Esophageal foreign bodies - Causes and pathogenesis

Causes of Foreign Bodies in the Esophagus

Foreign bodies entering the esophagus in children and the elderly are caused by the failure of the dental system, inattention and lack of self-control during meals, insufficient chewing of food when young children eat hastily, also important are the incomplete development and imperfect innervation of the laryngopharynx, insufficient supervision, defects in the organization of child care, insufficient fixation of cotton swabs for treating the oral cavity in newborns and infants, the use of faulty tubes for feeding the child, improper selection of toys and things around the child, playing with small objects, faulty pacifiers, various objects that children are given to chew on when teething, increased activity and curiosity of children, the habit of putting various small objects in the mouth, especially while running and playing. Older children swallow foreign bodies during games and when eating hastily. Multiple foreign bodies that normally pass freely into the stomach (crusts of bread, peas, small pieces of food, small coins) are retained in the stenotic esophagus, especially if the child continues to be fed despite the dysphagia phenomenon. Foreign bodies are often put into the mouths of infants by older sisters and brothers out of jealousy towards their parents.

In terms of the development of severe complications, late seeking of medical care, difficulties in diagnosis in young children, and insufficient use of available diagnostic methods in the pre-hospital medical care plan are important.

Pathogenesis of foreign bodies in the esophagus

The main role in the mechanism of foreign body infringement is played by the circular muscle layer, the most massive of the form-forming elements of the esophageal wall at the level of the cricoid cartilage of the larynx. Powerful contractions of the lower pharyngeal constrictor promote the movement of foreign bodies directly from the area of the upper stenosis of the esophagus to the underlying cervical part, where they are retained. In the development of complications of foreign bodies of the esophagus, late diagnostics, trauma to the esophageal wall by a pointed foreign body or iatrogenic trauma during attempts to remove foreign bodies are of primary importance, as is the level of qualification of the surgeon.

The presence of foreign bodies in the esophagus is dangerous in terms of the possibility of injury and infection of the soft tissues of the esophagus, the spread of infection to the periesophageal tissue and mediastinum, perforation of the esophageal wall with similar consequences, as well as the possibility of injury to adjacent organs. Most often, this concerns the wall of the aorta, the perforation of which largely depends on the variants of its topographic position in relation to the esophagus.

Perforation of the esophagus by foreign bodies almost always occurs on the posterior, least mobile wall. Perforation is followed by periesophagitis, gangrenous-purulent phlegmon, mediastinitis, emphysema, and sepsis. Usually, these complications lead to the death of the patient within 3-5 days, even despite massive antibiotic therapy. The probability of saving the victim from these complications increases significantly if surgery is performed no later than 24-48 hours after perforation of the esophagus. As noted by A. I. Feldman (1949), there are rare cases when a rupture of the esophagus wall ends successfully even with non-surgical treatment, provided that foreign bodies are removed early, no later than 8 hours after perforation. Other complications of esophageal perforation by a foreign body include damage to the recurrent nerve, vertebral osteomyelitis, spinal pachymeningitis, and brain abscess.

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