1. Foreign bodies and chemical burns of
the esophagus
Presented by ;
v.ramya,
Tutor.

2. objectives
 The students will be able to
 -introduce esophageal foreign bodies and chemical burns
 -signs and symptoms of esophageal foreign bodies and
chemical burns
 -diagnostic findings of esophageal foreign bodies and
chemical burns
 - management of esophageal foreign bodies and chemical
burns

3. introduction
 Many swallowed foreign bodies pass through the
GI tract without the need for medical
intervention.
 However ,some swallowed foreign bodies (e.g.,
dentures ,fish bones ,pins ,small batteries ,items
containing mercury or lead ) may injure the
esophagus or obstruct its lumen and must be
removed .

4. Upper esophageal foreign body ( coin )

5. SIGNS AND SYMPTOMS
Pain and
 Dysphagia may be present
Dyspnea may occur as a result
of pressure on the trachea.

6. DIAGNOSTIC FINDINGS
The foreign Body may be
identified by X – Ray .

7. X -RAY

8. DIAGNOSTIC FINDINGS
Glucagon, because of its relaxing effect on
the esophageal muscle, may be injected IV.
A flexible endoscope and retrieval devices
(e.g ., forceps ,graspers) may be used to
remove the impacted food or object from
the esophagus.

9. Foreign bodies
 Foreign bodies such as short – blunt objects ,
 Long objects,
 Sharp – pointed objects ,
 Disc batteries,
 Magnets ,
 Coins,
 Or narcotic packets require special consideration.

10. bougienage procedure
 For example , dilation techniques such as bougienage
procedure can be used to facilitate the passage of
foreign objects.
 In bougienage ,cylindrical rubber tubes of different sizes
called bougies, are advanced in to the esophagus via the
oral cavity
 The dialator can manually advance the foreign object.
 The procedure usually is performed in the endoscopy
suite or clinic by the gastroenterologist.

11. bougienage procedure

12. Chemical burns

13. Chemical burns
 Chemical burns of the esophagus occur most
often when a patient , either intentionally ( 67 %
; typically adults ) or unintentionally (33 %
typically children ) , swallows a strong acid or
base , with alkaline agents being the most
common.
 The patient is often emotionally distraught as
well as in acute physical pain.

14. causes
Chemical burns of the esophagus may
also be caused by undissolved
medications in the esophagus ,or they
may also occur after swallowing a
battery , which may release a caustic
alkaline

15. Acute chemical burn
 An acute chemical burn of the esophagus may
accompanied by
 Severe burns of the lips ,mouth and pharynx,
 With pain on swallowing.
 Breathing difficulties due to either edema of the throat
 Or a collection of the mucus in the pharynx may occur.

16. Signs and symptoms
The patient ,who may be profoundly toxic ,
Febrile,
And in shock , is treated immediately for
shock,
Pain and
Respiratory distress.

17. Diagnostic findings
Esophagoscopy and barium swallow are
performed as soon as possible to determine
the extent and severity of damage .
Vomiting and gastric lavage are avoided to
prevent further exposure of the esophagus
to the caustic agent.

18. esophagoscopy

19. Barium swallow

20. Surgical management
Emergent esophagectomy or
gastrectomy may be required.
The patient remains NPO and
IV fluids are given.

21. esophagectomy

22. Colon interposition

23. Colon interposition

24. Medical management
The use of corticosteroids to reduce
inflammation and minimize subsequent
scarring and stricture formation is of
questionable value.
Antibiotics are prescribed if there is
documented infection.

25. Nutritional management
After the acute phase has
subsided , the patient may need
nutritional support via enteral or
parenteral feedings.

26. dilators
 The patient may require further treatment to prevent or manage
strictures of the esophagus .
 Dilation of the bougienage may be sufficient , but may need to be
repeated periodically
 Progressively larger bougies are used to dilate the esophagus.
 Some strictures requires rigid dilators , such as savary dilators .
 These dilators are used in the same fashion as bougies but may be
more successful for opening difficult strictures.

27. rigid dilator

28. savary dilator

29. reconstruction
 For strictures that do not respond to either method of
dilation , surgical management may be necessary.
 Reconstruction may be accomplished by esophagectomy
and colon interposition.
 To replace the portion of esophagus removed.
 This surgery is quite complex and should be considered
only when other options have failed.

30. bibliography
 Brunner and Suddarth’s Textbook of Medical- Surgical Nursing
,South Asian Edition , Volume 1 , Published by Wolters Kluwer .
Page reffered to 849 -854.
 Ansari and Kaur, Textbook of Medical – Surgical Nursing 1 .
Published by Pee Vee 2011 Edition, Page reffered to 850 – 852.
 https://www.slideshare.net/rajinderdhaliwal92/f-b-esophagus
 https://www.slideshare.net/drpradeeppande/foreign-body-
oesophaguspptx-254455016
 https://www.webmd.com/first-aid/chemical-burns