Esophagus foreign bodies

Esophagus foreign bodies.

1. MSHANGA MJEMMAS,RESIDENT. Dr: FILBERT MTENGA ,SPECIALIST. ESOPHAGUS-FOREIGN BODIES

2. CONTENTS: 2/6/2022 2 Introduction. Epidemiology. Types of FB. Batteries FB injury. Clinical symptoms. Diagnosis Investigation. Management. Complications.

3. Introduction: 2/6/2022 3 The esophagus is the most common site of foreign body impaction and common clinical emergencies occurred in ENT department. Bones, particularly fish bones, may be swallowed if the meat in which they are embedded is not chewed sufficiently.

4. 2/6/2022 4 Infants and toddlers do not have fully mature oropharyngeal coordination and often inadvertently swallow small round foods which may become impacted . infants and toddlers often swallow a wide variety of inedible objects ( eg , coins, batteries) accidentally or because they are curious, and some of these objects become impacted in the esophagus.

5. EPIDEMIOLOGY : 2/6/2022 5 Children more affected than adults. Peak incidence is in children less than 4 years of age (up to 75%) More of male than females. No evidence of racial/geographical reported. Rare cases lead into death.

6. TYPES OF FB. 2/6/2022 6 Organic materials. Non organic materials:- buttons, toys parts, pins and needles, coins, batteries. SITE OF EFB 70% of EFB lodges at the level of the cricopharyngeus muscles Other two parts includes :- mid esophagus and gastro esophageal junction. Coins and smooth blunt objects are the most commonly ingested items.

7. Continue: 2/6/2022 7 SUMMARY: Cricopharyngeus muscle (C6 level) 63%-84% Aortic crossover mid esophagus 10%-17% Lower esophagus sphincter 5%-20 %

8. Why common in children?? 2/6/2022 8 Lack of molar teeth, poor mastication. Natural tendency of putting objects in mouth. Playing with objects inside mouth. Easily distractibility. Other group who are more affected includes: Psychiatric patients. Prisoners.

9. BATTERIES UNIQUE INJURIES : 2/6/2022 9 Ingestion of disc batteries is becoming common because of their widespread use in hearing aids, toys, calculators and other electronic devices. They contain sodium hydroxide, potassium hydroxide and mercury which leaks through them to cause esophageal injury .

10. 2/6/2022 10 It is observed that a disc battery causes damage to mucosa in 1 h, muscle coat in 2–4 h and perforation of the esophagus in 8–12 h, therefore it should be removed promptly from the esophagus.

11. SIGN AND SYMPTOMS: 2/6/2022 11 Difficulty swallowing. Difficulty breathing. Drooling of salivary. Poor feeding . Chest pain. Hematemesis. Tachycardia.

12. Diagnosis of EFB: 2/6/2022 12 History taking and physical examination. Investigations. X ray of the neck and chest AP/Lateral view. Barium swallow:- radio lucent FB visualized( mayb use it or not)

13. Continue: 2/6/2022 13

14. Treatment: 2/6/2022 14 Observations :- within 24hrs, child still stable. Balloon Catheter removal: performed in local centers, 80% efficacy. Rigid esophagoscopy and foreign body removal with forceps. Gold standard modality. GA needed. With complication of orodental injury or iatrogenic perforation.

15. Complications of EFB: 2/6/2022 15 Respiratory obstructions. Periesophageal cellulites or abscess. Esophageal perforations. Trachea esophageal fistula. Esophageal stricture.

16. Prognosis 2/6/2022 16 80% to 90% of ingested foreign bodies will pass spontaneously within 3 to 7 days . Children with esophageal injury from disc battery need short and long-term follow-up to look for complications related to erosion or perforation and esophageal stricture. Adults with food impactions have abnormalities 85 to 90% of the time and will need evaluation and treatment of the underlining abnormalities.

17. References: 2/6/2022 17 Scott-Brown’s Otorhinolaryngology Head and Neck Surgery, volume 2 diseases of ear, nose and throat & head and neck surgery,6 th addition. https://canadiem.org/sirens-to-scrubs-esophageal-foreign-body-obstructions https://slidetodoc.com/foreign-bodies-foreign-bodies-foreign-body-aspiration-foreign Other internet sources.

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