Impacted esophageal foreign bodies in children

Area of Science:

• Pediatric Gastroenterology
• Esophageal Foreign Bodies
• Pediatric Surgery

Background:

• Foreign body (FB) ingestion in children presents diverse challenges, particularly when unwitnessed or associated with pre-existing esophageal pathology.
• Diagnosing and managing impacted esophageal FBs requires careful consideration of underlying anatomy and FB characteristics.

Purpose of the Study:

• To analyze the clinical course, management strategies, and outcomes of children with impacted esophageal foreign bodies.
• To differentiate outcomes based on the presence or absence of predisposing anatomical pathology.

Main Methods:

• Retrospective chart review of pediatric patients with impacted esophageal FBs from January 2000 to February 2018.
• Exclusion of FBs in the cricopharynx and those that migrated to the stomach.
• Investigations and management tailored to anatomical pathology, impaction duration, and FB difficulty.

Main Results:

• 31 children (N1 group) with predisposing pathology presented earlier (42 months), had recurrent impactions (1-6), and required multiple dilatations (0-8) with longer follow-up (avg 35 months).
• Food matter was the most common impaction in the N1 group, often leading to persistent symptoms.
• 55 children (N2 group) with normal esophagus or difficult FBs commonly ingested coins, with strictures developing in long-standing or corrosive cases; most remained asymptomatic.

Conclusions:

• Abnormal esophageal anatomy predisposes to impaction by organic food boluses, leading to earlier presentation and more complex management.
• Metallic FBs in a normal esophagus are typically innocuous, while atypical or multiple FBs may suggest underlying psychiatric issues.
• Early identification and management are crucial, with outcomes varying significantly based on underlying esophageal integrity.