Disclaimer: This is in no means a substitute for getting a physician to look at you if you feel you have ingested a foreign body and feel it is stuck somewhere in your gullet. Please don’t delay in seeking medical advice.
Introduction to Foreign Body Ingestions
Retained foreign bodies upon oral ingestion can be quite a nightmare for the emergency physician.
These are some classic and new pneumonics that your doctor should certainly be considering as he or she works you up and figures out where the foreign body is and what to do about it.
First of all, which are the high risk foreign bodies that the emergency physician should prioritize in terms of urgency and need for emergent removal.
This first pneumonic is new. It will help you you were just entering this field. I propose a pneumonic that a doctor can keep in mind to remind them that they need to move these high-risk cases onto the next level, like endoscopy or surgical consideration, etc., because of their particularly high risk for morbidity and mortality.
Foreign body removal stat? High risk foreign body you shouldn’t just observe or move slowly on? You should definitely: “SELL’M” to the next level of care.
Sharp
Elongated
Large
Lithium button batteries
Multiple
If the foreign body in question is sharp, elongated, large, a lithium button battery, or multiple, this is most definitely an acute emergency. That foreign body must be removed aggressively, immediately because of the problems it will cause if there is any delay at all.
Another classic pearl that every physician knows when considering foreign bodies retained in the esophagus is known as the water test. It’s generally useful in all cases of esophageal obstruction as well.
Water test (Esoph FB or obstructions):
Fast N/V => upper
Slower => lower
Yes, it’s a little more old-school, but it works like this. If the patient vomit immediately after a water challenge, the foreign body or obstruction is somewhere in the upper gullet. If they vomit slower, it is in the lower esophagus.
Another classic pneumonic is known by all as one that helps us remember where foreign bodies like to hang up or ‘catch’ in the esophagus. It is “CATJ”. All esophageal foreign bodies get stuck in these locations for the most part:
Cricopharyngeal muscles: upper 1/3, 60%
Aortic arch
Tracheal bifurcation
(GE)Junction
So, CATJ. The radiographic anatomical level of the esophagus where foreign bodies tend to catch.
One final pearl about esophageal foreign bodies… There is an important distinction in gullet foreign body retention worth remembering that distinguishes children from adults. Foreign bodies in kids generally hang up in the upper esophageal sphincter. In the adult -> they get stuck in the lower esophageal sphincter more commonly.
Conclusion
These are the main pearls that every physician should keep in mind when the patient in front of them has a foreign body stuck in their esophagus, just waiting to inadvertently find its way into the airway and impact breathing… Or move on down and bother no one.
