ESOPHAGEAL FOREIGN BODY

Question 1

Approach to the Critically Ill Esophageal Foreign Body

Answer 1

A - Stridor
Suctioning for drooling patients. Intubate if unable to control secretions.
B - RR 30, 02 sats 90% on Fi02 30%
C - mottled appearance
D - GCS, PERRLA & check glucose
E - Exposure, take down dressings.
Full HEENT Exam for foreign bodies

Monitor
O2 Target to 94%. AVOID NIPPV
Vitals
IV Access: 2 large bore IV
Equipment for Airway and ECG

Elevate Head of Bead to 45 degrees

Urgent Surgery or GI consult for:
Button Battery
Severe symptoms
Unable to tolerate secretions
Airway compromise
Multiple magnets
Magnet with metallic objects
Objects in Esophagus > 24 hrs
Large size > 2.5 cm W or 6 cm L

Question 2

DDx

Answer 2

Esophageal Rupture*
Esophageal spasm
esophagitis
Tracheal foreign body
Globus pharyngeus (globus sensation)

Question 3

Clinical Features: Adult

Answer 3

Acute onset Dysphagia
Restrosternal pain
Odynophagia
Drooling

Question 4

Clinical Features: Children

Answer 4

Coughing
choking
drooling
refusal to eat
difficulty swallowing

Question 5

Red Flags

Answer 5

Pooling of Secretions

Stridor

Subcutaneous Crepitus

Question 6

Investigations

Answer 6

H&P often adequate

+/- AP and Lateral XR Neck, Chest, Abdomen

CT Chest with IV contrast if concern for rupture

Question 7

Complications

Answer 7

Airway obstruction
Stricture
Perforation

Question 8

MCC of food impaction in adults and children

Answer 8

Food - adults
Coins - children

Question 9

Management: Indications for urgent Surgical or GI consult

Answer 9

Button Battery

Severe symptoms

Unable to tolerate secretions

Airway compromise

Multiple magnets

Magnet with metallic objects

Objects in Esophagus > 24 hrs

Large size > 2.5 cm W or 6 cm L

Question 10

Time line for button battery removal

Answer 10

4-6 hours due to perforation

Question 11

Management: Non urgent

Answer 11

Early consult with Surgery for EDG if persistent symptoms

For partial obstruction: glucagon 0.5-1 mg intravenous over 1-3 minutes. After 5-10 minutes, a repeat dose of glucagon 1-2 mg intravenous can be administered over 1-3 minutes. Beware vomiting.

For passage or removal without complications: discharge home with surgical follow up

90% of esophageal foerign bodies will spontaneously pass through the GI system

Question 12

Common locations of impaction. Most common location of impaction. Most common location for children. Most common location for adults

Answer 12

Upper esophageal sphincter, Aortic arch,
Lower esophageal sphincter

MC Location: cricopharyngeus muscle (75%)

MC Pediatric Location: upper esophageal sphincter (cricopharyngeal muscle) at the level of C6

MC Adult location: lower esophageal sphincter or gastroesophageal junction, at the level of T11