Foreign Bodies In The Esophagus

Question 1

Most common age group prone for foreign ingestion……

Answer 1

The majority (80%) of accidental foreign-body ingestions occur in children, most of whom are 5 yr of age or younger

Question 2

The reason for mortality and morbidity in this case ……

Answer 2

Perforation and sepsis

Question 3

Most commonly ingested foreign body……..

Answer 3

Coins followed by small toys

Question 4

Food impaction as foreign body ……..

Answer 4

Association with eosinophilic esophagitis (diagnosed in 92% of those presenting with food impactions and dysphagia), repair of esophageal atresia, and Nissen fundoplication

Question 5

Common site of impaction ……

Answer 5

Most esophageal foreign bodies lodge at the level of the cricopharyngeus (upper esophageal sphincter), the aortic arch, or just superior to the diaphragm at the gastroesophageal junction (lower esophageal sphincter)

Question 6

Clues for perforation…….

Answer 6

Cervical swelling, erythema, or subcutaneous crepitations suggest perforation of the oropharynx or proximal esophagus.

Question 7

First Line of investigations…..

Answer 7

Pain anteroposterior radiographs of the neck, chest, and abdomen, along with lateral views of the neck and chest

Question 8

Differential features between buttons battery and coins……

Answer 8

Disk-shaped button batteries can look like coins and be differentiated by the double halo and step-off on anteroposterior and lateral views, respectively

Question 9

Highest risk for catastrophic events such as necrosis, tracheoesophageal fistula, perforation, stricture, vocal cord paralysis, mediastinitis, and aortoenteric fistula….

Answer 9

Children younger than 5 yr of age with ingestion of batteries ≥20 mm

Question 10

Witnessed or suspected BB ingestion Esophageal….

Answer 10

Otherwise stable: immediate endoscopic removal

Active bleeding or clinically unstable: endoscopic removal in OR with surgery/CV surgery present

Question 11

Button batteries, in particular, must be emergently removed within………?

Answer 11

Button batteries, in particular, must be emergently removed within 2 hr of presentation regardless of the timing of patient’s last oral intake because they can induce mucosal injury in as little as 1 hr of contact time and involve all esophageal layers within 4 hr

Question 12

Asymptomatic blunt objects and coins lodged in the esophagus can be observed for up to……

Answer 12

24 hr in anticipation of passage into the stomach. If there are no problems in handling secretions, meat impactions can be observed for up to 24 hr

Question 13

Sequelae of caustic ingestion…..

Answer 13

The medical sequelae of caustic ingestions are esophagitis, necrosis, perforation, and stricture formation

Question 14

Risk percentage for stricture ……

Answer 14

20%.

Question 15

Acute treatment for acid consumption…

Answer 15

Dilution by water or milk is recommended as acute treatment, but neutralization, induced emesis, and gastric lavage are contraindicated

Question 16

Strictures risk ….

Answer 16

Stricture risk is increased by circumferential ulcerations, white plaques, and sloughing of the mucosa and is reported to occur in 70–100% of grade IIB and grade III caustic esophagitis.

Question 17

Treatment for strictures….

Answer 17

trictures can require treatment with dilation, and in some severe cases, surgical resection and colon or small bowel interposition are needed.

Silicone stents (self-expanding) placed endoscopically after a dilation procedure can be an alternative and conservative approach to the management of strictures.

Question 18

The role of corticosteroids …..

Answer 18

The role of corticosteroids is controversial;

they are not recommended in grade 1 burns,

but they can reduce the risk of strictures in more-advanced caustic esophagitis.