Removal of Foreign Body from Airway or Esophagus
As children explore the world, they can put almost anything into their mouths and noses. These foreign bodies may be coins, toys, batteries, magnets, screws, marbles, etc. In addition, the tendency for a child to get distracted with play while eating can send food particles into the airway. Some foreign bodies get expelled or pass harmlessly through the body, while others (sharp or large objects) may get lodged in the airway or digestive tract, causing obstructions, toxicity and damage to the airway or esophageal tract lining. The esophagus or food pipe is the most common region where such objects can get stuck as it is the narrowest part of the digestive tract. These foreign bodies must be identified and removed from the body.
Foreign objects lodged in the esophagus and airway can lead to shortness of breath, coughing, choking, irritation in the esophagus, difficulty in swallowing (dysphagia), vomiting, refusal to eat, intense or loud breathing (stridor) and bluish coloration of the skin or mucous membrane (cyanosis).
The presence, location, size, number and shape of the foreign body can be diagnosed with X-ray imaging of the neck, chest and abdomen. In addition, a handheld metal detector can also be used to detect the site of the object in the esophagus. Some foreign bodies made of wood, plastic or glass are detected using an endoscope (small tube with a light attached).
The timing of treatment is crucial. Immediate intervention may be required in the following cases:
- airway compromise
- lodging of dried peas or beans, as they can soak up liquids in the tracts and swell up, causing further harm
- lodging of batteries in the esophagus, as they are corrosive and can lead to perforation and damage
Various methods are used for the removal of foreign bodies. Your child’s doctor will choose one of the below methods depending on the object and location it is lodged in:
- Flexible endoscopy: Most of the ingested foreign bodies are best treated by using an endoscope (bronchoscope or laryngoscope for airway, and esophagoscope for esophagus). It is performed under general anesthesia. Your doctor uses a flexible tube which is attached to an array of instruments which can grasp the foreign body. If the object is sharp or pointed, a protector hood is attached to the endoscope to protect the surrounding tissue from damage. The flexible endoscopy is commonly used to remove objects found in the lower part of the esophagus.
- Rigid endoscopy: In this procedure, your child’s doctor inserts a stiff tube into the esophagus under general anesthesia. Suction force or forceps introduced through the endoscope helps remove the foreign objects present in the upper part of the esophagus.
- Magill forceps: These are a pair of angled forceps which are used to remove the foreign objects present in the upper part of the airway.
- Foley catheter: This is a flexible tube connected with a deflated balloon on one end. Your doctor passes this catheter beyond the foreign body and inflates the balloon using a contrast dye. The catheter is then pulled out slowly through the mouth along with the foreign body. This method is mostly used for objects such as coins that are not sharp.
- Bougienage method: Your child’s doctor will insert a bougie, a thin tube, into the esophagus and push the object into the stomach, from where it gets dispelled through the bowels.
- Penny pincher: A grasping forceps is inserted through a nasogastric or NG tube into the passage, guided by fluoroscopy (live X-ray) that shows the region of the foreign object. Once your child’s doctor gets a firm grip on the object, they will carefully remove it.
As with any procedure, the removal of foreign objects from the airway and esophagus may involve complications. Some of these complications include perforations in the esophagus.
Prevention is the best treatment for foreign bodies in the airway and esophagus as this is an avoidable incident. Increased awareness and care among parents will go a long way in avoiding such problems.