Esophageal perforation may require surgical intervention, and consultations should not be delayed. Signs suggestive of perforation include fever, tachycardia, subcutaneous crepitus and swelling of the neck or chest. Ventilation, airway compromise and the risk of aspiration should first be assessed. The physical examination should focus on the assessment of the patient’s stability and any complications from the food bolus impaction. In general, the patient’s localization of food impaction is often unreliable and esophageal dysphagia is more likely to be referred proximally, rather than distally, from the site of obstruction ( 10, 11). The goal of the initial patient assessment is to determine the stability of the patient, the type of food ingested and time since ingestion, the presence of any complications and the presence of any underlying esophageal conditions or other medical comorbidities.Ī careful history should inquire of any previous history of dysphagia, food impaction, gastroesophageal reflux disease, known structural esophageal abnormalities and the contents of meals. Common respiratory symptoms include stridor, coughing, wheezing or choking.ĭiagnosis of food bolus impaction is rarely a problem because most patients are able to relate the type of food ingested and the approximate time symptoms began. Respiratory symptoms may result from compression of the trachea by a large food bolus impaction (rare), from aspiration of saliva or food (more common), or complete airway obstruction. Patients with a high-grade esophageal obstruction may experience hypersalivation and may be unable to swallow any liquids, including their own saliva. Retching and emesis are also very common, and patients sometimes try to self-induce vomiting in an attempt to dislodge the object. Odynophagia may occur as a result of distension of the esophagus by food bolus, but it is also a marker for esophageal injuries such as laceration, abrasion or perforation. However, impaction at sites lower in the esophagus may cause symptoms such as diffuse chest pain or pressure, dysphagia, odynophagia, a sensation of choking, and neck or throat pain ( 9). Impaction at the upper esophageal sphincter is generally easily localized by the patient. When these underlying esophageal conditions are present and, if food, especially meat, is poorly chewed and swallowed precipitously, acute food impaction can occur.įood bolus impaction usually presents acutely, especially in adults who have had a clear history of ingestion. A recent study ( 8) showed that up to 54% of adults who presented with esophageal food impactions over a three-year period had histological evidence of eosinophilic esophagitis. It is commonly found in younger patients presenting with food dysphagia and impaction. One other emerging condition that is especially important to recognize is eosinophilic esophagitis. Surprisingly, food bolus impaction is an uncommon presentation for esophageal carcinoma. Benign esophageal stenoses caused by Schatzki (B) rings or by peptic strictures are the most common causes, followed by webs, extrinsic compression, surgical anastomosis, esophagitis and motor disorders such as achalasia. Previous studies ( 5), revealed that food bolus impactions have underlying esophageal pathology in 88% to 97% of adult patients evaluated. Food impaction usually occurs as a result of two factors: the state of the esophagus, and the nature of the food that has been swallowed.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |