How to differentiate between foreign body in trachea and esophagus?
Answers
Most patients who present for evaluation of a foreign body in the esophagus do so after accidental ingestion of a known object, and the patient has mild symptoms and is in stable condition. The challenges come from patients who are unable or unwilling, for example, infants, children, mentally-impaired, psychiatric, prisoners, to provide a history of the object ingested or when it occurred. Also, the wide range of possible symptoms and clinical presentations, plus the wide range of potential complications, can make this a difficult condition to evaluate and manage
In adults, the esophagus is approximately 20 to 25 cm in length extending from the hypopharynx to the stomach. The esophagus has an inner mucosa layer and a muscle layer made up of inner circular muscles and outer longitudinal muscles. The upper third is voluntary striated muscles that allow initiation of swallowing, while muscles of the lower third are involuntary smooth muscles.
The esophagus is the most common site for acute foreign body or food impaction in the gastrointestinal tract and 80% to 90% of swallowed objects that reach the stomach will eventually pass without intervention.
While a wide variety of objects could be ingested, common accidental esophageal foreign body ingestions include food bolus (mostly meat), fish or chicken bones, dentures, and coins. The type of objects ingested varies between different regions and cultures. For example, in southern China, fish bones were the most common esophageal foreign body impaction.
Assuming a stable airway and no developing complications, the treatment and management are guided by the type of foreign body, the location, the degree of obstruction and the duration. Endoscopic removal is the procedure of choice and is successful more than 90% of cases with less than 5% complication rate. Endoscopic management can be divided into emergency, urgent, and nonurgent.
Emergency
Esophageal Obstruction: Inability to handle oral secretions
Disk batteries in the esophagus
Sharp-pointed objects in the esophagus
Urgent (within 12 to 24 hours)
Esophageal objects that are not sharp-pointed
Food impactions without complete obstruction
Sharp-pointed objects in the stomach or duodenum
Objects greater than 6 cm in length above duodenum
Multiple magnets (or single magnet plus another ferromagnetic object within endoscopic reach)
Coins in esophagus