2. Introduction
• Foreign Body in Aero-digestive
tract is a common clinical
occurrence
• It is an ENT Emergency
• Foreign Body enters the body by
either
–Ingestion: “F.B. Esophagus”
3. Foreign Body ingestion
• Epidemiology
– Children >>> Adults
– Boys > Girls
– No Racial / Geographical
Predisposition
4. Etiology
• More common in children
– Lack Molar teeth, poor mastication
– Natural tendency to put objects in mouth
– Play with objects inside mouth
– Easy Distractibility
• Types of F.B
– Coins: Commonest in children
– Household items, Pen cap, Small Toys
– Meat Bone: Commonest in Adults
5. Pathogenesis
• Foreign Body lodges in esophagus at
–Just below Crico-pharynx ;
Commonest ; ??
–Above Crico-pharynx
–Above Aortic constriction
–Above Left Bronchial constriction
6. Symptoms
• Odynophagia /Dysphagia
• Drooling of Saliva
• Refusal to take oral feeds
• Fever + Prostration
• Difficulty breathing
• Chest / Back Pain
• Collapsing Child
• Hematemesis
7. Signs
• Usually no clinically elicitable signs
• Drooling saliva
• Fever
• Tachypnea
• Tachycardia
• Hamman’s Sign
– Seen in esophageal Perforation with
pneumomediastinum
8. Investigations
• X-ray Neck and Chest
– Always get both AP and Lateral views
– Radio-opaque foreign body easily seen
– Radio-lucent F.B. evidenced by Air in the
Esophagus
• Barium Swallow
– Radio-lucent F.B well visualized
• Esophagoscopy
13. 1. Observation
– Usually for 24 hours
•Immediate presentation
•Blunt foreign body below the cricopharynx
•Child Stable
– Spontaneous passage of foreign body into the
stomach is expected
– If it doesn’t pass into stomach, Esophagoscopy
is done
– C/I: Disc Battery Ingestion: emergency (Risk of
14. 2. Balloon Catheter Removal
–Performed in centers where there
is no access to esophagoscopy
–90 % efficacy
–Advantages: No GA, Cost effective
–Complications: Emesis, Tracheal
placement
–Esophagoscopy needed in case of
15. 3. Rigid Esophagoscopy and foreign
body removal with forceps
– Gold Standard Modality
– GA Needed
– Complications
•Iatrogenic Perforation, Oro-dental
injury
4. Thoracotomy
– Migrated F.B, unsuccessful rigid
16. • Epidemiology
– More common in children than adults
– Boys > girls
– No racial / geographical
predisposition
Foreign Body Aspiration
17. Etiology
• Commonly seen in children
– Poor airway reflexes
– Lack Molar teeth ,poor mastication
– Natural tendency to put objects in mouth
– Play with objects inside mouth
– Easy distractability
• Type of F.B
– Vegetable Matter: Peanuts Commonest
– Pen cap, whistles, safety Pin
18. Pathogenesis
• Foreign Body lodges in
– Bronchi
•Right Main Bronchus Commonest
•Sitting / Standing Position
–Rt. Lower Lobe- Lower portion
•Supine Position
–Rt. Lower Lobe- Upper portion
– Trachea
– Larynx
22. Investigations
• X-ray Neck and Chest
– PA and Lateral Views
– Inspiratory and expiratory films – air
trapping
– Atelectasis
– Pneumonitis
– Consolidation
• Airway Fluoroscopy
– Radio-lucent F.B
• Bronchoscopy
– Diagnostic as well as therapeutic
35. Errors to avoid in suspected
foreign body cases
• Do not reach for the foreign body
with the fingers
• Do not blindly pass an esophageal
bougie or other instruments
• Do not hold up the patient by the
heels
37. • Do not fail to search
endoscopically for a foreign body
in all cases of doubt
38. • Do not tell the patient he has no
foreign body until after X-Ray
examination, physical
examination, indirect examination
and endoscopy all have proven
negative
