Distal esophageal foreign bodies: is it a common occurrence post-fundoplication requiring immediate intervention?

Dysphagia secondary to "tight" distal esophageal wraps are a well-known complication of Nissen fundoplication (NF). However, the literature makes no mention of distal esophageal foreign bodies (DEFB) appearing after NF. This study was undertaken to determine the occurrence of asymptomatic DEFB in children post-fundoplication.

A retrospective review and case series of radiographic images of children who underwent NF between 2001 and 2004. Images reviewed include chest and abdominal radiographs, esophagrams, and oropharyngeal motility studies.

DEFB on radiology report and image.

Two hundred and thirty-three children (135 males and 98 females) underwent NF at the ages of 15 days to 19.5 years. Two thousand and seven radiographs were reviewed. Five FBs (2.15%) were noted. Four of the five FBs (80%, overall incidence 1.72%) were present in the distal esophagus. Three required rigid esophagoscopy (one marble and one with multiple foreign bodies (FBs) for removal. One who had a distal FB seen on barium swallow 'spontaneously passed' during esophagoscopy.

DEFB in children status post-NF is unusual with an incidence 1.72% of our patients. Our review might be underestimating the incidence as translucent foreign bodies may have been missed. DEFB are surprising due to the fact that most of these children are neurologically impaired and gastrostomy-tube fed. The children's NPO status may also result in these DEFB remaining asymptomatic until being 'incidentally' found on radiographic imaging. Thus, NF may predispose to obstruction when a foreign body (FB) is ingested; but because of the population involved, this remains a fairly unusual entity. However, the presence of a DEFB in this population may necessitate prompt endoscopic retrieval as the likelihood of spontaneous passage is less.