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Oesophageal foreign body

Up Bowel ischaemia Clostridium difficile Diarrhoea GI bleed Hepatic failure Intra-abdominal infection Nutrition Oesophageal foreign body Oesophageal rupture Pancreatitis Pancreatoduodenectomy Pseudo-obstruction Stress ulceration Swallowing Typhilitis Ulcerative colitis


  • Incidence unknown
  • Male: female 1:3.1
  • Average age 3.1 years
  • Oesophageal pathology is a predisposing cause

Pathophysiology

Depends on:

  • physical characteristics
    • coin most common object
  • chemical composition
  • location
    • upper third most common
  • duration
  • associated oesophageal pathology

Symptoms

Early

  • coughing
  • choking
  • drooling
  • poor feeding

Delayed features

  • stridor
  • wheezing
  • cyanosis
  • recurrent pneumonia
  • bleeding
  • PUO
  • failure to thrive

Radiology

  • CXR
    • NB object may be radiolucent
    • If object is orientated in frontal plane the object is probably in the oesophagus. If it is in the sagittal plane suspect that the object is in the airway.
  • Barium swallow

Treatment options

Depend on physical properties, duration and associated pathology

  • Rigid oesophagoscopy
  • Balloon extraction
    • smooth object
    • readily visible on plain film
    • no respiratory distress
    • contraindications
      • known oesophageal pathology
      • present >2 days
    • Procedure
      • Foley catheter (with contraxt) directed posterior to foreign body
      • Fluoroscopy tuable
      • Restraint
      • No sedatives (to avoid losing airway)
      • Resuscitation equipment to hand
  • Open procedure

Complications

  • Perforation and mediastinitis
  • Oesophageal stricture
  • Tracheo-oesophageal fistula
  • Vascular erosions

Button battery ingestion

  • Age range: 11 months-90 years. 80% <5yrs
  • Contain strong base and heavy metals. Erodes through oesophagus
  • Requires immediate removal if in oesophagus. Antibiotics if there is significant inflammation.
  • Careful observation if past oesophagus. Majority will pass through without incident

 

 

©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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