Esophageal foreign bodies

Ingestion of foreign bodies is a major hazard, especially in early childhood, due to the risk of developing 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 in the esophagus

Foreign bodies are most frequently swallowed by children aged 1-5 years. Non-food foreign bodies predominate (63%). Foreign bodies are most frequently retained in the first physiological constriction (approximately 65% of cases), foreign bodies of the second physiological constriction make up 29% and of the third constriction - 6%.

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Symptoms of foreign bodies in the esophagus

Foreign bodies usually become lodged in areas of physiological stenosis of the esophagus, such as the cricopharyngeal zone, the aortic arch area, or above the esophageal-gastric junction. If complete obstruction occurs, regurgitation or vomiting occurs. Drooling occurs due to the inability to swallow saliva.

Types of foreign bodies in the esophagus

Foreign bodies are foreign objects, concretions and living objects (parasites, insects) that have penetrated into the body's tissues and organs or cavities through natural openings, damaged skin or from the intestines, disrupting the functions of the affected tissues, causing corresponding inflammatory reactions and causing significant discomfort to the victims. Foreign bodies are divided into household and gunshot, accidental and intentional (suicidal), exogenous and endogenous, as well as foreign bodies swallowed by small children and people with mental disorders. In wartime, gunshot foreign bodies become widespread. When a foreign body is introduced into tissue, infection plays a major role in the development of complications. In the absence of infection or with a fairly active resistance of the organism to this infection and its weak virulence, a foreign body that is inactive in a physicochemical sense causes aseptic inflammation with the proliferation of connective tissue, leading to encapsulation, i.e. to the formation of a cicatricial membrane around the foreign body. Encapsulated aseptic foreign bodies remain in the tissues, causing disorders only in certain localizations (proximity to a nerve trunk, joint capsule, pleura, etc.). Encapsulated foreign bodies from wartime gunshots can remain in soft tissues, for example, in muscles, for decades, causing concern in such individuals only under unfavorable meteorological conditions (seasonal crises). Radio- and chemically active, as well as poisonous foreign bodies, destroy tissues, causing their necrosis, and sometimes general poisoning. For example, fragments of an aniline copying pencil ("chemical") pen that have penetrated under the skin, into the eye, or into the oral mucosa are dangerous, or a wound caused by the end of a ballpoint pen containing a paste that is chemically active with respect to biological tissues. Radioactive foreign bodies, remaining in tissues, lead to their necrosis and disintegration with the formation of an ulcer, destruction of adjacent vessels, nerves, and other surrounding tissues at a distance of action of the radiated energy or particles. Bimetallic foreign bodies, consisting of a fusion of two metals, generate a current (similar to a bimetallic dental prosthesis), which can affect adjacent pain receptors or nerve trunks, causing local pain and pain radiating along the course of these trunks.

Bacterial contaminated foreign bodies cause implantation infection. Usually an abscess forms around the infected foreign body, which in fragile tissues (brain matter, liver, mediastinal tissue) is capable of moving, 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 a pressure sore on the pyogenic membrane (capsule), the destruction of which facilitates the movement of the foreign body and the progression of the infectious process. Such migration of the foreign body, accompanied by spreading purulent inflammation, can lead to damage to a blood vessel or prolapse of the foreign body into a hollow organ. For example, there are known cases of significant migration of a bullet when it enters a large venous trunk or the migration of a metal fragment that enters the pleural cavity. When pus breaks through the skin or into a wound, a fistula is formed, leading to a foreign body and supported by it.

At a high level of the body's defenses, as mentioned above, encapsulation of infected foreign bodies is possible, which sometimes become aseptic, but can retain a dormant infection, especially spores of the tetanus pathogen, anthrax, gas gangrene. With weakening of the body and immunodeficiency states, the probability of implantation of foreign bodies decreases, but sterile and biologically inert foreign bodies can be implanted even in acute radiation sickness. This feature is widely used in plastic surgery, osteosynthesis, vascular prosthetics, etc.

Classification of foreign bodies in the esophagus

Foreign bodies are retained in one of the physiological constrictions of the esophagus: the first is the place where the pharynx passes into the esophagus at the level of the lower edge of the cricoid cartilage of the larynx, the second is the area of the bifurcation of the trachea and its intersection with the aortic arch, the third is the cardiac section, the place where the esophagus passes into the stomach.

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Treatment of foreign bodies in the esophagus

Urgent endoscopic removal of sharp objects, coins from the proximal esophagus, and any foreign body causing obstructive symptoms is indicated. In addition, batteries lodged in the esophagus may cause direct corrosive injury, low-voltage burns, and positional necrosis, requiring urgent removal.

Other esophageal foreign bodies may be removed within 12 to 24 hours. Intravenous glucagon 1 mg relaxes the esophagus sufficiently to cause spontaneous passage of the object. Other methods, such as gas-forming agents, meat tenderizers, and bougienage, are not recommended. Foreign body removal is best accomplished using forceps, a basket, or a snare with a probe inserted into the esophagus to prevent aspiration. Endoscopic removal of esophageal foreign bodies is the method of choice.

Sometimes, when migrating, foreign bodies damage the esophagus but do not get stuck. In such cases, patients may complain of a sensation of a foreign body in the esophagus, even in its absence.