommended (Table 5).

Current Management of Esophageal Foreign Bodies

Between 1972 and 1978, a total of 159 cases of esophageal foreign body were treated at the University of Minnesota Affiliated Hospitals, Minneapolis. Although coins were the most frequent offending agent in the pediatric group, meat was the most common in the entire series (60%). Eighty percent of coins were impacted in the upper esophagus, while meat impaction occurred most frequently in the distal esophagus (42%). Rigid esophagoscopy was performed in 134 patients. The foreign body was removed during esophagoscopy in 122 cases, advanced into the stomach in two cases, and not found in ten cases. In addition to esophagoscopy, when meat obstruction was suspected, several pharmacologic agents were successful in relieving the obstruction, such as parenterally administered diazepam (Valium) (8/27) and glucagon (6/14). Spontaneous passage was noted in seven cases. No cases of esophageal carcinoma were discovered in this series.