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Foreign bodies in the esophagus create urgent but not life-threatening situations as long as the airway is not compromised. There is probably time to consult an experienced clinician for management. It is a useful diagnostic sign of complete obstruction if the patient is drooling or cannot handle secretions. Patients may often point to the exact level of the obstruction. Indirect laryngoscopy often shows pooling of saliva at the esophageal inlet. Plain films may detect radiopaque foreign bodies, such as chicken bones. Coins tend to align in the coronal plane in the esophagus and sagittally in the trachea. If a foreign body is suspected, a barium swallow may help make the diagnosis.

The treatment of an esophageal foreign body depends very much on identification of its nature. In children, swallowed nonfood objects are common. In adults, however, food foreign bodies are more common, and there is the greater possibility of underlying esophageal pathology. Endoscopic removal and examination are usually best via flexible esophagoscopy or rigid laryngoscopy and esophagoscopy. If there is nothing sharp, such as a bone, some clinicians advocate a hospitalized 24-hour observation period prior to esophagoscopy, noting that spontaneous passage of the foreign body will occur in 50% of adult patients. In the management of meat obstruction, the use of papain (meat tenderizer) should be discouraged because it can damage the esophageal mucosa and lead to stenosis or perforation.

Chirica  M  et al. Esophageal emergencies: WSES guidelines. World J Emerg Surg. 2019;14:26.
[PubMed: 31164915]  

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