Unsuspected esophageal foreign bodies in adults with upper airway obstruction

Foreign body Swallows with Airway Affection in Pediatrics

Aims

The current work aimed at evaluating how FBI can cause respiratory distress and stridor as well as their severity according to age, gender, lodgment site, and type of the object. Factors influencing morbidity and mortality among studied patients will be deliberated as well.

Methods

It is a hospital-based descriptive study where all children between birth and 16 years of age who were admitted to Sohag University Hospital, Egypt from January 1st, 2018, to December 31st, 2020, for FBs removal were analyzed. All cases were subjected to complete history taking, physical, radiological, and bronchoscopic examination.

Results

A total of fourteen [14] patients were presented with FBI based on a full history, examination, and essential investigation. The vast majority 92.9% of presented cases (13 out of 14) were less than 6 years old. 50% of them (50%) (7 out of 14) were less than one year old. Most cases presented early within a few hours after ingestion (71.4%). Two [2] patients had predisposing conditions like mental retardation and cerebral palsy. 28.6% of cases presented late (> 24 h after aspiration). Except for one case where a cervical oesophageal approach was needed. Endoscopic extractions of foreign bodies were successfully done. 50% of patients required admissions to the Pediatric Intensive Care Unit (PICU). The mortality rate was 14.3%.

Conclusion

FBI is a common clinical emergency in children younger than 6 years. A high index of suspicion is the keystone for diagnosis. Early detection and management are crucial for a positive outcome.

Endoscopic management of foreign bodies in the upper gastrointestinal tract: An analysis of 846 cases in China

Foreign body ingestion is a relatively common occurrence, which may lead to morbidity and mortality. The aim of the present study was to report the experience of management of upper gastrointestinal foreign bodies by endoscopy in a large center. All patients who presented at the Department of Gastroenterology at Nanfang Hospital (Guangzhou, China) with complaints regarding upper gastrointestinal (GI) foreign body ingestion from December 1987 to December 2013. Hospital medical charts and endoscopic records were examined to evaluate etiology, treatment, and outcomes for these patients. A total of 846 patients were enrolled in the present study, from which foreign bodies were detected in 737 (87.1%) patients via X-ray or endoscopy. The objects most frequently ingested were bones (n=395, 53.6%). The detected foreign bodies were predominantly located in the cervical esophagus (n=325, 44.1%). Endoscopic foreign body extraction was successful in 92.5% of cases, whereas surgery was required in 6 patients. The most frequently used endoscopic accessory devices were retrieval forceps (n=480, 65.1%). The complication rate was 6.9%, including mucosal laceration (n=10) and others, all of which were managed conservatively. Associated GI diseases were reported in 74 (10.0%) patients, including postesophagectomy (n=34) and others. In conclusion, the endoscopic procedure was safe and effective for the removal of foreign bodies from the upper gastrointestinal tract, with a high success rate and low complication rate.

[Foreign body ingestion in children: 105 case reports]

The ingestion of a foreign body (FB) is one of the most frequent childhood accidents requiring urgent care depending on the type and localization. Coins are the most frequent, and disk battery ingestion can lead to a significant risk of complications. FB stagnation in the esophagus entails a major risk of perforation. This article reports a retrospective study of 105 cases of foreign body ingestion admitted to the pediatric gastroenterology unit between November 2002 and June 2010. The average age of these patients was 4 years with a 1.5 sex ratio. Ten patients were followed for esophagus stenosis; the others had no considerable pathological histories. The fibroscopy performed on 104 patients allowed us to visualize the foreign body in 96 cases (91.4%). In the 8 remaining cases, the FB was not found (it had already migrated in the digestive tract). Coins were the most frequent (64.7%). Endoscopic extraction removed 83 FBs (86.4%). In 11 cases, it was pushed towards the stomach, split up in 1 case, and surgery was necessary in only 1 case. The progress of child digestive fibroscopy has decreased both the morbidity related to the ingestion of foreign bodies and the use of surgery. Prevention should be based on educating the parents by informing them about the risk of this kind of accident.

Management of foreign bodies of the upper gastrointestinal tract: update

Management of 242 foreign bodies of the upper gastrointestinal tract are reported. Thirty-nine were in the pharynx, 181 in the esophagus, 19 in the stomach, and 3 in the small bowel. The flexible panendoscope was used 211 times (87.2%) to manage these foreign bodies, while the rigid esophagoscope was used 12 times (5.0%). Two hundred thirty-nine foreign bodies (98.8%) were successfully managed endoscopically. The surgery rate was 0.4%. There was no morbidity or mortality. Twenty-five percent of the cases were done under general endotracheal anesthesia. Coins in the esophagus are removed promptly if in the cervical or mid esophagus, and within 12 hours if in the distal esophagus. Once in the stomach, they will usually pass without difficulty. Meat impaction resulting in an obstructed esophagus is an urgent problem and the bolus should be removed within hours. Sharp and pointed foreign bodies can be very difficult to manage. Dry runs with a reproduction of the foreign body are essential to successful removal. Button batteries lodged in the esophagus represent an emergency and should be removed without delay. Once in the stomach, they will usually pass through the gastrointestinal tract without difficulty. The forward-viewing flexible panendoscope has become the instrument of choice in managing foreign bodies in most tertiary medical centers as well as in the community hospitals.

Foreign bodies of the gastrointestinal tract

The majority of foreign bodies in the gastrointestinal tract require no medical or surgical intervention for removal. Prior to the era of modern gastrointestinal endoscopy, the management of ingested objects or nontherapeutic objects placed in the rectum required general anesthesia and was relegated to the general surgeon or otolaryngologist. With the advancement of therapeutic endoscopy, fewer affected individuals require surgical intervention. The physician involved with the initial evaluation of these patients must have a working knowledge of foreign bodies of the gastrointestinal tract to facilitate appropriate and timely management and referral.

Management of foreign bodies of the upper gastrointestinal tract

In the United States, 1500 people die yearly of ingested foreign bodies of the upper gastrointestinal tract. The flexible esophagogastroduodenoscope has had a major impact on the treatment of these foreign bodies. The following discussion includes the management of coins, meat impaction, sharp and pointed objects, button batteries, and cocaine packets; and it reflects both a personal experience and a review of the literature. The uses of the rigid and the flexible endoscopes, the Foley catheter, glucagon, papain, and gas-forming agents are presented. The cost-effectiveness impact of the flexible endoscope is also detailed, and morbidity and mortality rates for foreign body management are included.

Fatal aspiration pneumonia caused by an esophageal foreign body

Esophageal foreign body accompanied by respiratory complications is a rare condition. A few cases have been reported, only two of them in adults. We describe the case of a 34-year-old mentally retarded patient who was hospitalized for aspiration pneumonia and died 48 hours after admission. At autopsy, the prominent finding was a 3 X 3-cm stone impacted into the upper esophagus and compressing the trachea from behind. The possibility of an esophageal foreign body should be included in the differential diagnosis of unexplained respiratory distress or aspiration pneumonia in adults.

Dental prosthesis as an unsuspected foreign body

Ingested or aspirated dental prostheses may cause dysphagia and respiratory obstructions. We present the case of a patient with dementia who had a dental prosthesis lodged in his hypopharynx. This patient had routine radiologic studies and diagnostic scans to rule out primary and metastatic disease, was placed on total parenteral nutrition, and underwent several endoscopies before his dysphagia was related to aspiration of a dental prosthesis. The prosthesis was evident on radiologic examination, but was overlooked by the admitting service in the patient's differential diagnosis. After removal of the appliance, the patient had an uneventful recovery and was discharged after a 22-day hospital stay. Early diagnosis and definitive patient treatment depends on prompt recognition. The importance of recognizing the radiographic appearance of a dental prosthesis is emphasized.