34. Foreign bodies in the bronchial system, foreign bodies of the oesophagus
Foreign body aspiration
- Mostly in children < 3
- 4x more often in the right main bronchus, due to its steeper incline
- Peanuts, tablets, seeds
- Clinical features
- Coughing
- Choking
- Stridor
- Dyspnoea
- Complete obstruction – atelectasis
- Partial obstruction – distal hyperinflation
- Diagnosis
- If severe obstruction -> clinical diagnosis
- If non-severe obstruction
- Chest X-ray
- Bronchoscopy
- Treatment
- Heimlich
- Removal with bronchoscopy
Foreign body in oesophagus
- Foreign body in oesophagus is most common in children
- In children: Coins, nuts, toys, button batteries, magnets
- Button batteries are especially dangerous because they can short-circuit and perforate the oesophagus
- In adults: Fish bones, dentures
- Usually stuck in the hypopharynx or upper part of oesophagus
- Clinical features
- Pain
- Feeling of pressure
- Dysphagia
- Diagnosis
- X-ray
- Oesophagoscopy
- Treatment
- Nothing (if asymptomatic, low-risk)
- Try eating moist, wet bread or buns (eases passing)
- Endoscopic removal if not passed within 24 hours
- Urgent endoscopic removal (if high-risk)
- Nothing (if asymptomatic, low-risk)