ENT (Otorhinolaryngology) · MU Sofia

52. Foreign bodies in the esophagus.

Covers the definition of an oesophageal foreign body and the typical objects lodged in children and adults, followed by the four physiological sites where impaction occurs. It then sets out clinical symptoms and signs, with separate notes on button batteries and sharp objects, and summarises imaging findings on plain X-ray, CT and barium swallow. Emergency care, rigid and flexible endoscopy, and the battery-specific protocol close the note, with a list of complications such as perforation, fistula and stricture.

Inside: 5 sections · 6 labelled pictures · 16 flashcards · 3 min

Topic 52 of 52 in the MU Sofia syllabus for ENT (Otorhinolaryngology) (Medicine, Year 4). The free AceMed note covers it in 5 sections, about 483 words (3 min of reading), with 16 flashcards.

In this note

  1. Foreign bodies in the esophagus.
  2. Clinical Presentation
  3. Imaging and Diagnosis’
  4. Management Protocol
  5. Complications

Foreign bodies in the esophagus.

A foreign body in the esophagus is an ingested object that becomes lodged within the esophageal lumen, causing partial or complete obstruction and possible mucosal injury.

1. Common Types of Esophageal Foreign Bodies

  • In Children: Coins (most common), Toys, Buttons, Button batteries (most dangerous)
  • In Adults: Meat bolus (most common), Dentures, Bones (fish/chicken), Pins, safety pins

2. Common Sites of Impaction

The esophagus has four physiological constrictions where foreign bodies are most likely to lodge:

  1. 1. Cricopharyngeal Junction (Upper Esophageal Sphincter): The most common site (approx. 70–80%), especially in children. It is the narrowest part of the entire esophagus.
  2. 2. Level of Aortic Arch: Where the aorta indents the esophagus.
  3. 3. Level of Left Main Bronchus.
  4. 4. Diaphragmatic Hiatus (Lower Esophageal Sphincter).

Clinical Presentation

  • Symptoms:
  • Dysphagia and Odynophagia: Difficulty and pain during swallowing.
  • Drooling/Sialorrhea: Inability to swallow saliva indicates complete obstruction.
  • Foreign Body Sensation: Often localized to the suprasternal notch.
  • Respiratory Symptoms: In children, a large esophageal FB can compress the soft posterior tracheal wall, causing stridor or wheezing.
  • Signs:
  • Tenderness in the lower neck.
  • Surgical Emphysema: If you feel "crackling" (crepitus) in the neck tissues, suspect perforation.
  • Pooling of saliva in piriform recess
  • Special Types:
  • Button Battery:
  • Causes alkali burn
  • Leads to liquefaction necrosis
  • Can cause perforation within 2–6 hours
  • Emergency removal required
  • Sharp Foreign Bodies: Fish bones, Pins, Dentures
  • High risk of perforation

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