8-33: Foreign Bodies in the Esophageal

Foreign bodies in the esophagus create are typically not life-threatening situations. However, the acuity may rise depending on the type of foreign body (eg, a button battery) or if the airway is compromised. Button battery ingestion is a surgical emergency. If there is no concern for caustic ingestion or airway compromise, there is typically time to consult an otolaryngologist 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 in the sagittal direction in the trachea. If a foreign body is suspected, a CT or barium swallow may also help make the diagnosis.

The treatment of an esophageal foreign body depends on identification of its cause. 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. 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. Esophageal foreign bodies that do not pass need to be removed surgically. Endoscopic removal and examination are usually best via flexible esophagoscopy or rigid laryngoscopy and esophagoscopy. Complications of penetrating or erosive esophageal foreign bodies may include mediastinitis or erosion in the trachea with associated tracheitis.