Foreign bodys of a gullet — not chewed pieces of food which were late in it large and accidentally or purposely swallowed objects which are not used in food (pieces of chicken, meat or fish bones, a tree, glass, a nail, a needle, a coin, badges, buttons, etc.).
Epidemiology Foreign bodys of a gullet in practice of the doctor meet quite often. However exact data on the frequency of this disease are not known.
Etiology and pathogeny The reasons promoting hit of foreign bodys in a gullet are various. It is hasty food, laughter and talk during food negligence when cooking as a result of which pieces of meat, chicken or fish bones, and also splinters of glass or pieces of iron (which are formed when opening canned food) can get to food, decrease in sensitivity of a mucous membrane of a mouth at persons with dentures and at some neurologic diseases, a habit to hold in a mouth inedible objects (nails, needles, paper clips, etc.) at workers of some professions (carpenters, shoemakers, tailors etc.). In most cases the swallowed foreign bodys freely pass on a gullet, and further on a digestive tract, being allocated with a natural way.
At implementation its inflammation develops in a wall of the foreign body having the pointed end or an injury to them an esophageal wall, its perforation is dangerous by emergence of a mediastinitis.
Classification Classification of foreign bodys of a gullet is not developed.
Approximate formulation of the diagnosis: The foreign body (the metal needle which is accidentally swallowed 2 h back) fixed in a wall of the lower third of a gullet.
Clinical picture, preliminary diagnosis At a delay in a gullet of a large foreign body arise the pressing pain behind a breast, feeling of jamming of the swallowed foreign body in a gullet, impossibility of a proglatyvaniye even of water. At acute foreign bodys the main symptom is the pain amplifying at repeated drinks. In the absence of medical care in the next days body temperature can increase, the general condition of the patient worsens. At the X-ray inspection executed without use of a suspension of sulfate of barium it is possible to see X-ray contrast foreign bodys: metal objects, large pieces of meat and chicken bones; fish bones come to light worse. X-ray inspection using a suspension of barium of sulfate allows to reveal X-ray negative foreign bodys, however very small objects can remain unnoticed.
Ezofagoskopiya (previously surely conduct X-ray inspection of a gullet) allows to reveal a foreign body and in most cases to take it. It must be kept in mind that some patients considering that at them the foreign body was late in a gullet actually feel residual unpleasant feelings owing to traumatization of a mucous membrane of a gullet. In rare instances the foreign body of the small sizes can be late for a long time in a gullet and come to light accidentally at the examination conducted in other occasion (annual medical examination, existence of other disease of a stomach and duodenum, etc.).
Differential diagnosis, verification of the diagnosis With symptoms of a dysphagy and pain behind a breast at a proglatyvaniye also acute esophagitis, a round ulcer of a gullet, an esophagism proceed. Emergence of the first symptoms at these diseases can match the moment of a proglatyvaniye of a foreign body (which can pass on a gullet and not be late in it). In differential diagnosis X-ray inspection and an ezofagoskopiya have major importance.
Treatment, prevention Have to be the patient with complaints to the symptoms connected with the swallowed foreign body urgently (generally in the conditions of a surgical hospital) purposeful X-ray inspection and if necessary an ezofagoskopiya are carried out. At identification in out-patient conditions of a foreign body of a gullet which does not manage to be removed at an ezofagoskopiya hospitalization in a surgical hospital is necessary. After removal of a foreign body by the patient appoint a sparing diet (type No. 1, 1b). It is recommended to carry out body thermometry each 3 — 4 h (at a gullet wall injury an acute foreign body the local esophagitis, gullet abscess, in more hard cases — a mediastinitis can develop). Fervescence and strengthening of a retrosternal pain serve as the indication to hospitalization of the patient. It is not recommended to resort to so-called national methods of pushing through of a foreign body (water, liquid porridge, etc.) as it can promote a bigger fixing of an acute foreign body in a wall of a gullet and cause other complications.
Prevention consists in the careful relation to cooking (the prevention of hit in it foreign objects), to creation of a quiet situation during food; each meal has to be carried out without haste, without derivation by talk with neighbors in a table; during food it is impossible to read, it is necessary to chew food carefully. Parents have to keep in the place, unavailable to the small child, small objects (needles, nails, paper clips, etc.) which the child can put in a mouth and swallow. It is necessary to fight against a habit of some persons (tailors, carpenters etc.) to hold in a mouth sewing needles, nails and other objects which they use in operating time.