Ingested foreign bodies can lodge in:

• Tonsil: Usually sharp fish bones, needles etc.
• The base of tongue: Fish bone or a needles.
• Pyriform fossa: Fish bone, chicken bone, needle or dentures are commonly seen.
• Oesophagus: Coins, piece of meat, chicken bones, denture, safety pin, marble.

Aetiology:

• Age: Children more prone as they play with coins, marbles and accidently ingest them.
• Loss of protective mechanism: Use of upper denture prevents tactile sensation and a foreign body is swallowed undetected.
• Inadequate mastication.
• Oesophageal stricture, spasm.
• Psychotics.

Constrictions of Oesophagus:

• Sites of lodgment of foreign body in the Oesophagus:
• Just below cricopharyngeal sphincter.
• Flat objects like coins are held up at the sphincter while others are held in the upper oesophagus just below sphincter.
• At the broncho-aortic constriction.
• Sharp or pointed foreign bodies can be impacted anywhere in the oesophagus.

Clinical features:

• Symptoms:
• History of choking.
• Discomfort or pain just above the clavicle.
• Dysphagia (difficulty in swallowing).
• Drooling of saliva.
• Respiratory distress, dyspnea, cough and wheezing. These symptoms are due to compression overflow or fistulous communication with the air passages.
• Substernal or epigastric pain.

Indications:

• Signs:
• Tenderness in the lower part of neck on the right or left side of trachea.
• Pooling of saliva in pyriform fossa as seen on indirect laryngoscopy.
• Foreign body may be seen protruding from Oesophageal opening in post-cricoid region.

Management

• Rigid Oesophagoscopy under general anesthesia is usually safest and the best method of removal of Foreign bodies.
• If such foreign bodies cannot be removed by the above, then transthoracic oesophagotomy is done.
• Blunt non-impacted foreign bodies can be removed by fibre optic oesophagoscopy especially in high-risk patients.