Published - Fri, 04 Nov 2022

Esophageal Foreign Bodies – Gastrointestinal Disorders

80% of patients with esophageal foreign bodies are children. Usually, a caregiver will bring the child to the ED after seeing them eat anything. The diagnosis may be challenging if the ingestion was not seen.

CLINICAL FEATURES

1. Symptoms

a) Adults typically complain of a foreign body sensation in the throat or chest. The patient may appear anxious and experience retching or vomiting, choking, coughing, or drooling.

b) Children: Symptoms include refusal to eat, increased salivation, pain on swallowing, vomiting, choking, and referred respiratory symptoms (e.g., stridor, cough, and wheezing).

2. Physical examination may reveal signs of infection. Fever and/or subcutaneous emphysema in the neck is suggestive of esophageal perforation.

EVALUATION

1. Laryngoscopy: Direct or indirect laryngoscopy may be performed if the patient feels that the foreign body is in the throat or if respiratory symptoms are present.

2. Radiography

a) Radiographs can be used to pinpoint the location of radiopaque objects (e.g., coins, button batteries, sharp objects).

b) Pneumomediastinum or air in the soft tissues suggests perforation.

3. Endoscopy also allows localization of the object and is often therapeutic.

4. Esophagraphy: An esophagram should be performed only after consulting with a specialist because the contrast material may interfere with later attempts at endoscopy.

THERAPY

1. Coins and small smooth objects often pass through the gastrointestinal tract without difficulty. Coins that are too large to pass are removed by endoscopy. They can also be removed, by experienced physicians, using a Foley catheter guided by fluoroscopy.

2. Button batteries have the potential to cause chemical corrosion and perforation of the esophagus and must be endoscopically removed as soon as possible.

3. Sharp objects must be removed by endoscopy.

4. Food impactions can be treated expectantly if the patient is managing his or her secretions adequately. Medical interventions include the following:

a) Glucagon (1 mg intravenously) may relieve the impaction. A second 2-mg dose can be administered in 20 minutes if the first dose is ineffective.

b) Nitroglycerin (administered sublingually) may also assist in relieving the impaction.

c) Nifedipine (10 mg sublingually) relaxes the lower esophageal sphincter and may allow passage of the food bolus.

d) Diazepam may be used as a last resort.

e) Endoscopy should be performed if the bolus has not passed after several hours.

DISPOSITION: In order to rule out underlying esophageal pathology, all patients require follow-up.

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