This document discusses foreign bodies in the esophagus. It notes that coins and food items are commonly ingested, especially by children and elderly patients. Symptoms depend on the patient's age but may include irritability, coughing, and difficulty swallowing. Radiography is the main diagnostic tool, where radio-opaque objects like coins can be seen. Treatment depends on the object's size, shape and location. Flexible endoscopy under local anesthesia is generally preferred but surgery may be needed for sharp or impacted objects or if perforation is suspected. Complications of removal procedures include esophageal trauma and infections.

1. Foregion Body Esophagus
Dr R S Dhaliwal
MBBS,MS,DNB(Surgery),M.Ch,DNB(CTVSurgery)
FACS,FCCP,FICA,FNCCP,FIACS
Former Prof & HOD , CTV Surgery,
PGIMER,Chandigarh,India

2. Introduction:
• Esophageal foreign bodies are not so dangerous
as air way foreign bodies. But this is a very
common problem among children and elderly.
• Anatomically these foreign bodies are commonly
found at the various natural constrictions of
oesophagus (i.e.at cricopharynx, the cross over
of the aortic arch at the level of mid esophagus,
and at the lower end of esophagus).

5. Common F.B. in Esophagus
• Metalic - Coins, Pins, Safety pins, Buttons,
Button batteries, Pieces of metal object,
blades, broken spoons
• Non metallic – Glass beads, Marbles, Plastic
toys or pieces of plastic object, Impacted food
bolus, pencil piece
• Dentures partial , Teeth –artificial or natural,
Fish Bone, meat or chicken bone
• Any small thing

6. Patients with Esophageal foreign
bodies:
• 1. Pediatric patients
• 2. Psychiatric patients
• 3. Patients with underlying esophageal
disorders like malignancy,strictures,aclasia
• 4. Edentulous patients (elderly)

7. Clinical presentation:
• This depends on whether the patient is a child or adult. Adults usually
describe the event clearly and acknowledge the possibility of the presence
of foreign body in the food passage
• In children symptoms include:
1. Irritability
2. Poor feeding
3. Drooling
4. Chest pain
5. Coughing
• Respiratory symptoms due to esophageal foreign body is common in
children because of their small and compressible tracheal lumen. These
symptoms include stridor, coughing, and labored breathing.
• Physical examination:
This does not play an important role in establishing the
diagnosis. Children with oesophageal foreign body tends to drool. Clinical
examination is usually unremarkable in most of these patients

8. Role of radiography:
• Main diagnostic tool in oesophageal foreign bodies is
radiography. Commonly these foreign bodies tend to be
radio opaque. coins are commonly ingested by
children. Food products are the other commonly
encountered foreign body. Plain radiographs in these
patients may demonstrate bone / cartilage present in the
food elements.Both antero posterior and lateral views must
necessarily be performed to localize the foreign body. CT
Scan gives better information If plain films are not diagnostic
then barium swallow should be performed
*Caution: Gastrograffin should not be used because it
may cause severe chemical pneumonitis if aspirated.

10. Radiology

11. Radiology

12. Glass Marble D e n t u r e w i t h h o o k

13. Treatment:
• Following factors should be considered in the management
of foreign body oesophagus -
a. Type / location of the ingested foreign body
b. Interval between ingestion and presentation
c. Age of the patient – Child, Old person
Ingestion of caustic foreign bodies like button batteries
should be considered as an emergency. Delay in these
patients may lead to esophageal perforation.
Sharp metallic objects like pins, needles, razor blades, and
nails should always be removed under controlled operating
room conditions.Danger of perforation is significant

14. Endoscopic removal of foreign bodies:
• Foreign bodies impacted at the level of cricopharynx should
be removed using an upper esophageal speculum. This can
be performedeither under local / general anesthesia.
• Foreign bodies of esophagus can be removed using an
oesophagoscope. General anesthesia is preferred in
children .It provides adequate relaxation making the
passage of oesophagoscope smooth and atraumatic. Local
anesthesia can be used if flexible oesophagoscope is used.
• Types of Esophagus- -
a. Rigid Esophagoscope – Made of metal .G.A is needed in
most of patients. - Lumen is large so forceps can be used
easily. - Needs more expertise. – Perforation rate more
b. Fiberoptic Esophagoscope - Flexible structure, Can be
done under L.A. in OPD or bedside. - Small lumen forceps
manipulations not easy. Lower perforation rate.

15. Endoscopic removal of F.B
• Balloon catheters can be used to extract impacted
foreign body in the oesophagus. This method can be
used only if the foreign body ingested is single,
smooth and radio opaque. These patients should
have no history of esophageal disorder / injury.
This procedure is performed by placing the patient in
head down position. The catheter is passed nasally or
orally under fluoroscopic guidance past the foreign
body. The balloon is inflated with a radio opaque
solution and is slowly pulled out along with the
foreign body under fluoroscopic guidance.

16. Esophagoscopes

17. Complications of oesophagoscopy
• 1. Oesophageal trauma
2. Mediastinitis
3 Pneumothorax
4 Surgical emphysema
5 Tracheo oesophageal fistula
6 Aorto esophageal fistula

18. Surgery for F.B. Esophagus
• Indications-a.
F.B. Impacted in wall of esophagus-dentures,
metal nails or screws
b. Sharp F.B. – blade, knife, needles,
c. Suspected perforation
d. F.B. along with esophageal pathology -
Carcinoma, cardiac achalasia, stricture

19. Surgical procedures
• Depending upon where the F.B. is lodged in
esophagus the procedure is planned
a. In neck left side cervical esophagostomy
is done and F.B. is removed
b. If it is in the thoracic esophagus a right
side postolateral thoracotomy is approach
of choice to remove F.B. Whole thoracic
esophagus can be approached from RT PLT
C.F.B. impacted near cardiac end (lower end)
is removed by a upper laparotomy.