Foreign Bodies of

Ae ro-Di ge st i ve
Tra ct
 I nt roduct i on
• Foreign Body in Aero-
digestive tract is a common
clinical
occurrence
• It is an ENT Emergency

• Fore ign Body e nt e rs t he body

by either
 Fore i gn Body
i nge st i on
• Epidemiology

– Children >>> Adults

– Boys > Girls

– No Racial / Geographical
Predisposition
 Etiology
• More common in children
– Lack Molar teeth, poor mastication
– Natural tendency to put objects in
mouth
– Play with objects inside mouth
– Easy Distractibility

• Types of F.B
– Coins: Commonest in children
– Household items, Pen cap, Small
Toys
 Pathogenesis

• Foreign Body lodges in esophagus at

– Just be low Crico-pha rynx

; Commonest ; ??

– Above Crico-pharynx

– Above Aortic
constriction
 Sympt oms
• Odynophagia /Dysphagia

• Drooling of Saliva

• Refusal to take oral feeds

• Fever + Prostration

• Difficulty breathing

• Chest / Back Pain

• Collapsing Child

• Hematemesis
 Si gn
• s
Usually no clinically elicitable signs
• Drooling saliva

• Fever

• Tachypnea

• Tachycardia

• Hamman’s Sign

– Seen in esophageal Perforation

with pneumomediastinum
 Investigations
• X-ray Neck and Chest

– Always get both AP and vie ws

Lateral
– Radio-opaque foreign body easily seen

– Radio-lucent F.B. evidenced by Air in

the Esophagus

• Barium Swallow

– Radio-lucent F.B well visualized

• Esophagoscopy
Radio - Opaque F.B Esophagus
Double Lumen Sign: Disc Battery
Radio-Lucent F.B Esophagus
 Treatment
• Observation

• Balloon Catheter Removal

• Rigid Esophagoscopy and removal

with forceps
• Thoracotomy
1. Observation
– Usually for 24 hours

• Immediate presentation

• Blunt foreign body the cricopharynx

below
• Child Stable
– Spontaneous passage of foreign body into
the stomach is expected
– I f i t doe sn’ t pa ss int o st oma ch,
Esopha goscopy is done
– C/I: Disc Battery Ingestion: emergency (Risk
2. Balloon Catheter Removal

– Performed in centers where there

is no access to esophagoscopy

– 90 % efficacy

– Advantages: No GA, Cost Tracheal

Emesis, effective
–

Complications:
3. Rigid Esophagoscopy and foreign
body removal with forceps
– Gold Standard Modality

– GA Needed

– Complications

• Iatrogenic Perforation, Oro-dental

injury
4. Thoracotomy
– Migrated F.B, unsuccessful rigid
 Fore i gn Body
Aspi ra t i on
• Epidemiology

– More common in children than adults

– Boys > girls

– No racial / geographical

predisposition
 Etiology
• Commonly seen in children
– Poor airway reflexes

– Lack Molar teeth , poor mastication

– Natural tendency to put objects in

mouth
– Play with objects inside mouth
– Easy distractability

• Type of F.B
– Vegetable Matter: Peanuts
Commonest
 Pathogenesis
• Foreign Body lodges in

– Bronchi

• Right Main Bronchus Commonest

• Sitting / Standing Position

– Rt. Lower Lobe- Lower portion

• Supine Position
– Rt. Lower Lobe- Upper port i on
– Trachea
– Larynx
Right main Bronchus- Straighter
and Wider
 Symptoms
• Choking

• Gagging

• Violent Coughing

• Dyspnea

• Stridor

• Wheezing

• Cyanosis

• Hoarseness
 Si gns

• Inspiratory Stridor

• Bi-phasic Stridor

• Expiratory Stridor

• Unilateral Wheezing

• Decreased Breath Sounds

 Investigations
• X-ray Neck and Chest
– PA and Lateral Views
– Inspiratory and expiratory films – air
trapping
– Atelectasis
– Pneumonitis
– Consolidation
• Airway Fluoroscopy
– Radio-lucent F.B
• Bronchoscopy
– Diagnostic as well as therapeutic
adio - Opaque F.B Rt. Main Bronchus
Radio-Lucent F.B. Rt. Lung
( Hyperinflation)
Radio-Lucent F.B Lt. Bronchus
(Atelectasis)
Radiolucent F.B seen
 Treatment
• Rigid Bronchoscopy and foreign body
removal
– Gold Standard

• Fiber-optic Bronchoscopy

– F.B in distal bronchus

• Tracheostomy & F.B Removal

– Large F.B in Sub-glottis

• Thoracotomy: Migrated F.B

F.B . Trachea
Bronchoscope
s
 Opt i ca l forceps

Net F. B retrieval system

 First aid ‘choking’

• Back blows

• Abdominal thrusts /Heimlich

maneuver
• Chest thrusts
 Back Blows

Five rapid blows given by heel of hand

between shoulder blades
 Abdomi na l
t hrust s

5 ra pi d t hrust s gi ve n be t we e n umbi l l i cus

a nd xiphisternum
 Chest thrusts

5 rapid thrusts given in middle of sternum

Errors to avoid in suspected
foreign body cases

• Do not reach for the foreign

body with the fingers
• Do not blindly pass an
esophageal bougie or other
instruments
• Do not hold up the patient by the
• Do not f a il t o ha ve a n X-ra y
done
• Do not fail to search
endoscopically for a foreign
body in all cases of doubt
• Do not tell the patient he has no

foreign body until after X-Ray

e xa mina t ion,

physica l

examination, indirect examination

and endoscopy all have proven

negative