Gilyoma and Chalya BMC Ear, Nose and Throat Disorders 2016, 11:2

http://www.biomedcentral.com/1472-6815/11/2

RESEARCHARTICLE Open Access

Endoscopic procedures for removal of foreign bodies of the aerodigestive tract: The Bugando Medical Centre
experience
Japhet M Gilyoma*†, Phillipo L Chalya†

Abstract
Background: Foreign bodies in the aerodigestive tract continue to be a common problem that contributes
significantly to high morbidity and mortality worldwide. This study was conducted to describe our own experience
with endoscopic procedures for removal of foreign bodies in the aerodigestive tract, in our local setting and compare
with what is described in literature.
Methods: This was a prospective descriptive study which was conducted at Bugando Medical Centre between
January 2008 and December 2009. Data were collected using a structured questionnaire and analyzed using SPSS
computer software version 15.
Results: A total of 98 patients were studied. Males outnumbered females by a ratio of 1.1:1. Patients aged 2 years
and below were the majority (75.9%). The commonest type of foreign bodies in airways was groundnuts (72.7%)
and in esophagus was coins (72.7%). The trachea (52.2%) was the most common site of foreign body’s lodgment in
the airways, whereas cricopharyngeal sphincter (68.5%) was the commonest site in the esophagus. Rigid
endoscopy with forceps removal under general anesthesia was the main treatment modality performed in 87.8% of
patients. The foreign bodies were successfully removed without complications in 90.8% of cases. Complication
rate was 7.1% and bronchopneumonia was the most common complication accounting for 42.8% of cases. The
mean duration of hospital stay was 3.4 days and mortality rate was 4.1%.
Conclusion: Aerodigestive tract foreign bodies continue to be a significant cause of childhood morbidity and
mortality in our setting. Rigid endoscopic procedures under general anesthesia are the main treatment modalities
performed. Prevention is highly recommended whereby parents should be educated to keep a close eye on their
children and keep objects which can be foreign bodies away from children’s reach.

Background time of ingestion, and the poor coordination of swallow-

Foreign bodies in the aerodigestive tract are an impor-tant ing [4,5]. On the other hand, the elderly are those with
cause of morbidity and mortality in the two extremes of thoracic neurological disease, decreased gag reflex due to
life and pose diagnostic and therapeutic challenges to alcohol seizures, stroke, Parkinsonism, trauma and senile
otorhinolaryngologists [1]. The ingestion and inhalation dementia [6].
of foreign bodies occurs most commonly in children’s The accurate diagnosis of aerodigestive tract foreign
population, especially in their first six years of life [2,3], bodies may be missed even by an experienced clinician.
with a peak incidence in children between 1 and 3 years The delayed symptoms of foreign body in the aerodiges-
[1,4]. Children are naturally susceptible to be involved in tive tract may mimic other common conditions like
FB injuries due to lack of molar teeth, the tendency to oral asthma, recurrent pneumonia, upper respiratory infec-tion
exploration and to play during the and persistent cough [1,7-10].
Foreign bodies in the aerodigestive tract present with a
* Correspondence: drgilyoma2@yahoo.com wide spectrum of clinical presentation, patients often
† Contributed equally present in the emergency with acute onset respiratory
Department of Surgery, Weill- Bugando distress and occasionally in a cyanosed state. At the
University College of Health Sciences, Mwanza,
Tanzania
© 2016 Gilyoma and Chalya; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the
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distribution, and reproduction in any medium, provided the original work is properly cited.
Gilyoma and Chalya BMC Ear, Nose and Throat Disorders 2011, 11:2 Page 2 of 5 http://www.biomedcentral.com/1472-6815/11/2

other end of the spectrum is the patient presenting with esophagus. Small objects, such as pills and smaller button
nothing more than a history of aspiration and on inves- batteries, may adhere to the slightly moist esophageal
tigation is found to have a foreign body in his aerodiges- mucosa at any point.
tive tract [10].
The symptoms and signs produced depend upon the Methods
nature, size, location and time since lodgment of the This was a prospective descriptive study which was con-
foreign body in the aerodigestive tract. A large foreign ducted at the Accident and. Emergency department of
body occluding the upper airway or esophagus may lead Bugando Medical Centre (BMC) over a 2-year period
to severe symptoms and even sudden death whereas a between January 2008 and December 2009. BMC is a
small foreign body lodged in the aerodigestive tract may 1000-bed, tertiary care and teaching hospital for the
present with less severe symptoms [10,11]. Weill-Bugando University College Health Sciences
Foreign bodies lodged in the esophagus for a long time (WBUCHS). The study subjects included all patients of
may be associated with complications such as mucosal all age groups and gender who presented to the A &E
ulceration, esophageal obstruction, perforation, intrinsic department with history of foreign bodies in the aerodi-
stenosis and esophageal diverticulum [12], whereas gestive tract. Patients with history of foreign bodies in the
foreign bodies retention in the airway may lead to aerodigestive tract but could not be identified at
complications such as severe respiratory distress, lung endoscopic examination and those who died before
collapse and recurrent chest infection [13]. Early diagno- endoscopic procedures were excluded from the study. All
sis and treatment are imperative to prevent mortality as patients included in the study were, after informed written
well as complications. consent to participate in the study, enrolled in the study.
Approval to conduct the study was sought from the
There is paucity of local data regarding the manage-ment
of foreign bodies in the aerodigestive tract as there is no WBUCHS/BMC joint institutional ethic review
study which has been done in our setting or any other committee before the commencement of the study.
hospital in the country. This study was done in our setting All patients with history of foreign bodies in the aero-
to describe our experience with endo-scopic procedures digestive tract were subjected to endoscopic examina-
for the removal of foreign bodies in the aerodigestive tions (oesophagoscopy or bronchoscopy). Data were
tract, with a review of the pertinent literature. collected using a structured, pre-tested and coded ques-
Pathophysiology tionnaire. Included in questionnaire were; age, sex, area
of residence, family history of foreign bodies in the
Esophagus
Most complications of pediatric foreign body ingestion
are due to esophageal impaction, usually at one of three
typical locations. [1] The most common site of esophageal
impaction is at the thoracic inlet. Defined as the area
between the clavicles on chest radiograph, this is the site
of anatomical change from the skeletal muscle to the
smooth muscle of the esophagus. The cricopharyngeus
sling at C6 is also at this level and may "catch" a foreign
body. About 70% of blunt foreign bodies that lodge in the
esophagus do so at this location. Another 15% become
lodged at the mid esophagus, in the region where the
aortic arch and carina overlap the esophagus on chest
radiograph. The remaining 15% become lodged at the
lower esophageal sphincter (LES) at the gastroesophageal
junction.
Children with preexisting esophageal abnormalities (eg,
repair of a tracheoesophageal fistula) are likely to have
foreign body impaction at the site of the abnormality. If a
child with no known esophageal pathology has a blunt
foreign body lodged at a location other than the 3 typical
locations described above, the possibility of a previously
unknown esophageal abnormality should be considered.
The presence of eosinophilic esophagitis has been
recognized as contributing to adult esophageal foreign
body impaction and may be its presenting feature;
although less common in children, eosinophilic
esophagitis has also been associated with pediatric
esophageal food impaction. [2]
Pointed objects, such as thumbtacks, may become
impaled and, therefore, lodged anywhere in the
aerodigestive tract, the type of foreign body, anatomical
location of the foreign body, treatment and outcomes
(length of hospital stay, mortality & postoperative com-
plication). Data were analyzed using SPSS computer
software version 15.

Results
During the period under study, a total of 98 patients with
established foreign body in the aerodigestive tract were
studied. 52 (53.1%) were males and females were 46
(46.9%) with a male to female ratio of 1.1:1. Their ages
ranged from 1 year to 63 years (mean 7.04 ± 14.62 years).
The median was 2 years. Patients aged ten years and
below were the majority and accounted for 87 (88.8%).
Of these, 66 (75.9%) patients were aged two years and
below. The majority of patients 64(65.3%) were from the
urban areas around Mwanza city. No patient had family
history of foreign body in the aerodi-gestive tract (Table
1).
Patients with foreign bodies in the esophagus were the
majority accounting for 54 (55.1%) of cases, whereas
patients with foreign bodies were 44(44.9%). Sixty-three
(64.3%) patients presented to hospital within 24 hours,
whereas 20 (20.4%) presented between 1 day to 7 days
and the remaining 15(15.3%) presented to hospital after 7
days. The most common reasons for delay presenta-tion
were lack of money for transport and inappropriate
diagnosis and treatment given in the peripheral hospi-tals.
A positive history of foreign body in the aerodiges-tive
tract were recorded in 92 (93.9%) of cases, whereas in the
remaining 6 (6.1%) patients the diagnosis of for-eign
bodies in the aerodigestive tract was made based on
clinical presentation and radiological investigation on
admission. Sixty-eighty (69.4%) of the patents were
asymptomatic on admission despite positive history of
foreign bodies in the aerodigestive tract. The most com-
mon clinical presentations were cough, wheezing, dys-
pnea, choking, vomiting, and drooling of saliva and

Table 1 Patients characteristics

Number of Percentag
Patients characteristics patients e

Age (years)
° ≤ 10 87 88.8
° > 10 11 11.2
Sex
° Males 52 53.1
° Females 46 46.9
Area of residence
° Urban 64 65.3
° Rural 34 34.7
Family history of foreign
bodies
° Yes - -
° No 98 100