History

Oropharyngeal foreign bodies

Patients with oropharyngeal foreign bodies normally present with a foreign body sensation, especially after eating chicken or fish, although a variety of other objects, including toothpicks, may be involved.

They may have variable degrees of discomfort, from minor to more severe. Patients may complain of inability to swallow or handle secretions.

Rarely, patients may have airway compromise, typically in delayed presentations with subsequent infection or perforation.

Patients can usually localize the foreign body sensation in the oropharynx.

Esophageal foreign bodies

Adults with esophageal foreign bodies usually present acutely, with a history of ingestion. A foreign body sensation or vague discomfort in the epigastrium suggests that the foreign body is entrapped at the LES.

Dysphagia is the norm in adults. If the obstruction is complete, an inability to handle secretions is common. The classic adult presentation is the person with dentures who has had some alcohol and is eating meat. Incomplete chewing leads to an impaction at the LES. Adults should be asked about the use of dentures, alcohol intake, and circumstances surrounding the ingestion.

In children with esophageal foreign bodies, the history may be less clear.^{[11, 19]}As many as 35% of children with esophageal foreign bodies are asymptomatic; the history is given by a parent who has seen the child with an object in his or her mouth and suspects the child might have swallowed it. Such reports must be taken seriously and investigated.^[20]Gagging, vomiting, and neck or throat pain are common presentations. Children with chronic esophageal foreign bodies may also present with poor feeding; irritability; failure to thrive; fever; stridor^[21]; or pulmonary symptoms, such as repetitive pneumonias from aspiration.^[22]Large esophageal foreign bodies at the UES can cause tracheal impingement in children, with resultant stridor or respiratory compromise.

Stomach/small intestine foreign bodies

Patients with foreign bodies in the stomach or small intestine may present with a history of swallowing an object, which has passed through the esophagus.

Patients may present with vague symptoms such as fever, abdominal pain, or vomiting.

Physical Examination

The physical examination typically is not helpful, but the oropharynx, neck, chest, lungs, heart, and abdomen should be carefully examined.

Occasionally, a foreign body in the oropharynx can be visualized and removed. In cooperative patients, indirect laryngoscopy or fiberoptic nasopharyngoscopy provides better information than a direct examination.

In children, tracheal compression and stridor suggest a large foreign body at the upper esophageal sphincter.

Complete obstructions can cause drooling and the inability to swallow.

Delayed presentations may be accompanied by signs of infection, including peritonitis.

Differential Diagnoses

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Media Gallery

Coin (quarter) lodged at the level of the cricopharyngeus muscle.
Coin lodged at the level of the aortic crossover.
Coin lodged at the lower esophageal sphincter.
A screw in the stomach; peristaltic action will carry the screw through the GI tract with the blunt end (head) leading and the sharp end trailing.