DOI No.: 10.21176/ ojolhns.0974-5262.2016.10.

A STUDY OF FOREIGN BODY OESOPHAGUS

*Richa Meena, **Vikas Sikarwar, ***R.S Bisht, ****Amit Arya

Date of receipt of article -04-01-2016

Date of acceptance -2-5-2016
DOI-10.21176/ojolhns.2016.10.1.5
ABSTRACT
Introductions: Esophageal foreign bodies (FB) and food bolus impaction is a common problem presented in
emergency. Children and elderly population are commonly affected. Although majority of esophageal foreign
bodies do not pose serious problem or mortality but, bodies like sharp objects and button batteries are dangerous
and may cause life threatening complications.
Objectives: This study was undertaken to know the epidemiology of foreign body ingestion, types of foreign
bodies commonly ingested, clinical features and investigations contributing in diagnosis; techniques of foreign
body removal, and complications associated with foreign bodies.
Methods: A positive history of foreign body ingestion, pain on deglutition, difficulty in swallowing, drooling
of saliva, is obtained. A thorough clinical examination including indirect laryngoscopy (IDL) is undertaken,
looking for evidence of FB viz. pooling of saliva, fullness in the postcricoid region, neck swelling and neck
crepitus. Children were especially screened for any respiratory distress due to foreign body oesophagus compressing
on the trachea. X Ray of neck & chest, anteroposterior and lateral views are done to confirm the diagnosis,
ascertain the type of foreign body, site of impaction and to look for other information like osteophytes,
retropharyngeal abscess etc. Rigid esophagoscopy under general anaesthesia was planned for removal of foreign
body.
Results: A total of 54 patients reported, in which Thirty six (66.66%) were males and eighteen (33.33%) were
females. Wide age group of patients was affected and youngest patient was 10 months old and oldest patient was
72 years old. In adults commonest foreign body is impacted food bolus .Commonest foreign body esophagus
found is coin, seen in thirty (55.55%) cases. In children commonest foreign body is coin i.e. in thirty cases and
other foreign bodies found were plastic button and button battery.
Key words: Foreign body, FB,Cricopharynx, Esophagus, esophagoscopy.

INTRODUCTION common in esophagus with underlying pathology like

Foreign body of esophagus is a common problem
in ENT emergencies, mostly seen in children and
elderly population. In adults its association with alcohol
intoxication, psychiatric disorders, edentulous
condition, is often noted 1, 2. Some foreign bodies are
particularly seen in specific age groups like coins in
children, Dentures and meat pieces in elderly
population. Particular types of foreign bodies like
button battery, sharp materials, that are capable of
inflicting greater damage, even perforation of esophagus,
must be removed immediately on emergency basis 3.
Whereas many foreign bodies like coins are benign in
nature, can be removed electively or may be waited for
spontaneous passage. Food bolus impaction is
stricture, malignancy, or some underlying disorders of
peristalsis 8 . Foreign body removal should be
meticulously planned for a better outcome.
Vol.-10, Issue-I, Jan-June - 2016
METHODS
A total of 54 patients were included in the study
who presented in ENT department of VSGGMS&RI
Affiliations:
*SeniorResident,**Assistant,professor,***Associate professor,****Senior
resident, Department of ENT and Head & Neck Surgery; Veer Chandra
Singh Garhwali Govt. Medical science and Research institute, Srinagar,
UK, India
Address of Correspondence:
Dr Vikas Sikarwar, Assistant professor
Room no 40, Deptt of ENT, Base hospital, VCSGGMS&RI, Srinagar U.K,
INDIA 246174;Cell : +91 9012754085;
E mail. vikassikarwar79@gmail.com.

29
 DOI No.: 10.21176/ ojolhns.0974-5262.2016.10.1
with foreign body ingestion or food bolus impaction
between August 2014 to July 2015.
A positive history of foreign body ingestion, pain
on deglutition, difficulty in swallowing, drooling of
saliva, is obtained. A thorough clinical examination
including IDL is undertaken, looking for evidence of
FB viz. pooling of saliva, fullness in the postcricoid
region, neck swelling and neck crepitus.
Children were especially screened for any
respiratory distress due to foreign body oesophagus
compressing on the trachea. X Ray of neck & chest in
anteroposterior and lateral views are done to confirm
the diagnosis, ascertain the type of foreign body, site
of impaction and to look for other information like
osteophytes, retropharyngeal abscess etc. Rigid
esophagoscopy under general anaesthesia was planned
for removal of foreign body. The timing of procedure
was decided on the basis of the nature of foreign body
and clinical scenario. Foreign bodies with high
complications like sharp materials, button cells, magnets,
bones etc. were removed urgently in emergency.
Foreign bodies with near total obstruction or total
obstruction were also removed at the earliest possible,
whereas non corrosive foreign bodies and foreign bodies
with partial obstruction were removed in first elective
OT within 24 hours. Occasionally inert atraumatic,
asymptomatic foreign bodies were waited for
spontaneous passage. During procedure other fine
details are noted like nature of foreign body, site of
impaction , condition of surrounding esophageal tissue,
technique and type of instruments used for retrieval
and complications, if any . After retrieval of foreign
body, re- endoscopy was done to see for any other
foreign body, mucosal injury, previous stricture,
growth, malformation etc. as a cause for esophageal
impaction. Post procedure patient kept for observation
Vol.-10, Issue-I, Jan-June - 2016
for few hours and then discharged.
RESULTS
A total of 54 patients reported, in which Thirty
six (66.66%) were males and eighteen (33.33%) were
females. Wide age group affected, youngest patient was
10 months old and oldest patient was 72 years old.
Higher incidence was seen in children in comparison
to adults, thirty-four (62.96 %) patients were under 10
years of age, and in case of adults highest incidence was
seen in the age group of 41-50 years, a total of 10 cases
30
(18.51%) were reported. Time interval between ingestion
and retrieval of foreign body was 1-7 days. Thirty six
(66.66%) patients were seen within 24 hours after
ingestion of foreign body. Ten (18%) patients were seen
between 24-48 hours after ingestion. Rest of the patients
were seen between 2-7 days. Commonest foreign body
esophagus found is coin, seen in thirty (55.55%) cases.
In children commonest foreign body is coin (30) and
other foreign bodies found were plastic button and
button battery. In adults commonest foreign body is
impacted food bolus see in ten cases followed by
dentures seen in five cases. In adults, association of
esophageal foreign body and intoxication was seen in
ten (18.51%) cases. Cricopharynx the most common
site of coin impaction was being seen in 78% of cases.
Food bolus impaction was mainly seen in upper 1/3rd
of esophagus. Esophageal foreign body related
complications such as mucosal damage but no
perforation were found in 2 cases. In these cases Ryles
tube was put prophylactically after FB removal.
DISCUSSION
Foreign body ingestion is a common problem
commonly seen in children and elderly population.
Children have a tendency of putting everything in
mouth and sometimes it is accidently ingested. Coin is
the commonest foreign body ingested by children 4. In
middle age population food bolus impaction generally
occurs under the influence of alcohol intoxication. In
elderly population denture ingestion is a common
problem. Older children and Adult patients generally
give the history of foreign body ingestion but small
children and psychotic patients may not give proper
history. So probable diagnosis must be made on the
basis of suspicion raised by the parents and presenting
symptoms and signs like vomiting, dysphasia, pain,
drooling of saliva, choking and respiratory distress 5.
Radiological investigations are important in
identifying the type of FB, its shape, size and location.
It also gives the information regarding the condition
of surrounding tissue and complications if any viz.
cellulitis, retropharyngeal abscess, gas shadow,
prevertebral widening, straightening of vertebral bodies
etc. X-ray neck & chest anterior-posterior & lateral
views can readily identify most of the foreign bodies,
but some foreign bodies like a thin fish bone, plastics,
wood, are not identifiable in X-rays. Even in case of

negative radiological findings, if history of foreign body
ingestion is there and supportive esophageal signs and
symptoms are present then esophageal endoscopy
should be done 6.
Timing of foreign body removal depends on the
type of foreign body ingested, severity of dysphagia,
and risk of aspiration, age of the patient and duration
of foreign body impaction. Sharp foreign body in
esophagus is a medical emergency as it may cause
esophageal perforation and it must be retrieved earliest
possible 7 . Coin in esophagus generally passes
spontaneously, can be watched for 24 hours if patient
is asymptomatic. Button battery in esophagus is a
medical emergency due to its corrosive nature and it
may cause perforation of esophagus if not removed
early 3. Esophageal foreign objects and food impactions
should be removed within 24 hours because; as duration
increases it makes successful removal difficult and
increases the risk of complications including risk of
perforation 8.
Esophageal foreign body is retrieved with rigid
or flexible esophagoscope, both has its merits and
demerits. Flexible esophagoscope has the advantage that
it can be performed under sedation in cooperative
patients. It also has less chances of esophageal
perforation 9.Rigid oesophagosopy has high success rate
of foreign body removal and it aids in air way
protection 9.Various retrieval forceps and devices are
available, like rat tooth forceps, crocodile forceps,
peanut forceps, Dormier baskets for smooth round
foreign bodies, polypectomy snare. Rigid
esophagoscopy is an effective and safe means of foreign
body removal when handled by an experienced
operator.
CONCLUSIONS
Foreign body ingestion is common in children
and elderly population. In Children and adults
commonest foreign bodies are coin and meat bolus
respectively. In adults, association between food bolus
impaction and alcohol intoxication is clearly established.
Even without reliable history, suspicion of foreign body
on the basis of signs & symptoms of child is an
indication for esophagoscopy. Sharp and corrosive
foreign bodies should be removed at the earliest on
emergency basis to avoid perforation and subsequent
life threatening complications. Small asymptomatic,
DOI No.: 10.21176/ ojolhns.0974-5262.2016.10.1
non traumatic, inert foreign bodies may be watched
for spontaneous expulsion. Rigid esophagoscopy is an
effective and safe means of foreign body removal when
handled by an experienced operator.
DISCLOSURES
(a) Competing interests/Interests of Conflict- None
(b) Sponsorships - None ,
(c) Funding - None
(d) No financial disclosures
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