Oesophageal foreign bodies

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In upper airway, see choking
10 pence coin lodged in distal oesophagus in 7 year old girl.

A variety of ingested objects may become lodged in the oesophagus. Food boluses are considered foreign bodies only because their passage through the oesophagus should be transitory. Non-food materials can also become lodged in the oesphagus, e.g. dentures and dental bridges, though most smaller objects often pass into the stomach. A chest radiograph may help to confirm the presence and identify the level of the lodged foreign body. However, radiolucent items will not show up and can be falsely reassuring (missed foreign bodies may result in pressure necrosis, perforation and mediastinitis).

Safe endoscopic retrieval is the mainstay of treatment, with recourse to surgery only if this fails.

Main considerations:

  • Assess control over secretions. If danger of aspiration, deal with problem more urgently.
  • For sharp or pointed objects need to have a high suspicion for oesophageal perforation.

Contents

Food Boluses

May be simply due to rapid ingestion without adequate chewing, but many will have underlying oesophageal pathology.

Principles outlined in [1][2][3][4]

Treatment

Endoscopy

  • Ideal wait until fasted
  • Try to pass scope past food bolus rather than proceeding to blind pushing of food bolus down into stomach as there may be an underlying unseen abnormality impeding passage.

References

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