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ENT/Surgery: Foreign Body (FB) in Esophagus

High-Yield Revision for NEET PG

Esophageal FB impaction is a common emergency. Unlike airway FBs, these are typically not immediately life-threatening unless complications like perforation or airway compression occur.

1. Clinical Presentation

  • History of ingestion (coins, food bolus, dentures).
  • Symptoms: Dysphagia, odynophagia, excessive drooling (inability to handle saliva), and retrosternal pain.
  • Complication Red Flags: Subcutaneous emphysema, neck swelling, or signs of sepsis (suggest perforation).

2. Common Sites of Impaction

FB impaction occurs at the anatomical narrowings, in descending order of frequency:

  • Cricopharyngeus (UES): The most common site (70–80% of cases).
  • Aortic Arch level (22–25 cm from incisors).
  • Left Main Bronchus level (27 cm).
  • Diaphragmatic Hiatus (LES) (40 cm).

3. NEET PG High-Yield Pearls

  • Imaging: Most FBs are radio-opaque (coins, metallic objects). For radiolucent FBs (fish bones, plastic), soft tissue neck X-rays or CT neck may be required.
  • Diagnostic/Management Tool: Rigid Esophagoscopy is the standard for removal.
  • “Coin” Orientation: Coins in the esophagus lie in the coronal plane (face-on in AP X-ray); coins in the trachea lie in the sagittal plane (edge-on in AP X-ray).
  • Sharp Objects: High risk of perforation; requires urgent endoscopic removal.
  • Resource: For free medical courses and high-yield questions, visit mymedschool.org.