FOREIGN BODY IN THE FOOD PASSAGE

Causes

  • Types of FBs commonly involved include:
    • Fish or chicken bones, often lodging in the tonsils, behind the tongue, or in the pharynx, occasionally in the oesophagus
  • Coins, especally in children. Coins are particularly likely to be ingested. Disc battery is particularly dangerous and requires immediate referral

Clinical features

  • Difficulty and pain in swallowing
    • Patient winces as he attempts to swallow
  • Drooling of saliva
  • Patient may point to where foreign body is stuck with a finger (pointing sign)
  • FB may be seen, e.g., in tonsil, pharynx

Differential diagnosis

  • Infection in pharynx
  • Trauma by foreign body
  • Medication ulcer (e.g. doxycycline)

Investigations

  • X-ray may reveal radio-opaque FB
    • Coins may appear on X-rays done for other reasons
  • Many FBs are radiolucent
    • Look for a gas shadow if in the oesophagus

MANAGEMENT

The approach depends upon the type of object ingested, the location of the object, and the patient’s clinical status.
If negative radiographs, no symptoms and the FB does not belong to a dangerous category (magnets, disc batteries,
sharp long objects, superabsorbent polymer), expectant management is advised.

If patient is symptomatic and/or the object is dangerous, immediate referral for further management.

TREATMENT

First Aid

  • Allow only clear fluids
  • Do NOT try to dislodge/move the FB with solid food
    • This may push it into the wall of the oesophagus causing infection and sometimes death
  • Give IV infusion if unable to swallow liquids or if oral fluid intake is poor

If FB is invisible on X-ray or symptoms persist >24 hours from time of ingestion

  • Refer to hospital with ENT facility

If FB is visible in the pharynx, tonsil, etc.

  • Grasp and remove it with long forceps

If patient tried to push FB with solid food:

  • Give broad-spectrum antibiotic cover with amoxicillin 500 mg every 8 hours for 5 days

Prevention

  • Keep potential FBs out of children’s reach
  • Advise on care in eating, i.e., not taking in too large pieces of food, chewing thoroughly before swallowing
  • Advise once a FB is stuck to avoid trying to “push” it down with solid food as this may sometimes be fatal