ESOPHAGEAL FOREIGN BODY

Esophageal foreign body is a condition where an object stuck in the esophagus, either intentionally or unintentionally. This condition can occur at any age, but is more common in children aged 1-3 years and in the elderly. Esophageal foreign bodies are frequent in children because they often put objects in their mouths, teeth that have not yet grown, and the swallowing process is still not perfect. Meanwhile, in the elderly population, loss of teeth and impaired swallowing due to disease or the aging process are factors that cause esophageal foreign bodies. Other population that has high incidence of esophageal foreign bodies are adults with psychiatric disorders.

The type of foreign body ingested is usually specific for each age group. Coins, button batteries, toys, earrings, and rings are examples of objects that are often swallowed at a young age. Foreign bodies that are often found in the elderly group are pieces of meat that are not chewed and dentures. Bone fragments are the most common foreign bodies found in adults. Other examples of foreign bodies are missing teeth, safety pins, nails, and pins. Foreign objects that must receive special attention are button batteries because they are corrosive and within hours can cause tearing or perforation of the esophagus.

Patients with esophageal foreign body generally complain of a lump or stabbing feeling in the lower neck to the upper chest. If the foreign body is in the middle and lower esophagus, pain may be felt in the chest, solar plexus, or back. Children or adult patients with communication disorders will be restless and crying. Other complaints include difficulty eating or drinking, to the point of not being able to eat or drink at all. If a foreign body causes complete obstruction, when the patient tries to drink or eat, they will regurgitate, and they may even unable to swallow their own saliva which causes drooling. In some cases, a foreign body can press against the airway and cause breathing difficulty. Sharp or corrosive foreign bodies can cause perforation or tears in the esophagus and injure surrounding organs or tissues.

If a patient is suspected of having an esophageal foreign body, a series of examinations will be performed to confirm the presence of the foreign body. Complaints specific to the case of an esophageal foreign body will be asked, and if possible, the family will be asked to bring a sample of the ingested foreign body. Physical examination such as measurement of vital signs and examination of the neck and chest will also be performed. X-ray of the neck, chest, and/or abdomen will be performed. Foreign objects made of metal or bone will be immediately visible in Roengent's photo. Other foreign bodies that are not visible will cause an abnormal appearance of the surrounding tissue.

About 80% of cases of esophageal foreign body can pass on its own into the stomach without intervention. However, patients are not advised to delay seeking medical attention, because the longer the object is stuck in the esophagus, the esophageal tissue will be compressed and can be damaged.

Often the patient or family tries to expel the foreign body by inducing vomiting or trying to push it with food. This also should not be done because of the risk of causing swelling at the opening of the upper esophagus which will make it difficult to remove the foreign body.

If upon arrival to the health facility, the foreign body is found to have descended into the stomach or intestines, the patient can be sent home with a note that he is asked to collect his feces  to determine whether the foreign object has come out or not. Another alternative is to perform evaluation using x-ray 3-7 days later.

Foreign bodies that are still inside the esophagus should be removed by esophagoscopy and extraction. Esophagoscopy and extraction are performed under generall anesthesia so that some preparations are required, such as blood tests, chest X-ray, and fasting for 6-8 hours. Generally, esophageal foreign body is not an urgent condition so that maximum preparation can be made. With the exception of sharp or corrosive objects, they must be removed immediately because they can cause perforation or tearing of the esophagus within hours.

Esophagoscopy allows the doctor to look directly into the esophagus and remove any foreign bodies in it and evaluate other conditions that may be present. After the procedure, the patient is usually hospitalized. Most patients recover quickly without any complications, so they can be discharged 1-3 days after esophagoscopy. Patients and their families will be provided with information and education to prevent the recurrence of the same incident.