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Foreign bodies the aerodigestive tract

  • Children ingest foreign bodies whilst playing

  • Adults ingest foreign bodies either when intoxicated or for perceived gain
  • Most foreign bodies are innocuous and may require no active treatment
  • Other may warrant urgent removal

Oesophagus

  • Objects that stick in the oesophagus do so at sites of anatomical narrowings
  • Commonest sites are cricopharyngeus, aortic indentation and diaphragm
  • Usually present with acute dysphagia and drooling
  • Diagnosis may be confirmed with a plain x-ray
  • If object radiolucent and diagnostic uncertainty consider a water-soluble contrast study
  • Foreign bodies can usually be removed by rigid oesophagoscopy
  • Occasionally difficult with sharp objects (e.g. open safety pins)
  • If removal difficult then advancement into stomach is a safer option
  • Neglected objects can result in oesophageal perforation and mediastinitis
  • Can also result in fatal haemorrhage from an aorto-oesophageal fistula

Coin in the pharynx

Stomach

  • If a foreign body reaches the stomach it will usually pass spontaneously
  • Sharp objects may result in GI perforation often in the 3rd or 4th part of the duodenum
  • The only objects that require urgent retrieval are button batteries
  • Contain silver oxide, lithium and sodium hydroxide
  • If they leak they can cause major caustic injuries
  • Foreign bodies do not require the prescription of emetic or cathartic agents

A button battery within the stomach

Pharynx

  • Sharp objects (e.g. fish bones) can stick in the pharynx
  • Commonest sites are tonsil, pyriform fossa, and post-cricoid region
  • Objects often result in a  'scratch'
  • Symptoms can persist after object has passed
  • Diagnosis can often be confirmed by indirect laryngoscopy
  • Fish bones may be seen on a soft-tissue x-ray of the neck
  • May require removal under general anaesthetic
  • Often removed by the anaesthetist!

Bronchus and lung

  • Inhaled foreign bodies usually pass down the right main bronchus
  • Radio-opaque objects seen on chest x-ray
  • Radio-lucent objects (e.g. peanuts) are more dangerous and more difficult to diagnose
  • Organic material produces a inflammatory reaction
  • If neglected results can in bronchiectasis and a lung abscess

Rectal foreign body

Bibliography

Friedman E M.  Tracheobronchial foreign bodies.  Otolaryngol Clin North Am 2000;  33:  179-185.

Lai A T Y,  Chow T L,  Lee D T Y et al.  Risk factors predicting the development of complications after foreign body ingestion.  Br J Surg 2003;  90:  1531-1535.

Reilly J S.  Cash S P.  Stool D.  Rider G.  Prevention and management of aerodigestive foreign bodies in childhood.  Pediatr Clin North Am 1996;  43:  1403-1411.   

 

 
 

Last updated: 05 January 2008

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