Esophageal Foreign Body Impaction: Diagnostic and Therapeutic Challenges in the Emergency Department
Abstract
Background: Esophageal foreign body (EFB) impaction is a frequent emergency department presentation. While many cases involve witnessed, low-risk ingestions, significant diagnostic and therapeutic challenges arise when clinical history is incomplete, as in young children or cognitively impaired individuals. The risk spectrum is broad, ranging from spontaneous passage to life-threatening complications like perforation or aortoesophageal fistula.
Aim: This article reviews the etiology, epidemiology, pathophysiology, and management of EFB impaction, highlighting the complexities faced in emergency settings and outlining evidence-based strategies for evaluation and intervention.
Methods: A comprehensive review synthesizes current clinical knowledge on EFB impaction. It examines age-related epidemiological patterns, the pathophysiology of impaction at physiological narrowings, and the specific mechanisms of injury from high-risk objects like button batteries, magnets, and sharp items. Diagnostic approaches, including radiography and computed tomography, and therapeutic algorithms are detailed.
Results: Management is dictated by patient stability, object type, location, and dwell time. Endoscopic removal is the cornerstone of treatment, with success rates >90%. Button batteries in the esophagus require emergency removal due to rapid caustic injury. Most blunt objects pass spontaneously, but food impactions in adults often indicate underlying pathology (e.g., strictures, eosinophilic esophagitis), necessitating further evaluation.
Conclusion: Successful outcomes rely on prompt recognition of high-risk scenarios, timely endoscopy, and understanding object-specific risks. A coordinated, interprofessional team approach from triage through discharge and prevention counseling is essential to minimize morbidity.
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References
Anderson KL, Dean AJ. Foreign bodies in the gastrointestinal tract and anorectal emergencies. Emergency medicine clinics of North America. 2011 May:29(2):369-400, ix. doi: 10.1016/j.emc.2011.01.009.
Al Lawati TT, Al Marhoobi RM. Timing of Button Battery Removal From the Upper Gastrointestinal System in Children. Pediatric emergency care. 2021 Aug 1:37(8):e461-e463. doi: 10.1097/PEC.0000000000001697.
Zhang XR, Li Q. [A case of magnetic pharyngeal foreign body in children]. Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology head and neck surgery. 2018 Sep:32(18):1432-1433. doi: 10.13201/j.issn.1001-1781.2018.18.017.
Malik SA,Qureshi IA,Muhammad R, Diagnostic Accuracy Of Plain X-Ray Lateral Neck In The Diagnosis Of Cervical Esophageal Foreign Bodies Keeping Oesophagoscopy As Gold Standard. Journal of Ayub Medical College, Abbottabad : JAMC. 2018 Jul-Sep
Al Lawati TT, Al Marhoobi R. Patterns and Complications of Ingested Foreign Bodies in Omani Children. Oman medical journal. 2018 Nov:33(6):463-467. doi: 10.5001/omj.2018.86.
Shatani N, Alshaibani S, Potts J, Phillips B, Bray H. Chest Radiograph Alone Is Sufficient as the Foreign Body Survey for Children Presenting With Coin Ingestion. Pediatric emergency care. 2021 Sep 1:37(9):e524-e527. doi: 10.1097/PEC.0000000000001688.
Arana A, Hauser B, Hachimi-Idrissi S, Vandenplas Y. Management of ingested foreign bodies in childhood and review of the literature. European journal of pediatrics. 2001 Aug:160(8):468-72
Triadafilopoulos G, Roorda A, Akiyama J. Update on foreign bodies in the esophagus: diagnosis and management. Current gastroenterology reports. 2013 Apr:15(4):317. doi: 10.1007/s11894-013-0317-5.
Gretarsdottir HM, Jonasson JG, Björnsson ES. Etiology and management of esophageal food impaction: a population based study. Scandinavian journal of gastroenterology. 2015 May:50(5):513-8. doi: 10.3109/00365521.2014.983159.
Leinwand K, Brumbaugh DE, Kramer RE. Button Battery Ingestion in Children: A Paradigm for Management of Severe Pediatric Foreign Body Ingestions. Gastrointestinal endoscopy clinics of North America. 2016 Jan:26(1):99-118. doi: 10.1016/j.giec.2015.08.003.
Alfonzo MJ, Baum CR. Magnetic Foreign Body Ingestions. Pediatric emergency care. 2016 Oct:32(10):698-702
Aiolfi A, Ferrari D, Riva CG, Toti F, Bonitta G, Bonavina L. Esophageal foreign bodies in adults: systematic review of the literature. Scandinavian journal of gastroenterology. 2018 Oct-Nov:53(10-11):1171-1178. doi: 10.1080/00365521.2018.1526317.
Huang T, Li WQ, Xia ZF, Li J, Rao KC, Xu EM. Characteristics and outcome of impacted button batteries among young children less than 7 years of age in China: a retrospective analysis of 116 cases. World journal of pediatrics : WJP. 2018 Dec:14(6):570-575. doi: 10.1007/s12519-018-0188-9.
Bekkerman M, Sachdev AH, Andrade J, Twersky Y, Iqbal S. Endoscopic Management of Foreign Bodies in the Gastrointestinal Tract: A Review of the Literature. Gastroenterology research and practice. 2016:2016():8520767
Cervi E. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3: management of asymptomatic children with a history of coin ingestion. Emergency medicine journal : EMJ. 2010 May:27(5):395-6. doi: 10.1136/emj.2010.094904.
. BET 1: use of glucagon for oesophageal food bolus impaction. Emergency medicine journal : EMJ. 2015 Jan:32(1):85-8. doi: 10.1136/emermed-2014-204467.1.
Bolton SM, Saker M, Bass LM. Button battery and magnet ingestions in the pediatric patient. Current opinion in pediatrics. 2018 Oct:30(5):653-659. doi: 10.1097/MOP.0000000000000665.
Ham PB 3rd, Ellis MA, Simmerman EL, Walsh NJ, Lalani A, Young M, Hatley R, Howell CG, Hughes CA. Analysis of 334 Cases of Pediatric Esophageal Foreign Body Removal Suggests that Traditional Methods Have Similar Outcomes Whereas a Magnetic Tip Orogastric Tube Appears to Be an Effective, Efficient, and Safe Technique for Disc Battery Removal. The American surgeon. 2018 Jul 1:84(7):1152-1158
Authors
Copyright (c) 2025 Sultan Hulayyil Ashwi Aldhafeeri, Satam Mutair A. Aljameeli, Gumran Mubark Al-Harbi, Oqla Adhman Ali Aljmaeeli, Naif Mofareh Dakhel Alshammari, Saud Khalaf Alkhibl Alsharari, Abdullah Mufadhi Hanif Alruwaili, Jubayr Khashm Jubayr Alruwaili, Mohammed Mufadhi Alruwaili, Ibrahim Youssef Shaddad Al-Mutairi, Fayez Farhan Mashouj Al-Ruwaili, Fahad Khemais Mishal Alshammari
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