Management of foreign bodies in the airway and oesophagus

• Published in: International journal of pediatric otorhinolaryngology 2012-05, Vol.76, p.S84-S91
• Main Authors: Rodríguez, Hugo, Passali, Giulio Cesare, Gregori, Dario, Chinski, Alberto, Tiscornia, Carlos, Botto, Hugo, Nieto, Mary, Zanetta, Adrian, Passali, Desiderio, Cuestas, Giselle
• Format: Article
• Language: English
• Subjects: Aspiration; Child, Preschool; Endoscopic removal; Endoscopy - methods; Esophagus; Foreign Bodies - diagnosis; Foreign Bodies - diagnostic imaging; Foreign Bodies - therapy; Foreign body; Humans; Infant; Ingestion; Location; Otolaryngology; Pediatrics; Radiography; Respiratory System
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/j.ijporl.2012.02.010

Abstract Background Ingestion and/or aspiration of foreign bodies (FB) are avoidable incidents. Children between 1 and 3 years are common victims for many reasons: exploration of the environment through the mouth, lack of molars which decreases their ability to properly chew food, lack of cognitive capacity to distinguish between edible and inedible objects, and tendency to distraction and to perform other activities, like playing, whilst eating. Most FBs are expelled spontaneously, but a significant percentage impacts the upper aerodigestive tract. Approximately 80% of children's choking episodes are evaluated by pediatricians. The symptoms of aspiration or ingestion of FBs can simulate different paediatric diseases such as asthma, croup or pneumonia, delaying the correct diagnosis. Symptoms There are three clinical phases both in aspiration and in ingestion of FBs: initial stage (first stage or impaction or FB) shows choking, gagging and paroxysms of coughing, obstruction of the airway (AW), occurring at the time of aspiration or ingestion. These signs calm down when the FB lodges and the reflexes grow weary (second stage or asymptomatic phase). Complications occur in the third stage (also defined as complications’ phase), when the obstruction, erosion or infection cause pneumonia, atelectasis, abscess or fever (FB in AW), or dysphagia, mediastinum abscess, perforation or erosion and oesophagus (FB in the oesophagus). The first symptoms to receive medical care may actually represent a complication of impaction of FB. Locations and management Determining the site of obstruction is important in managing the problem. The location of the FB depends on its characteristics and also on the position of the person at the time of aspiration. Determining the site of obstruction is important in managing the problem. Larynx and trachea have the lowest prevalence, except in children under 1 year. They are linked with the most dangerous outcomes, complete obstruction or rupture. Bronchus is the preferred location in 80–90% of AW's cases. Esophageal FBs are twice more common than bronchial FBs, although most of these migrate to the stomach and do not require endoscopic removal. Diagnosis of FB proceeds following the traditional steps, with a particular stress on history and radiological findings as goal standards for the FB retrieval. The treatment of choice for AW's and esophageal FBs is endoscopic removal. Endoscopy should be carried out whenever the trained personnel