Suspected esophageal foreign body -- choosing appropriate management

Twenty-two cases of probable esophageal or pharyngeal foreign body seen at an emergency service were studied retrospectively, using 15 predetermined factors chosen to detect or anticipate the acute consequences of foreign body ingestion. Three findings were particularly predictive: 1) foreign body visualized directly or on plain x-ray films; 2) hypersalivation; 3) obstruction or foreign body image in the esophagus on barium swallow. No patient with none of these three abnormal findings, even in the presence of localized pain increased by swallowing, received further treatment, and no complications developed. All patients with any one of these three findings underwent direct foreign body removal (four cases) or esophagoscopy (11 cases). Five esophageal foreign bodies passed spontaneously into the stomach before esophagoscopy; four foreign bodies were removed, and two esophagi were abnormal (stricture, myasthenia gravis). In two cases no foreign body was found. Hypersalivation was the only finding always associated with an abnormal esophagoscopy. Particular attention must be paid to the interpretation of plain x-ray films, with regard to probable foreign body location at the cricopharyngeal constriction and to indirect signs such as fluid levels, soft tissue swelling, free air, if small foreign bodies are not to be missed.