Foreign Bodies in the Esophagus

More than 100,000 cases of ingested foreign bodies occur in the pediatric population each year. Although most are accidental, intentional ingestion starts in adolescence. Children under 5 years of age are often exposed to random household objects, and they often swallow coins; such cases were as high as 76% in one large study. Children also swallow toy parts, jewels, batteries, sharp objects (needles, pins, fish or chicken bones), metal objects, food, seeds, plastic material, magnets, buttons, nuts, hard candy, and jewelry, which can become lodged in the esophagus. Sharp objects such as a safety pin can become impacted in the esophagus of an infant or small child. Batteries represent less than 2% of foreign bodies ingested by children. Ingestion of multiple magnets can cause esophageal obstruction and perforation.

Foreign bodies become entrapped as frequently in adults as in children ( Fig. 6.1 ). Psychiatric patients and prisoners may intentionally swallow objects for ulterior motives. In adults, the foreign body most often entrapped is food, usually meat (33%). Hasty eating may result in the swallowing of chicken or fish bones. Tacks, pins, and nails held between the lips may be swallowed and may attach to the esophageal wall or descend into the stomach and beyond. Pill ingestion may also be a cause of impaction.

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Foreign Bodies in the Esophagus.

In the esophagus, obstruction typically occurs at the three narrowest areas, including the upper esophageal sphincter, compression by the aortic arch in the esophagus, and at the lower esophageal sphincter. Of the 40% to 60% that become lodged in the esophagus, ingested objects are found above the cricopharynx in 57% to 89% of patients, at the level of the thoracic esophagus in approximately 26% of patients, and at the gastroesophageal junction in 17% of patients. A large proportion (30%–38%) of these people may have an underlying esophageal disease. Along their way, foreign bodies can cause destruction in the form of impactions, ulcerations, and perforations. The presence of other lesions in the esophagus—such as rings, strictures, diverticula, and tumors—may form a nidus for impaction. Impaction is also more likely in the presence of a dysmotility disorder such as achalasia. Most foreign bodies, or 80%, will migrate through the intestine and into the stool without incident. The remaining 20% will have to be extracted surgically.