gastrointestinal disorders
Esophageal Foreign Bodies
Diagnosis of Esophageal Foreign Bodies
Clinical evaluation Sometimes imaging studies Often endoscopic evaluation Many patients give a clear history of ingestion; those with significant symptoms suggesting complete obstruction should have immediate therapeutic endoscopy. Patients with minimal symptoms and no high-risk factors (eg, ingestion of sharp objects, disk or button batteries or packets of illicit drugs) who are able to swallow normally may not have an impacted foreign body and can be observed for resolution of symptoms. Other patients may require imaging studies. Some patients, such as young children, mentally impaired adults, older people, and those with psychiatric illness, may not be able to give an adequate history of ingestion. These patients may present with choking, refusal to eat, vomiting, drooling, wheezing, blood-stained saliva, or respiratory distress. Imaging studies also may be needed in these patients. Some foreign bodies can be detected with plain x-rays (2 views preferred). These x-rays are best for detecting metallic foreign objects and steak bones as well as for detecting signs of perforation (eg, free air in the mediastinum or peritoneum). However, fish bones and even some chicken bones, wood, plastic, glass, and thin metal objects can be difficult to identify on plain x-rays. If there is any suspicion of a foreign body or of intentional or dangerous (eg, packets of illicit drugs) foreign body ingestion, imaging studies, such as CT, should be done, sometimes before endoscopy, to confirm and localize the foreign body. Endoscopic evaluation is typically required in patients with suspected foreign body ingestions and ongoing symptoms despite negative imaging results. An oral contrast imaging study typically should not be done because of the risk of aspiration and of contrast leakage in patients with perforation. Also, the presence of residual contrast material can make subsequent endoscopic retrieval more difficult. 