Ingested Foreign Bodies in Erbil

Abstract

Background and Objectives

Ninety-two patients with a history of ingested foreign bodies (FB) were seen between Jan 2002 to January 2010 in an otolaryngology clinic in Erbil. The majority of cases were children. Food particles and animal bones were found to be the most common types of foreign bodies. Cases are managed by endoscopic removal of the FBs under General anaesthesia. Complications were rare except in two cases. The management of these cases is discussed. Rare foreign bodies of interest is reported .it is recommended that children under 5 years should be supervised and not be left alone to feed themselves. A patient who has denture shall take enough time with his meal and take small bullous chewing them properly. Patients who have swallowed sharp , irregular FBs must be managed by senior staff with good skill in endoscopy.

Patients and Methods

This is a prospective study where data of cases collected and saved on computer for future analysis . Ninety two patients with history of recent foreign body ( F B ) ingestion were seen in an Otolaryngology clinic in Erbil. The detail of history of each case including age , sex, social status , symptoms and state of ingestion of the foreign body were recorded. All patients had clinical and endoscopic examination of oro and hypopharynx to localize the F B . Patients in whom the F B was not localized by clinical examination, were sent for radiological imaging of the neck , chest and upper abdomen to identify the type of FB and the site of impaction. Barium swal- low was done only with high suspicious of ingested radio-translucent FBs when the FB could not be localized with plain X -ray. Patients with F B in hypopharynx and oesophagus were admitted and prepared for diagnostic and therapeutic en- doscopic examination under general anaesthesia ( G A ) with endotracheal intubation. Imaging study wasrepeated immediately before endoscopy specially with smooth ingested FBs . The type of the F B removed was recorded . Patients who had uneventful endoscopic examination and those with smooth F B were discharged home on the same day, while patients who had ingested sharp F B , or had neglected and infected F B or had excess manipula- tion during endoscopic removal of the F B were kept under observation for 24 hours . Cases who developed any complication and required farther intervention were sent for new radiological imaging to confirm the complica- tion occurred and treated accordingly .

Results

Total of 92 patients with F B in pharynx and oesophagus were recorded . Age ranged from 12 months to 70 years , age distribution charted in (chart 1). Majority of them (47) were children in the first decade of life . 17 cases were above 45 years. Sixty five were male and 27 female . Painful swallowing was the presenting symptom in 90 cases . Progressive dysphagia and vomiting was present- ing symptoms in 2 cases . FBs were swallowed either ac- cidentally or with meals . Two patients swallowed sharp FBs ( needle and glass ) in suicidal attempt. The types of ingested FBs are listed in (table 1).