Esophageal foreign bodies.

Over 80 per cent of ingested foreign bodies pass through the gastrointestinal tract without incident. Sharp (bones, pins, needles, wire) or long (greater than 6.5 cm) foreign bodies are most commonly implicated in perforation. Food boluses are most common in obstruction seen in adult patients and associated esophageal pathology is common in patients aged 60 years and older. Adults with nonfood foreign bodies have a high incidence of psychiatric, social, or chemical derangements. Pediatric patients most commonly ingest coins. Ingestions tend to occur during nonschool months or in high-risk situations, and repeat ingestions are not uncommon. Fatalities and other major complications are linked to type of foreign body, location, and duration of the impaction. Deaths have also occurred with endoscopic and enzymatic modalities of treatment. Glucagon and Foley catheter removal are safe techniques in selected patients, provided resuscitative skill and equipment are available. Based on these data, an algorithmic approach to the management of esophageal foreign bodies by the emergency physician is recommended (Table 5).