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Cervical esophageal foreign body. (Esophagoscopy Clinic).

A 61-year-old woman came to the clinic with a chief complaint of severe odynophagia, which had begun after she had eaten quail for dinner 11 days earlier. She was seen in the emergency department, where the results of barium esophagography were normal. Subsequent transnasal esophagoscopy (TNE) revealed the presence of a small, white foreign body in the left postcricoid region (figure, A). A 2-mm forceps was used in an attempt to separate the foreign body from the surrounding mucosa (figure, B). However, at that point the patient swallowed and the foreign body was lost in the cervical esophagus. Because of the danger of foreign-body aspiration, the patient was taken to the operating room, where the foreign body was removed uneventfully via rigid esophagoscopy under general anesthesia (figure, C).

This case illustrates the limitations of foreign-body removal via TNE. The small size of the 2-mm forceps makes grasping irregularly shaped objects difficult. Compared with rigid esophagoscopy, TNE does not allow for good visualization of the postcricoid region. In addition, the airway is unprotected during TNE, and foreign-body aspiration is a concern. Even if a foreign body were to be safely grasped and removed from the esophagus via TNE, it would still have to be withdrawn through the tight nasal vault.

Our approach to the patient with a suspected esophageal foreign body is to perform TNE for diagnostic purposes only, unless it is a distal esophageal foreign body. TNE requires no sedation, and it offers better diagnostic accuracy than does radiologic evaluation. If a distal foreign-body impaction is discovered, we attempt to gently push the bolus into the stomach. Otherwise, once the diagnosis is made, the patient is taken to the operating room for rigid esophagoscopy.

From the Center for Voice Disorders, Department of Otolaryngology, Wake Forest University, Winston-Salem, N.C., and the Scripps Center for Voice and Swallowing, La Jolla, Calif.
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Article Details
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Author:Koufman, James A.
Publication:Ear, Nose and Throat Journal
Article Type:Brief Article
Geographic Code:1USA
Date:Jan 1, 2003
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