Disease Description (Causes and Symptoms)
- Definition: An esophageal foreign body refers to a condition in which food or another object remains lodged in the esophagus after being swallowed. It occurs more frequently than foreign bodies in the airway.
- Main causes: In children (especially ages 1–3 years, approximately 75–80%), accidental ingestion of coins, small toys, beads, pins, and similar objects is common. Adults more often swallow bone fragments, dislodged denture pieces, sharp metal objects, and similar items. The risk is higher in people with mental illness, incarcerated people, and those with preexisting esophageal diseases (such as strictures or achalasia).
- Pathophysiology: Foreign bodies are likely to become lodged at anatomical constrictions of the esophagus (such as the upper esophageal constriction) and may progress to mucosal injury, necrosis, perforation, or vascular injury due to pressure, pressure-induced absorption, or chemical damage (such as from batteries).
- Main symptoms: Dysphagia (difficulty swallowing), a foreign-body sensation in the throat, excessive salivation (drooling), nausea and vomiting, chest pain, coughing and shortness of breath; adults may also be asymptomatic. It may be discovered incidentally on chest radiography.
- Notable statistics: Some reports state that >1,500 people in the United States die each year in connection with this condition (in cases of severe complications).
Treatment Methods and Precautions
- Indications for emergency treatment (immediate removal required)
- Airway compression or shortness of breath
- Ingestion of a battery (especially a button battery)
- Sharp objects (needles, pins, razor blades, nails, etc.)
- Suspected esophageal perforation or active bleeding
- Standard treatment
- Diagnostic and therapeutic endoscopy (endoscopic foreign-body removal) is the standard treatment in most cases (removal by endoscopy under sleep/sedation).
- If a radiolucent foreign body is suspected, its location can be identified with plain chest and abdominal X-rays.
- If the object is radiopaque (e.g., some plastics) and the conditions are met, retrograde removal using a balloon catheter (under fluoroscopic guidance) may be used: this is considered only when there is one object, it is soft, the patient has no esophageal disease or shortness of breath, and it is within 72 hours of ingestion.
- Observation (conservative management): Short-term observation may be possible when the object is small and not pointed, there are no problems with breathing or swallowing, and it is judged likely to pass naturally into the gastrointestinal tract. However, observation alone is generally not recommended when more than 24 hours have passed since ingestion or when salivation is severe.
- Surgical treatment is necessary if complications (such as perforation or infection) occur.
- Medications and supportive treatment
- Antibiotics may be considered when perforation or infection is suspected.
- Supportive treatment, such as pain control and fluid management.
- Precautions (including self-care)
- Visit the emergency room immediately if a battery, sharp object, denture, or similar item may have been swallowed.
- Record and inform the medical staff of the time of ingestion, the type of object swallowed (if known), and when symptoms began.
- Fasting before endoscopy (usually at least 6–8 hours) may be required — follow the medical institution’s instructions regarding whether to fast before an outpatient visit.
- Complications (important)
- Esophageal perforation, necrosis, vascular injury (such as an aortoesophageal fistula), tracheoesophageal fistula, mediastinitis, pneumothorax, pneumonia and atelectasis, etc. These complications can be life-threatening, so prompt diagnosis and treatment are important.
Checklist Before an Outpatient Visit (Items to Bring and Example Questions)
- Items to bring
- A photo of the swallowed object (if available), its packaging, or a similar item
- Chest/abdominal X-rays and examination records performed in the emergency room (if available)
- A list of current medications and allergy history
- Records related to existing esophageal disease or surgical history (e.g., esophageal stricture, esophageal surgery, gastroesophageal reflux disease)
- A record of when symptoms began and their progression (when and what was swallowed, and changes in symptoms)
- Identification card and insurance card
- Points to check before the outpatient visit
- Whether there is current shortness of breath, severe difficulty swallowing food, or severe drooling (if present, go to the emergency room immediately)
- Fasting in preparation for the possibility of endoscopy (check the medical institution’s instructions)
- Example questions (items for the patient to record personally)
- Exactly when was the object swallowed?
- Please describe the shape of the swallowed object (size, shape, and material).
- Do you currently have difficulty swallowing, shortness of breath, or vomiting mixed with blood?
- Do you have dentures, esophageal disease, or a recent history of surgery?
General Example Questions to Ask the Doctor
- What examination or procedure do you recommend to remove this object? What are the risks?
- What methods of anesthesia or sedation are used during the procedure (endoscopy), and what side effects can occur?
- How likely are complications (perforation or infection), and how are they treated if they occur?
- When can I begin eating after the procedure, and when can I return to daily activities?
- What precautions should I take to prevent recurrence?
Examples of Condition-Specific Questions
- I am not sure whether the swallowed object is a button (coin-shaped) battery. Is immediate endoscopic examination necessary in this case?
- The swallowed foreign body is plastic (radiolucent). Can it be removed with a balloon catheter, and what are the advantages and disadvantages?
(Note: Emergency symptoms — if you have severe shortness of breath, persistent bleeding, rapidly worsening pain, or vomiting mixed with blood, visit the emergency room immediately.)