Foreign bodies in aerodigestive tract

1. Foreign Bodies in
Aero-Digestive Tract
Dr. Krishna Prasad Koirala
MBBS, MS ( ENT-HNS)
4-05-2020 @ 11:00AM

2. Introduction
• Common clinical occurrence in children,
psychiatric patients and patients in coma
• ENT Emergency
• Entry :
–Ingestion: F.B. Esophagus
–Aspiration: F.B. Bronchus

3. Foreign Body ingestion
• Epidemiology
– Children >>> Adults
– Boys > Girls
– No Racial / Geographical
Predisposition
• Types of F.B
– Coins: Commonest in children
– Household items, pen cap,
small toys
– Meat Bone : commonest in
Adults
• More common in children
– Lack molar teeth, poor
mastication
– Natural tendency to
put objects in mouth
– Play with objects
inside mouth
– Easy distractibility

4. Pathogenesis
• Foreign Body lodges in esophagus at the sites of
constriction
– Just below crico-pharynx (commonest)
– Above crico-pharynx
– Above aortic constriction
– Above left bronchial constriction
– Above gastro-esophageal junction

5. Symptoms Signs
• Odynophagia /Dysphagia
• Drooling of Saliva
• Refusal to take oral feeds
• Fever + Prostration
• Difficulty breathing
• Chest / Back Pain
• Collapsing Child
• Hematemesis
• Usually no clinically elicitable
signs
• Tenderness over the tracheo-
esophageal groove
• Drooling of saliva
• Fever/Tachypnea/Tachycardia
• Hamman’s Sign
– Quashing sound over
precordium with each
heartbeat (esophageal perfn)

6. Investigations
• Plain X-ray soft tissue neck and chest
– Always get both AP and Lateral views
– Radio-opaque foreign body easily seen
– Radio-lucent foreign body evidenced
by air in the esophagus
• Barium Swallow
– Radio-lucent F.B well visualized
• Esophagoscopy
– Diagnostic as well as Therapeutic

7. Treatment
• Observation
• Balloon catheter removal : for
round/ spherical FB e.g. glass
marbles
• Rigid esophagoscopy and
removal with forceps
• Thoracotomy: for large, irregular,
impacted FB (e.g. dentures)

8. 1. Observation
– Usually for 24 hours
•Immediate presentation and stable patient
•Blunt foreign body below the cricopharynx
– 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: risk of liquifactive / coagulation
necrosis)

9. 2. Balloon Catheter Removal
– Performed in centers where there is no access to
esophagoscopy
– 90 % efficacy
– Advantages: No GA, cost effective
– Complications: Emesis, dislodgement to tracheal
– Esophagoscopy needed in case of failure

10. 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 esophagoscopy,
large dentures

11. Foreign body Bronchus
• Type of F.B
– Peanuts commonest among the vegetable matters
– Pen cap, whistles, safety pin are also not uncommon
• Right main bronchus is the commonest site of FB impaction
– Sitting or standing position : right lower lobe lower portion
is common
– Supine position: right lower lobe upper portion
• Trachea
• Larynx

12. Right main bronchus - Shorter, straighter and wider

13. Clinical features
• Symptoms
– Choking , gagging, violent coughing*, dyspnea,
stridor, wheezing, cyanosis, hoarseness
• Signs
– Stridor :inspiratory, biphasic or expiratory
according to the lodgment of foreign body
– Unilateral wheezing *
– Decreased breath sounds*

14. Investigations
• Plain 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

15. Radio - Opaque F.B Rt. Main Bronchus

16. Radio-Lucent F.B. Rt. Lung ( Hyperinflation)

17. Radiolucent F.B seen on Fluoroscopy

18. Treatment
• Rigid Bronchoscopy and foreign body removal
– Gold Standard
• Fiber-optic Bronchoscopy
– F.B in distal bronchus
• Tracheostomy & F.B Removal
– Large F.B in Sub-glottis
• Thoracotomy: Migrated F.B

19. F.B . Trachea

20. Bronchoscope

21. Optical forceps
Net F.B retrieval system

22. Safety pin closing forceps (Clerf- Arrowsmith type)

23. First aid for 'choking’
• Back blows
– Five rapid blows given by heel of hand between
shoulder blades
• Abdominal thrusts /Heimlich maneuver
– Five rapid thrusts given between the umbilicus
and xiphisternum
• Chest thrusts
– Five rapid thrusts given in middle of sternum

25. Errors to avoid in suspected foreign body
• Do not fail to have an X-ray done
• Do not fail to search endoscopically for a foreign
body in all cases of doubt
• 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