Foreign Body in the Food Passage (Esophagus)

Clinical assessment

Based on history of ingestion and symptoms (dysphagia, odynophagia, drooling, chest pain). Examination of oropharynx may reveal FB (e.g., fish bone). Assess for respiratory distress.

Investigations

• X-rays:
• - Neck/Chest AP and Lateral views: Can identify radio-opaque FBs (coins, bones, batteries, metal objects) and their location. Coins appear round on AP view if in esophagus, edge-on if in trachea. May show signs of perforation (air in mediastinum/soft tissues).
• - Many FBs (food, plastic, wood, glass) are radiolucent and won't be seen on X-ray.
• CT Scan: May be used for suspected complications (perforation, abscess) or to better visualize certain FBs.
• Endoscopy (Esophagoscopy - flexible or rigid): Gold standard for diagnosis and removal of most esophageal FBs. Allows direct visualization and retrieval.

Diagnostic criteria

Clinical suspicion based on history and symptoms +/- Radiographic evidence of FB +/- Endoscopic visualization.

Non-pharmacological management

• Initial Assessment: ABCs. Assess for airway compromise.
• NPO: Keep patient nil per os.
• Avoid Blind Attempts: DO NOT try to dislodge FB blindly with fingers or instruments. DO NOT encourage patient to eat solid food to 'push it down' (risk of perforation).
• Expectant Management (Limited Role): May be considered ONLY for small, blunt objects located distally in esophagus in asymptomatic patients (controversial, usually specialist decision).
• Endoscopic Removal (Primary Treatment): Most esophageal FBs require removal via flexible or rigid esophagoscopy under sedation or general anesthesia by specialist (ENT/Gastroenterology/Surgery). Urgent endoscopy needed for sharp objects, button batteries, magnets, objects causing complete obstruction or airway compromise.
• Removal of Pharyngeal FBs: Objects visible in tonsil/pharynx (e.g., fish bone) may be removed directly using forceps under good lighting.

Pharmacological treatment

• IV Fluids: If unable to swallow liquids or dehydrated.
• Glucagon: Sometimes used IV (1mg) to relax lower esophageal sphincter for distal food bolus impaction (efficacy debated, specialist decision).
• Antibiotics: Not routinely needed unless perforation suspected or significant mucosal injury/delay in removal. (UCG suggests Amoxicillin if patient tried to push FB down with solid food).
• Analgesia: For pain.
• Sedation: For endoscopic procedures.

Monitoring

Monitor for respiratory distress. Monitor for signs of perforation (chest/neck pain, fever, subcutaneous emphysema) before and after removal. Ensure successful passage after removal if expectant management used.