Diabetes is an independent risk factor for delayed perforation after foreign bodies impacted in esophagus in adults

Perforation is the most serious complication of esophageal foreign bodies. Studies examining the association between diabetes and esophageal foreign body-induced perforation are largely non-existent.

The purpose of this study was to identify the risk factors for esophageal foreign body-induced perforation.

A retrospective chart review of patients with esophageal foreign bodies between January 2012-January 2017 was performed at the Chinese People's Liberation Army General Hospital. The patients were divided into two groups: those complicated with perforation and those without perforation. Date on patient demographics, symptoms, foreign bodies, and diabetes were collected and analyzed. Study-specific odds ratio and 95% confidence intervals (CI) were estimated using multivariable logistic regression models.

Of 294 patients with esophageal foreign bodies (41.84% male, mean age, 56.73 years), 33 (11.22%) complicated by perforation. Diabetes (odds ratio = 6.00; 95% confidence interval = 1.72-20.23), duration (>24 h) of foreign bodies retention (odds ratio = 4.25; 95% confidence interval = 1.71-10.86), and preoperative fever (odds ratio = 8.19; 95% confidence interval = 3.17-21.74) were strongly associated with an increased risk of perforation, whereas the sensation of a foreign body (odds ratio = 0.32; 95% confidence interval = 0.09-0.92) was a protective factor of perforation. Glucose level was not observed to have an association among patients with or without perforation.

Diabetes and duration of foreign body retention increase risk for esophageal foreign bodies complicated by perforation, and cases with elevated armpit temperature may represented a more likely perforation compared with those without fever.