Clinical diagnosis and treatment of foreign bodies in a complex esophagus
- LI Fei, YAO Jun, LIU Leifeng
Journal of Otolaryngology and Ophthalmology of Shandong University. 2019, 33(6):
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Objective To investigate the types and characteristics of severe complications associated with complicated foreign bodies of the esophagus, and to summarize the clinical diagnosis and treatment. Methods From January 2015 to January 2018, 244 cases with an esophageal foreign body were hospitalized in the affiliated Hospital of Guangdong Medical University, of which 22 were accompanied by severe complications. The clinical data of 22 patients were analyzed retrospectively. This data includes patients, the time of their visit, the types of foreign bodies, the location of the Kanton, types of complications, diagnosis, and treatment. Results Apart from 4 children, all patients had tried to force the foreign body into their stomach by eating steamed bread, vegetables and swallowing. This resulted in a number of serious complications. The longest time from onset to treatment was 32 days, with an average of 5.9 days. Seventeen(77.3%)of the foreign-body cases resulted from animal bones, mainly fish and chicken bones. Ten cases were at the esophageal entrance level, 5 cases at the T1-T2 level and 3 cases at the T8-T9 level. In 6 cases(27.3%), severe complications included esophageal perforation or local inflammation emphysema in the neck and diaphragm, an abscess in 5 cases(22.7%)and an esophageal or phrenic fistula in 4 cases(18.2%). There were 3 cases(13.6%)of extraesophageal foreign bodies, 1 case of a posterior pharyngeal abscess(4.5%), 1 case of a pneumothorax(4.5%), 1 case of an tracheoesophageal fistula(4.5%)and 1 case of an esophageal aortic fistula(4.5%). Foreign bodies were removed under esophagoscopy in 14 cases, foreign bodies in 3 cases by lateral cervical incision, incision and drainage of a cervical and mediastinal abscess in 3 cases, thoracoscopic exploration of the esophagus in 1 case, and pneumonectomy in 1 case. One patient underwent a tracheoesophageal fistula repair with a bronchoscopic foreign body removal. Of the 22 patients, 21 were cured(95.5%), with an average hospital stay of 6.2 days. One patient passed away(4.5%). Conclusion Foreign body of the complex esophagus is more common in elderly patients. Patients who swallow foreign bodies by mistake generally start violently swallowing and do not seek medical treatment in enough time. This leads to the patients condition worsening. A positive correlation was observed between the type of foreign body, the admitting hospital, and the time of medical treatment with the occurrence and severity of complications. An upper gastrointestinal angiography and computed tomography(CT)examination were the most effective in diagnosing an esophageal foreign body and its potential complications. These tools can clearly show the relationship between foreign bodies and the important tissues and organs around them. Multidisciplinary assistance therapy is important in reducing the occurrence of serious complications.