Describe foreign bodies in the throat and oesophagus.

Foreign Bodies in the Throat and Oesophagus

• Foreign bodies in the throat lodge at the tonsil, tongue base, vallecula, pyriform fossa or the oesophagus.
• They are common, straightforward, and occasionally lethal — and the whole skill lies in recognising which is which.
• The sites of impaction in the oesophagus are its three normal constrictions — the cricopharyngeal sphincter at 15 cm from the incisors, which is much the commonest; the aortic arch and left main bronchus at 25 cm; and the oesophagogastric junction at 40 cm
• WHO and what — children swallow coins, buttons, batteries and toys; adults impact fish and meat bones, and meat bolus; and bolus obstruction in an adult suggests an underlying oesophageal abnormality — a stricture, ring, malignancy or eosinophilic oesophagitis — which must be investigated afterwards, not merely relieved
• The edentulous, those with dentures (which reduce palatal sensation), the intoxicated, the elderly and the psychiatrically unwell are at particular risk
• Features — a clear history.
• The three emergencies, which must be recognised immediately:
• 1. A disc (button) battery — which causes liquefactive necrosis from local alkali generated by the current within hours.
• A battery is distinguished on radiograph by its double-ring or halo sign and a step-off on the lateral view, unlike the uniform disc of a coin — and if there is any doubt, treat it as a battery
• 2. Paired magnets, which attract across bowel walls and cause pressure necrosis, fistula and perforation
• 3. Complete obstruction with drooling and inability to manage secretions.
• Investigation — plain radiographs of the neck (lateral soft tissue) and chest, and abdomen where indicated. Radiolucent objects — fish bones, plastic, most food — are frequently not visible, so a normal radiograph does not exclude a foreign body
• A coin in the oesophagus lies in the coronal plane (flat on the AP film).
• Look for surgical emphysema and widening of the prevertebral soft tissue.
• Barium should not be given where endoscopy is planned or perforation is suspected.
• CT is used where perforation is suspected or the object is not found
• Management — Direct visualisation and removal with forceps for an accessible tonsillar or tongue base foreign body, under good light after topical anaesthesia
• Rigid or flexible oesophagoscopy under general anaesthesia for an oesophageal foreign body.
• A smooth object in the stomach may be observed.
• Do not push an oesophageal foreign body into the stomach blindly