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1、Foreign Bodies in the Esophagus食道异物7-8年制基础、临床、预防、口腔医学类专业用广西医科大学第一附属医院耳鼻咽喉-头颈外科温文胜IntroductionThe inherent curiosity of children may lead them to ingest many types of objects.The vast majority of ingested objects pass through the gastrointestinal tract without problems.Some of these foreign bodies be
2、come lodged in the esophagus because of normal physiologic narrowings,while others may become lodged at the site of underlying pathology.A foreign body that is retained for a long period can serve as a nidus for a local tissue reaction and result in chronic inflammatory change.Anatomy of the Esophag
3、usConstrictions of the esophagusThe thoracic inletat its commencement.The mid esophagus crossed by the aortic arch and the left main bronchus.The gastroesophageal junction where it pierces the diaphragm.Clinical FeaturesPain Pain is the predominant symptom.It is frequently retrosternal and epigastri
4、c.Extends to the back.This is often occasionally constant but is more often present in the act of swallowing.Clinical FeaturesDysphagiaDue to the obstruction of food in the food passage or mucosal oedema.Occasionally,regurgitation of food.Clinical FeaturesDyspnoea and hoarseness Swelling of the lary
5、ngeal mucosa.Compression of the larynx and the trachea by the object in the esophagus.Occurs especially in small children.ComplicationsLocal infection and perforation of esophagus;Retropharyngeal abscess;Aorto-esophageal fistula Tracheoesophageal fistula;Mediastinitis.ComplicationsLocal infection an
6、d perforation of esophagus;颈部组织间隙气肿颈部组织间隙气肿ComplicationsRetropharyngeal abscess;DiagnosisHistoryA history of having swallowed something that has become stuck in the food passage.Indirect laryngoscopy Show pooling of saliva in th hypopharynx.RadiographyProvide evidence of presence of foreign body.Dia
7、gnosisRadiographyRadiopaque foreign body Anteroposterior and lateral films of the chest.Lateral soft tissue film-most useful single film.Nonradiopaque foreign bodyBarium.Barium swallowed with a shreds of cotton-wool.Foreign body in the upper esophagusAn artificial teeth is in the upper esophagus.Tre
8、atmentGeneral treatments.Removal of FBs.Rigid esophagoscopy.Flexible esophagoscopy.Surgery.Temporization.General treatments.Prohibiting oral food and liquidsSurgical drainageAntibiotics Airway protectionTreatmentTreatmentRemoval of FBs.Rigid esophagoscopy Most common method.General or superficial an
9、esthesia.AdvantagesHigh success rate Direct visualization of the foreign body Direct visualization of the esophagus after removal of the object.食管镜 esophagoscopeTreatmentRemoval of FBs.Flexible esophagoscopy Small objects.纤维食管镜 fibropticesophagoscopeTreatmentRemoval of FBs.External cervical or transthoracic oesophagotomyOccasionally indicated in difficult cases.A foreign body cannot be removed endoscopically.TreatmentTemporization Within 24 hours after ingestionA single smooth object In the distal aspect of the esophagus Search for the object in the stoolRepeat radiography