Oesophageal emergencies: foreign bodies Flashcards
(19 cards)
What is the definition of oesophageal foreign bodies?
Swallowed foreign objects that become lodged in the oesophagus
This includes items such as coins, button batteries, and food boluses.
In what part of the oesophagus do most oesophageal foreign bodies get lodged in children?
Majority children <10 years
Cervical (70%) > thoracic (20%) > lower oesophagus (10%).
Classify the types of foreign bodies found in the oesophagus.
True FB and food bolus
True FB includes coins, button batteries, and fish/chicken bones; food bolus is more common in adults.
What are the physiological narrowings that can cause oesophageal obstruction?
- Cricopharyngeus
- Aortic arch
- Left main bronchus
- Gastro-oesophageal junction (GOJ)
These narrowings can lead to difficulties in swallowing.
What are some benign causes of oesophageal stricture?
- Schatzki rings
- Peptic strictures
- Eosinophilic oesophagitis
Malignant strictures are uncommon due to long development phases.
What are common clinical symptoms of oesophageal foreign bodies?
- Dysphagia
- Odynophagia
- Refusal to eat
- Sensation of foreign body
- Respiratory symptoms (stridor in children)
- Drooling
Poor localisation of obstruction level may occur.
What is a severe complication of oesophageal foreign bodies?
- Perforation
- Complete obstruction
- Fistulisation
Complete obstruction can lead to inability to swallow saliva and pulmonary aspiration.
What is the initial management approach for complete airway obstruction due to a foreign body?
Straight to endoscopy
Further imaging is not required if there are signs of complete airway obstruction.
What imaging techniques can be used for oesophageal foreign bodies?
- X-ray lateral neck soft tissue
- CT scan
CT can be considered if suspected perforation or sharp/pointed foreign bodies.
What factors influence the need for intervention in cases of foreign body ingestion?
- Clinical presentation
- Nature of foreign body (sharp vs blunt; small vs large)
- Location of impaction
- Duration of impaction
Majority of foreign bodies will pass with extent management.
What are indications for emergency intervention within 2-12 hours?
- Airway compromise
- Complete oesophageal occlusion
- Absolute dysphagia with aspiration risk
- Foreign body at pharynx/cricopharyngeus
- Sharp object or button battery in oesophagus
Signs of drooling are also a critical indicator.
What is the typical timeframe for a foreign body in the stomach to pass?
4-6 days
However, intervention is indicated for certain types of foreign bodies.
What are the criteria for surgical intervention in cases of foreign body ingestion?
- Signs of SBO, perforation, or bleeding
- Failed endoscopic retrieval
- Failure of extent management
- Failure to pass from stomach >72hrs
- Accumulation of multiple foreign bodies
- Size criteria: >2.5cm or >5-6cm long or sharp objects
Perforation risk is estimated at 35% for sharp objects.
In the case of incomplete obstruction, how long can endoscopic removal be delayed?
12 hours
Many foreign bodies may pass spontaneously in this timeframe.
What should be done with button batteries in the oesophagus?
Remove promptly
An acid-free environment predisposes to alkali burns.
What is the recommendation for ingested narcotic packages?
Endoscopic removal not advised
There is a risk of perforating the package, and they often pass without issue.
What percentage of oesophageal foreign bodies pass to the stomach?
90%
This statistic indicates a high likelihood that foreign bodies will move into the stomach.
If an oesophageal foreign body is greater than _______ cm, where does it tend to remain?
> 2.5 cm tends to remain in the stomach
Larger foreign bodies are less likely to pass through the digestive system.
What is the recommended follow-up procedure if a foreign body has not been removed?
Follow-up x-rays to ensure FB has passed through
This helps in monitoring the movement of the foreign body.
