Foreign bodies of the esophagus

The ingestion of foreign bodies poses a great danger, especially in early childhood, in connection with the threat of development of severe, life-threatening complications and the difficulty in removing these foreign bodies.

ICD-10 code

T 18.1 Consequences of penetration of a foreign body into the esophagus.

Epidemiology of foreign bodies of the esophagus

Foreign bodies most often swallow children aged 1-5 years. Non-food foreign bodies predominate (63%). Most foreign bodies are retained in the first physiological constriction (about 65% of cases), foreign bodies of the second physiological constriction are 29% and the third narrowing is 6%.

[1], [2], [3], [4]

Symptoms of foreign bodies of the esophagus

Foreign bodies usually get stuck in places of physiological narrowing of the esophagus, such as the cryopharyngeal zone, the region of the aortic arch or above the esophageal-gastric junction. If there is a complete obstruction, regurgitation or vomiting occurs. There is drooling due to the inability to swallow saliva.

Types of foreign bodies of the esophagus

Foreign bodies - objects alien to the body, concrements and living objects (parasites, insects), embedded in its tissues and organs or cavities through natural openings, damaged skin or from the intestine, violating the functions of the affected tissues, causing appropriate inflammatory reactions and causing significant concern to the affected . Foreign bodies are divided into domestic and gunshot, accidental and deliberate (suicidal), exogenous and endogenous, as well as foreign bodies swallowed by young children and persons with mental disabilities. In wartime, firearm foreign bodies acquire a mass character. When introducing a foreign body into the tissue in the occurrence of complications, an important role is played by infection. In the absence of infection or with a sufficiently active resistance of the organism of this infection and its weak virulence, an inactive physicochemically foreign body causes aseptic inflammation with proliferation of connective tissue leading to encapsulation, i.e., the formation of a scar around the foreign body. Encapsulated aseptic foreign bodies remain in the tissues, causing disorders only in certain localizations (proximity to the nerve trunk, joint bag, pleura, etc.). Encapsulated wartime firearms can be in soft tissues, for example in muscles, for decades, causing anxiety in such individuals only under unfavorable weather conditions (seasonal crises). Radioactive and chemically active, as well as poisonous foreign bodies, destroy tissues, causing necrosis, and sometimes general poisoning. For example, fragments of the rod of an aniline copy ("chemical") pencil, or a wound applied by the end of a ball pen containing chemically active paste against biological tissues, are dangerous to the skin, mucous membrane of the oral cavity. Radioactive foreign bodies, remaining in tissues, lead to necrosis and disintegration of them with the formation of ulcers, destruction of neighboring vessels, nerves and other surrounding tissues at the distance of the action of radiated energy or particles. Bimetallic foreign bodies consisting of a junction of two metals generate a current (analogous to a bimetallic denture) that can affect adjacent pain receptors or nerve trunks, causing local and irradiating pain in the course of these trunks.

Bacterially contaminated foreign bodies are the cause of implant infection. Usually around the infected foreign body an abscess is formed, which in unstable tissues (substance of the brain, liver, mediastinal tissue) is able to move, usually in the direction of gravity. This phenomenon, in addition to the proteolytic action of pus, is associated with the pressure of the foreign body, causing bedsore on the pyogenic membrane (capsule), the destruction of which promotes the movement of the foreign body and the progress of the infectious process. Such migration of a foreign body accompanied by a spreading purulent inflammation can lead to damage to the blood vessel or prolapse of the foreign body to the hollow organ. For example, there are cases of significant bullet migration when it enters a large venous trunk or the migration of a metal fragment that has entered the pleural cavity. When a pus breakthrough through the skin or into the wound, a fistula is formed, leading to the foreign body and supported by it.

With a high level of protective forces of the organism, as mentioned above, it is possible to encapsulate infected foreign bodies, which sometimes become aseptic, but can retain a dormant infection, especially spores of the causative agent of tetanus, anthrax, gas gangrene. With the weakening of the body and immunodeficiency states, the probability of implantation of foreign bodies decreases, but sterile and biologically inert foreign substances can get used even in acute radiation sickness. This feature is widely used in plastic surgery, with osteosynthesis, vascular prosthetics, etc.

Classification of foreign bodies of the esophagus

Foreign bodies linger in one of the physiological constrictions of the esophagus: the first is the place of the pharyngeal passage into the esophagus at the level of the lower edge of the cricoid cartilage of the larynx, the second is the tracheal bifurcation area and its intersection with the aortic arch, the third is the cardiac compartment, the place of the esophagus into the stomach.

[5], [6], [7], [8], [9], [10]

Treatment of foreign bodies of the esophagus

Urgent endoscopic removal of acute objects, coins from the proximal esophagus, as well as any foreign body that causes obstruction symptoms is indicated. In addition, batteries stuck in the esophagus can cause direct corrosion damage, low-voltage burns and positional necrosis, which requires their immediate removal.

Other foreign bodies of the esophagus can be removed within 12-24 hours. Intravenous administration of 1 mg of glucagon causes sufficient relaxation of the esophagus to induce a spontaneous passage of the object. Other methods, such as gas-forming substances, meat tenderers and bougie, are not recommended. Removal of foreign bodies is best achieved using a forceps, a basket or a trap with the introduction of a probe into the esophagus to prevent aspiration. Endoscopic removal of foreign bodies of the esophagus is the method of choice.

Sometimes, during migration, foreign bodies damage the esophagus, but do not get stuck. In such cases, patients can complain about the sensation of having a foreign body in the esophagus, even if it is absent.