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  • • Ingestion of foreign object or bolus of meat

    • May be asymptomatic or accompanied by dysphagia, chest pain, or respiratory distress

    • Radiopaque objects can be detected on chest x-ray

    • Rings, webs, and bands usually detected by endoscopy or contrast radiographic study

    • Endoscopic treatment (extraction of foreign objects or dilation of ring, web or band) is usually successful

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Epidemiology

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  • Foreign objects

    • -90% pass into the stomach and pass without incident

      -Usually lodge just beyond the cricopharyngeus

      -Most cases occur in children; in adults esophageal meat impaction is most common and many affected patients have underlying esophageal disease

      -10% require endoscopic removal, and 1% require surgery

      -Cocaine smugglers may swallow small packets of cocaine which, if ruptured, can be fatal

    Congenital bands or webs may develop at any level but are most frequent in the subcricoid region

    Schatzki ring: Narrow mucosal ring at the squamocolumnar junction that occurs with gastroesophageal reflux

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Symptoms and Signs

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  • • May be asymptomatic

    • Dysphagia

    • Chest pain

    • Respiratory distress

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Imaging Findings

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  • Anteroposterior and lateral chest film

    • -If ingested object is radiopaque, determine whether the object is in the esophagus or trachea

      -X-ray small children from the base of the skull to the anus in order to find any additional objects in the gut

    • Endoscopy will identify foreign objects suspected of causing esophageal obstruction

    • Endoscopy or contrast radiography may identify esophageal rings, bands, or webs that may be associated with esophagitis

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Rule Out

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  • • Underlying esophageal disease precipitating obstruction, particularly with meat impaction

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  • • If radiopaque foreign object, chest film may be performed

    • Most foreign objects as well as webs, rings, or bands can be diagnosed endoscopically

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When to Admit

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  • • Suspected esophageal perforation

    • Severe respiratory distress

    • Need for surgery

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  • • Foreign objects should be removed promptly

    • Most extracted endoscopically

    • Webs, bands, and rings are treated by endoscopic dilation

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Surgery

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Indications

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  • • Inability to treat endoscopically

    • All ingested packets containing cocaine

    • -Endoscopic extraction may cause rupture and death

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Treatment Monitoring

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  • • Subsequent diagnostic endoscopy to exclude underlying esophageal disease

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Complications

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  • • Esophagoaortic or esophagotracheal fistula

    • Tracheal obstruction and aspiration

    • Esophageal ulceration or perforation

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Prognosis

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  • • 1500 deaths yearly from complications of ingested foreign bodies

    • Most webs, rings, and bands treated effectively by dilation

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References

Arana A et al. Management of ingested foreign bodies in childhood and review of the literature. Eur J Pediatr. 2001;160:468.  [PubMed: 11548183]

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