Management of foreign body in the upper aerodigestive tract
Foreign body aspiration or ingestion in children is a very common scenario encountered in the emergency department. The clinical history is often ambiguous, and symptoms and signs can vary widely depending on the type of foreign body, and the location at which the foreign body has become lodged.
If the foreign body is obstructed at the level of hypopharynx/oesophagus, the patient will complain of a foreign body sensation, odynophagia, dysphagia and drooling. If the foreign body is above the cricopharyngeus, patients can reliably locate the site of impaction. The area can be examined with a flexible nasoendoscope.
Foreign bodies, such as a bone, sharp fragment, or non-organic material, require urgent removal to avoid oesophageal perforation and subsequent complications. It is worth noting that most ingested foreign bodies pass through the gastrointestinal tract safely without symptoms.
A foreign body in the larynx or trachea can cause stridor, voice change, choking, cyanosis, difficulty in breathing, tachypnoea and pneumonia. A back slap or abdominal thrust (Heimlich manoeuvre) is employed in an emergency where total or partial obstruction causes compromise. Most inhaled foreign bodies enter the trachea and become lodged in the right main bronchus. Foreign bodies at the laryngeal inlet can be removed using an anaesthetic laryngoscope and Magill forceps. Foreign bodies in the trachea and main bronchus require formal bronchoscopy.
The incidence of button battery inhalation/ingestion is increasing in children. When the button battery becomes lodged, contact with the body tissue completes a circuit and allows current to flow. Electrical current from the battery results in generation of hydroxide radicals. This electrochemical burn to the area results in tissue necrosis, fistula formation, and perforation. This can happen very quickly and can be life threatening. Button batteries must be removed immediately. The radiological hallmark is a small circular radio-opaque object with a ‘halo’ or a ‘double ring’, which represents the small bevelled indentation around the edge of the battery.