Esophageal foreign body

Introduction to esophageal foreign bodies Foreign body of the esophagus refers to a foreign body that is inadvertently swallowed by a diet, such as a fishbone, a bone piece or a denture that has fallen off. The foreign body can temporarily stay or be invaded into the esophagus. Often manifested as esophageal foreign body sensation, difficulty swallowing, post-sternal pain. Severe cases can cause esophageal fistula, mediastinal abscess, piercing large blood vessels and even life-threatening, and should be treated immediately after diagnosis. basic knowledge Sickness ratio: 0.1% Susceptible people: no specific population Mode of infection: non-infectious Complications: abscess acute mediastinal inflammation abscess

Esophageal foreign body etiology

Individual factors (30%):

1, the common causes of children's esophageal foreign body: A. Children's nature is naughty and active, like to put coins, badges or other small items in the mouth, occasionally inadvertently swallowed into the esophagus. B. The swallowing function is not perfect. Eat foods with bones, thorns or nucleus and inadvertently swallow. C. Eating and crying or playing, it is easy to swallow the food in the mouth or swallow foreign objects. D. Incomplete teeth, the food is swallowed without chewing, causing foreign bodies in the esophagus.

2, common causes of adult esophageal foreign body: A. The diet is too fast or the spirit is not concentrated when eating, so that the fishbone, chicken bones, meat bones are swallowed into the esophagus. B. The denture is too loose, the food is too sticky or the oral mucosa feels weak, causing the denture to fall off and enter the esophagus with food. C. The degree of awakening during sleep is low, the denture is detached, and the esophagus is swallowed. D. The small nuclei and bone spurs doped in the food are swallowed into the esophagus. E. The esophagus itself has diseases such as stenosis and sputum. F. Swallowing dysfunction, pharyngeal sensation diminished and caused by swallowing. G. Bad working habits, such as woodwork, shoemakers or decorators, include nails, screws, etc. in the mouth and inadvertently swallowed. H. Anesthesia is not awake, coma or mentally ill patients may be swallowed when they are unconscious. I. Those who have committed suicide.

Dietary habits (20%):

1. The coastal areas are accustomed to mixing fish, shrimps and vegetables, which may cause small fish bones and fish bones to be swallowed. 2. The northern scorpion contains a jujube with a nucleus or a meat mass with bones, which is easy to cause swallowing. 3, the custom of the North Festival, built-in metal coins in the dumplings, easy to cause swallowing.

Mental factors (10%):

In the state of falling asleep, drunkenness, coma, and anesthesia, it is prone to accidental swallowing.

Iatrogenic factors (10%):

The dentures fall off during general anesthesia, the dental molds fall off when the teeth are inserted, and the sleeves fall off when the tubes are inserted.

Disease factor (10%):

1, esophageal lesions, esophageal tumors, esophageal scars, etc., resulting in food or small food retention. 2, mediastinal lesions mediastinal tumor or abscess formation lesions, oppression of the esophagus, resulting in esophageal stricture, easy to retain food or small foreign bodies. 3, neurological lesions pharyngeal reflexes or loss of swallowing reflexes, easy to cause accidental swallowing.

Esophageal foreign body prevention

The main points to prevent the occurrence of esophageal foreign bodies are:

1, when eating, you should chew slowly, should not be too hasty, the teeth fall off more or use the dentures of the elderly, in particular, the damaged dentures should be repaired in time to avoid loosening, falling off, and swallowed into foreign bodies.

2, educate children to correct the bad habits of small playthings, in case of inadvertent ingestion.

3. For general anesthesia or coma patients, the active dentures should be removed.

4, after swallowing foreign bodies, avoid swallowing rice balls, steamed bread, Philippine food and other foods, so as not to aggravate the damage, increase the difficulty of surgery, as soon as possible to confirm the diagnosis, timely removal of foreign bodies, to prevent the occurrence of complications is of great significance.

Esophageal foreign body complications Complications, abscess, acute mediastinal abscess

If you do not take timely delay treatment can cause inflammation and abscess around the esophagus, mediastinal inflammation and abscess, esophageal fistula, piercing large blood vessels caused by fatal bleeding.

Esophageal foreign body symptoms Common symptoms Post-sternal pain, difficulty breathing, oropharyngeal foreign body, difficulty swallowing, swallowing pain

1. Pain: A sharp foreign body pierces the esophageal wall and causes heavier pain. According to the location of the foreign body in the esophagus, the pain can be located on both sides of the lower neck or behind the sternum, and the pain is aggravated when swallowed. Sometimes the location where the patient feels pain is not necessarily the location where the foreign body stays. Only a sense of obstruction or discomfort.

2, difficulty in swallowing : light or early incomplete obstruction can enter the flow of food. The cervical esophageal foreign body can increase the parotid gland fluid. The severe ones refused to eat due to esophageal reflex spasm and swallowing pain. Esophageal inflammatory swelling, large foreign body can cause complete obstruction, so that saliva and liquid food can not swallow.

3, respiratory symptoms : large foreign bodies oppress the trachea, or saliva that is retained in the pharynx is inhaled into the trachea, can cause breathing difficulties, cough and other symptoms.

4. Restricted neck activity: There are sharp foreign bodies at the entrance to the esophagus or those with inflammation around the esophagus. Because the neck muscles are stiff, the neck is stiff and the head is difficult to turn.

5, fever : caused by complications such as esophagitis, esophageal inflammation, mediastinal inflammation and deep neck infection, patients may have symptoms such as elevated body temperature and general malaise.

Esophageal foreign body inspection

According to the history, symptoms, examination and diagnosis is not difficult, you can lick the patient to make a mouthwash action, at this time the face can immediately appear a special sloppy painful expression, turn head and neck, hand pain.

Indirect laryngoscopy revealed salivary retention in the pear-shaped fossa, or edema of the sacral cartilage, which should be considered as esophageal foreign body.

X-ray examination of the esophagus can confirm the diagnosis of metal opaque foreign matter or large dense bone, and can be positioned by X-ray film. For small, non-developed, non-metallic foreign objects can be checked with tincture, or cotton fiber can be added for perspective positioning. Iodine oil should be used when there is suspected perforation of the esophagus. In a few cases, especially in children with X-ray examination, no foreign body is found, but there is a history of obvious foreign body, and if the symptoms persist and cannot be diagnosed, esophagoscopy should be performed.

Diagnosis and differentiation of esophageal foreign body

diagnosis

Foreign body history: Most patients have a clear history of foreign body swallowing, and should further understand the nature, shape and duration of foreign bodies for further reference and treatment.

When the foreign body is located in the upper part of the esophagus, the affected neck often has slight tenderness. Indirect laryngoscopy, sometimes piriform fossa effusion.

X-ray examination: For foreign bodies that are not developed under X-ray such as fishbone and meat bone, X-ray examination of esophageal tincture should be performed to determine whether the foreign body exists and where it is located. For foreign objects that are not developed under the X-ray, they can be directly positioned for X-ray filming.

Esophagoscopy: For a small number of foreign body history, but X-ray examination can not be diagnosed, the symptoms are not obvious after drug treatment, esophagoscopy can be used as appropriate to confirm the diagnosis.

Differential diagnosis

Note the differentiation from esophagus, tracheal cysts or tumors.

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