Esophageal Foreign Bodies

Esophageal foreign bodies take many forms: they may be smooth or blunt, food or nonorganic objects, and ingestion may be intentional or accidental. History may be absent, and symptoms vary; the diagnosis and management largely depend on a high index of suspicion, the nature of the object ingested, and the symptoms and signs present. Although less than 1 % of foreign body ingestions result in perforation or other serious complications, they account for 15% of esophageal perforations. Once past the esophagus, most foreign bodies pass through the GI tract without complication.

Causes

The cause of swallowed GI foreign bodies is accidental.

• Young children often put any object they find into their mouths and may accidentally swallow them.
• Older children also put smooth objects, such as coins or marbles, in their mouths and may swallow them. But, because their esophagi are greater in diameter than those of young children, foreign body lodgment in this location is less common in older children.
• Repeated cases may suggest a chaotic home environment and neglect.
• Children with known GI tract abnormalities or previous complications of foreign body ingestion are more likely to have complications.
• Older children may be seeking attention or be manifesting psychological abnormalities.
• In adults, accidental swallowing involves toothpicks, dentures, and other objects.
• Psychiatric patients may swallow a wide variety of objects, such as including multiple objects, large objects, and bizarre items.

Symptoms

• Suspected ingestion in small children +++, but more than half of children with an esophageal foreign body have no such history; up to 18% are asymptomatic.
• Choking, gagging, or coughing that has resolved on arrival to the ED is a common presentation.
• Poor feeding
• Drooling
• Vomiting
• Difficulty swallowing
• Older children and adults usually report chest, throat or neck pain, dysphagia, or foreign body sensation.

Signs

• Physical signs are absent in most of childhood ingestions +++.
• Drooling
• For delayed cases, see Esophageal Rupture

Treatment

• Most children who have swallowed a foreign body do not require specialized care.
• Patients with drooling may require suction.
• Children benefit by being allowed to remain with their parents and being allowed to assume a position of comfort
• Do not attempt to dislodge a foreign body from a spontaneously breathing patient by giving abdominal thrusts or syrup of ipecac.