Foreign bodies of the esophagus: causes and pathogenesis

Causes of foreign bodies of the esophagus

Foreign bodies entering the esophagus in children and the elderly are facilitated by the incompetence of the dentoalveolar system, inattention and lack of self-control during meals, insufficient chewing food with hasty eating of young children, the incompleteness of the development and imperfection of the innervation of the larynx is also important, insufficient supervision, for children, insufficient fixation of cotton swabs for oral cavity treatment in newborns and infants, use of faulty probes for a long time child feeding, improper selection of toys and the things surrounding the child, games with small items, malfunctioning nipples, various items that children give gnawing teeth, increased activity and curiosity of children, the habit of taking in mouth various small items, especially during running and playing . Older children swallow foreign bodies during games and with hasty food. In the stenosed esophagus, multiple foreign bodies that normally freely pass into the stomach (crusts of bread, peas, small parts of food, small coins) are delayed, especially if the child continues to be fed, despite the dysphagia of the phenomenon. Foreign bodies to infants are often put into the mouth by older sisters and brothers because of jealousy towards parents.

In terms of the development of severe complications, the late application for medical assistance, the difficulties of diagnosis in young children, the insufficient use of available diagnostic methods on the prehospital plan for the provision of medical care are important.

Pathogenesis of foreign bodies of the esophagus

The main role in the mechanism of infringement of foreign bodies is played by the circular muscular layer, the most massive of the formative elements of the esophageal wall at the level of the cricoid cartilage of the larynx. Powerful contractions of the lower constrictor of the pharynx promote the advance of foreign bodies directly from the region of the upper narrowing of the esophagus into the underlying neck part where they linger. With the development of complications of foreign bodies of the esophagus, late diagnosis, esophageal wall injury by a pointed foreign body or iatrogenic trauma when trying to remove foreign bodies are of major importance, the level of surgeon's qualification also matters.

The presence of foreign bodies in the esophagus is dangerous with respect to the possibility of injury and infection of the soft tissues of the esophagus, the spread of infection to the near-esophageal cellulose and mediastinum, perforation of the esophagus wall with similar consequences, and the possibility of injuring neighboring organs. Most often this affects the aortic wall, the perforation of which largely depends on the variants of its topographical position in relation to the esophagus.

Perforation of the esophagus by foreign bodies almost always occurs on the posterior, least movable wall. Following perforation, peri-esophagitis, gangrenous-purulent phlegmon, mediastinitis, emphysema, sepsis develop. Usually, these complications lead to the death of the patient within 3-5 days, even despite massive antibiotic therapy. The probability of rescuing the victim from these complications increases significantly if surgery is performed no later than 24-48 hours after perforation of the esophagus. As AI Feldman (1949) notes, there are rare cases when the rupture of the esophagus wall ends safely and with nonoperative treatment, provided that the foreign bodies are removed no earlier than 8 hours after perforation. Of the other complications of esophageal perforations by an alien body, damage to the recurrent nerve, vertebral osteomyelitis, spinal pachymeningitis, and cerebral abscess should be noted.

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