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Foreign Body in the Esophagus

Esophagus Foreign Body


Presentation

  • She became symptomatic 2 years before presentation, but presented for treatment when dysphagia to both solids and liquids developed.[ncbi.nlm.nih.gov]
Anorexia
  • Toothbrush as an esophageal foreign body is more common in young females with eating disorders such as anorexia nervosa and bulimia in the age group of 15–23 [ 7 - 10 ].[karger.com]
  • Bezoars, regardless of composition, often present with symptoms of abdominal pain, anorexia, nausea, and vomiting. The physical exam may reveal abdominal distention or a palpable abdominal mass.[hawaii.edu]
  • […] of Foreign Body Ingestion The litany of possible symptoms of children with foreign body ingestion include dysphagia, vomiting, abdominal pain, cough, localization or foreign body sensation, and refusal of the child to take solids and liquids. 16-19 Anorexia[ahcmedia.com]
Weight Gain
Intermittent Fever
  • She developed abdominal distension and had intermittent fever spikes. Further evaluation was suggestive of electrolyte disturbances with hypokalemia and hypomagnesemia.[laryngologyandvoice.org]
Cough
  • As she had cough on drinking sips of water, she was kept nil per oral. On the same day, the child had tachypnea and was drowsy. She developed abdominal distension and had intermittent fever spikes.[laryngologyandvoice.org]
  • They are generally characterized by dysphagia, hypersilorrhea, refusal to eat, vomiting, irritant cough, often dyspnea and failure to thrive [ 4, 9, 13 ].[jorl.net]
  • Coughing • Respiratory symptoms due to esophageal foreign body is common in children because of their small and compressible tracheal lumen.[slideshare.net]
  • Symptoms may include: Choking or gagging when the object is first inhaled Coughing Stridor Wheezing (a whistling sound, usually made when the child breathes out) Although the initial symptoms listed above may subside, the foreign body may still be lodged[stanfordchildrens.org]
  • […] occur bowel perforation bowel obstruction Typically, radio-opaque objects are swallowed - coins, screws, button-batteries, small toy parts Presentation Esophageal foreign body: may be asymptomatic symptoms, when present, may include: bloody saliva, coughing[medbullets.com]
Respiratory Distress
  • Final diagnosis was esophagobronchial fistula caused by a foreign body in the esophagus provoking aspiration pneumonia, mediastinitis and respiratory distress syndrome (ARDS). The foreign body was found to be part of a plastic toy.[ncbi.nlm.nih.gov]
  • He presented with dysphasia, but no respiratory distress. X-ray soft tissue of the neck with upper chest AP view revealed a circular foreign body of 1cm in diameter at the T1-T2 level.[waent.org]
  • Our patient had absolute dysphasia without any cough, fever or respiratory distress.[medcraveonline.com]
  • distress, stridor, tachypnea, vomiting, wheezing Once beyond esophagus, objects typically pass but with increased risk of complications: bowel obstruction, perforation, erosion to adjacent organs - abdominal pain, nausea/vomiting, fever, hematochezia[medbullets.com]
  • A single coin must have been lodged in the esophagus for less than 24 hours in a child with no history of esophageal abnormalities, no respiratory distress, and no prior foreign body ingestion. 10 In the Foley technique, a Foley catheter is passed beyond[aafp.org]
Inspiratory Stridor
  • Haegen TW,Wojtczak HA, Tomita SS (2003)Chronic inspiratory stridor secondary to a retained penetrating radiolucent esophageal foreign body. J PediatrSurg38:e6.[jorl.net]
Dysphagia
  • The better patient comfort with FE was also reflected in a significantly lower rate of dysphagia (15%) compared to RE (48%; p 0.0001).[ncbi.nlm.nih.gov]
  • ., child of 3 years and 2 months complaining of drool and dysphagia for solid foods for about 14 months.[jorl.net]
  • We report a case of retained esophageal foreign body presenting as recent onset dysphagia and mediastinal widening. Case Report A 29-year-old female presented with progressive dysphagia since 2 months.[mjdrdypu.org]
Odynophagia
  • […] in throat Gagging Irritability Pain in neck, throat, or chest Recurrent aspiration pneumonia Respiratory distress Stridor Tachypnea or dyspnea Vomiting Wheezing TABLE 1 Symptoms of Esophageal Foreign Bodies Blood in saliva Coughing Drooling Dysphagia/odynophagia[aafp.org]
  • Other symptoms include odynophagia, diffuse chest pain, respiratory difficulties. Our patient had absolute dysphasia without any cough, fever or respiratory distress.[medcraveonline.com]
  • Sometimes even a piece of bone within a meal can lead to perforation of the oesophagus and even injure the pericardium and myocardium. [ 3 ] If an object perforates the oesophagus, it tends to cause acute mediastinitis with chest pain, dyspnoea and severe odynophagia[patient.info]
Bulimia
  • Toothbrush as an esophageal foreign body is more common in young females with eating disorders such as anorexia nervosa and bulimia in the age group of 15–23 [ 7 - 10 ].[karger.com]
Chest Pain
  • Abstract A 31-year-old male presented with chest pain started after eating chicken about 2 weeks earlier. Upper endoscopy and Computed tomography scan of the chest revealed a sharp chicken bone penetrating the esophageal wall into the right lung.[ncbi.nlm.nih.gov]
  • She was brought to the emergency room for sudden chest pain accompanied by dyspnea while eating, which was deemed a probable broncho-aspiration event.[scielo.isciii.es]
  • Severe vomiting or retching can present with chest pain or blood in the vomit depending on the extent and depth of injury.[eapsa.org]
  • , button-batteries, small toy parts Presentation Esophageal foreign body: may be asymptomatic symptoms, when present, may include: bloody saliva, coughing, drooling, dysphagia, failure to thrive, decreased feeding, gagging, irritability, neck/throat/chest[medbullets.com]
  • She was unable to swallow her saliva and she was complaining of retrosternal chest pain. A general physical examination was normal.[medcraveonline.com]
Retrosternal Chest Pain
  • She was unable to swallow her saliva and she was complaining of retrosternal chest pain. A general physical examination was normal.[medcraveonline.com]
Convulsions
  • This report presents an unusual esophageal foreign body (endotracheal tube) caused by a physician who was inexperienced in endotracheal intubation during the treatment of generalized convulsive status epilepticus.[ncbi.nlm.nih.gov]

Workup

  • Preoperative Workup The patient should have evidence of an esophageal foreign body either by history and physical examination and/or radiographic evidence.[csurgeries.com]
  • In one study, endoscopy averaged 2700; Foley catheter removal, 660; and bougienage, 614. [51] In another study, the average cost of endoscopy was 6087, whereas that of bougienage was 1884. [52] Negative workup If the workup is negative for a foreign object[emedicine.medscape.com]
  • The initial workup is the same as with any foreign body sensation in the throat.[ncemi.org]

Treatment

  • The authors' experience indicates that early diagnosis and an aggressive surgical treatment without delay is the only form of effective therapy for AEF.[ncbi.nlm.nih.gov]

Prognosis

  • Pathophysiology: The location of the foreign body ingested is important for determining the appropriate investigations, prognosis and treatment. This is usually categorized anatomically into esophagus and stomach/lower gastrointestinal tract.[learn.pediatrics.ubc.ca]
  • Prognosis On the whole, prognosis is good, especially with appropriate investigation, management and follow-up.[patient.info]

Etiology

  • Foreign body-induced perforation is one of the common etiologies of benign esophageal perforations. Although the primary treatment is surgery, endoscopic therapy may be appropriate in individualized cases like our patient.[ncbi.nlm.nih.gov]
  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Clinical Take Home Point: Given the weak evidence for the benefits of glucagon, the potential side effect of nausea/vomiting, and the fact that nearly 1/4 th of patients will have an anatomic etiology to their obstruction, avoid the use of glucagon and[rebelem.com]
  • Both of these milestones are important in the etiology of foreign body ingestion. Higher incidence of ingestions and greater age ranges were found in pediatric populations that were psychotic, prisoners, or had histories of suicide attempts. Gender.[ahcmedia.com]

Epidemiology

  • Epidemiology: In 2014, 2.1 million caustic ingestions occurred in the US. 48% occurred in children younger than five years of age. In the younger age group, most swallowing incidents are accidental.[eapsa.org]
  • Epidemiology Most common in children, psychiatric patients and jail inmates IV. History Object swallowed How long ago was the ingestion V.[fpnotebook.com]
  • Epidemiology The ingestion of foreign bodies is most commonly a problem in young children aged 6 months to 5 years.[patient.info]
  • Longstreth GF, Longstreth KJ, Yao JF: Esophageal food impaction: epidemiology and therapy. A retrospective, observational study . Gastrointest Endosc 2001, 53 :193–198. An informative study of food impactions in a large series of adult patients.[link.springer.com]
  • Lodgment of food boluses or foreign bodies occurs at this site usually as the result of the size and shape of the object, or due to an LES malfunction or anomaly, such as a Schatzki’s ring, strictures, webs, or varices. 1,2 Epidemiology of Pediatric Foreign[ahcmedia.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology: The location of the foreign body ingested is important for determining the appropriate investigations, prognosis and treatment. This is usually categorized anatomically into esophagus and stomach/lower gastrointestinal tract.[learn.pediatrics.ubc.ca]
  • Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Management, second edition. 1999, Philadelphia: W.B. Saunders Company, pp. 116-125. 5. Conners GP, Chamberlain JM, Ochsenschlager DW.[hawaii.edu]

Prevention

  • Prevention of such incidents should be emphasized.[ncbi.nlm.nih.gov]
  • Preventive antibiotic treatment was carried out and no complications were observed. All of our 3 patients have left the hospital the day of extraction.[jorl.net]
  • Foreign bodies should be removed within 24 hours to prevent erosive changes. The majority of objects that have passed into the stomach will go through the GI tract.[pedclerk.bsd.uchicago.edu]
  • Prevention It is difficult to prevent toddlers from examining things with their mouths. However, basic home-safety measures, such as cupboard catches and vigilance about not leaving objects within children's reach, are helpful.[patient.info]

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