Foreign Bodies of Food Passage

Foreign Bodies (FB) of Food Passage

Overview: Ingested foreign bodies may lodge in the tonsil, base of tongue, posterior pharyngeal wall, pyriform fossa, or oesophagus.

Specific Sites & Removal

1. Oropharynx & Hypopharynx

Site	Common FB	Management
Tonsil	Fish bone, needle (in crypts)	Observation & Removal.
Base of Tongue / Vallecula	Fish bone, needle	Mirror/Endoscope + Curved Forceps. Note: Embedded needles may require Pharyngotomy.
Posterior Pharyngeal Wall	Wire, needle, staple	Usually visible on exam; removal with forceps.
Pyriform Fossa	Fish/Chicken bone, Denture	Small FB: Local anaesthesia + Curved forceps. Large FB: General Anaesthesia + Endoscopy.

2. Oesophagus

Common Objects: Coin, meat, chicken bone, denture, safety pin, marble, disc batteries.
Site of Lodgement:
- Cricopharyngeal Sphincter (Most common site).
- Bronchoaortic constriction.
- Cardiac end.
Clinical Alert: If FB lodges lower down, suspect underlying stricture or malignancy (in adults).

Aetiology

Age: 80% are children < 5 years (exploratory nature).
Loss of Protective Mechanism: Upper dentures (loss of tactile sensation), Deep sleep, Epilepsy, Alcohol.
Carelessness: Hasty eating, poorly prepared food.
Narrowed Lumen: Stricture or Carcinoma (First symptom of Ca Oesophagus may be sudden obstruction).
Psychotics: Deliberate ingestion (suicide attempt).

Clinical Features

Symptoms:

History of choking/gagging.
Dysphagia: Partial or Total (Drooling of saliva).
Pain: Supraclavicular, Substernal, or Epigastric.
Respiratory Distress: Tracheal compression (common in children).

Signs:

Tenderness in lower neck (Right or Left of trachea).
Pooling of secretions in Pyriform Fossa (Indirect Laryngoscopy).

Investigations

X-Ray (Neck, Chest, Abdomen): PA and Lateral views.

Coins: Coronal plane in PA view (Oesophagus) vs. Sagittal plane (Trachea).
Radiolucent FBs: May show as an Air Bubble in cervical oesophagus (Lat view).
Disc Batteries: Double shadow or "Stacked coin" appearance.

⚠ Do NOT do Barium Swallow: Risk of aspiration into larynx + makes subsequent endoscopy difficult.

Management

1. Oesophageal Foreign Bodies

Rigid / Flexible Oesophagoscopy (Under GA)

↓

Cervical Oesophagotomy (If impacted near inlet)

↓

Transthoracic Oesophagotomy (Thoracic oesophagus)

2. Foreign Bodies in Stomach (Passed Pylorus)

Usually pass spontaneously. Check stools for 3-4 days. Operate ONLY if:

Pain/Tenderness in abdomen.
No progress on X-ray over several days.
Sharp object (Needles, Pins).
Long object (>5cm) in young child (cannot pass duodenum).
Pyloric stenosis present.

Special Topic: Disc Batteries

Contain NaOH, KOH, Mercury. Extremely Dangerous.

Timeline of Injury:
⏰ 1 Hour: Mucosal damage
⏰ 2-4 Hours: Muscle coat damage
⏰ 8-12 Hours: PERFORATION

Management: Remove promptly! If in stomach (child < 6y, size > 1.5cm), remove if not passed in 48h.

Important Caveats

NO Foley's Catheter: Risk of aspiration into pharynx.
NO Pushing Down: Do not push FB into stomach blindly.
NO Papain (Meat Tenderizer): Can digest oesophageal wall.
NO Glucagon: Does not relax strictures/rings.

Comparison: Rigid vs. Flexible Oesophagoscopy

Feature	Rigid	Flexible
Anaesthesia	General	Topical (+/- Sedation)
Route	Oral	Oral (or Nasal)
Neck Issues	Cannot be done in stiff neck/jaw	Can be done
FB Removal	Easy (Various forceps, can ensheath sharp objects)	Difficult for impacted/sharp objects. Limited forceps.
Setting	Requires Admission (OT)	Outpatient

📚 Source: ENT Dhingra

MedicosHelper