Transcript AERODIGESTIVE FOREIGN BODIES

AERODIGESTIVE FOREIGN BODIES:
A public health concern
Dr. Samson Kichiba MD
Department of otorhinolaryngology.
27/4/2016
Introduction
• Aero digestive fb means fbs in oesophagus
and airway.
• They remain to be common problem that
contributes significantly to high morbidity and
mortality worldwide and in our country
specifically our setting.
epidemiology
• Incidence has been constant over past several
decades
• Aspiration or ingestion
• Common in extremes of ages
• Common age group 1-4 years.
 <5 yrs – 84% of cases
<3 yrs – 73% of cases
M>F (2:1)
• Children are naturally susceptible to fb
because:
 They lack molar teeth
 The tendency to oral exploration
 Tendency of playing during time of ingestion
 Poor coordination of swallowing
• On the other hand, elderly are those with
 Thoracic neurological diseases
 Decreased gag reflex due to alcohol seizures ,stroke,
parkinsonism, trauma and senile dementia.
Location of fb
• Oesophageal fb commonly lodge;
 Upper esophageal sphincter
– Cricopharyngeus sphincter
 Mid esophagus-level of aortic notch
 Lower esophageal sphincter
• Airway foreign bodies commonly lodge:
 Larynx/glottis
 Trachea
 Bronchus, R>L
Etiology
• Carelessness of parents
• Explore environment
• May not have full posterior dentition-needed for
proper grinding of food
• Less coordination of swallowing
• Immaturity in laryngeal elevation and glottic
closure
• Running/playing at time of ingestion
• May have anatomic or neurologic impairment
• Poor vision, drug addiction, rapid eatig.
• Common fb in esophagus are;
 Coins 75%
 Disk batteries
 Bones
 Toys
 Piece of metals
Disk batteries
One hourMucosa damage
Four hoursLeakage of contents
May cause erosion through muscular wall
Six hoursperforation
• Common airway fb;
Groundnuts, pins, earrings, beans, dental
prosthesis, pieces of charcol, stones, piece of
bricks
Airway Foreign Bodies: Presentation
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Initial symptoms: coughing, choking, gagging
Often an acute episode of gagging and choking.
Symptoms:
Laryngeal FB :stridor, hoarseness, croupy cough,
sudden respiratory distess, aphonia, choking
 Tracheobronchial FB: stridor, cough, SOB
• About 50% of patients with foreign-body
aspiration do not have a contributing history.
• History of choking/coughing
• Oesophageal foreign bodies pts mainly
present with h/o:
Dydphagia
Drooling of saliva
Odynophagia
Emesis
Diagnosis
• challenge????
Lack of clear hx and characteristic clinical features
Absence of characteristic radiological findings
20-50% airway fb not detected initialy.
DX of airway fb
• 5-40% of patients with airway FB have no obvious
signs.
• Radiologic studies
 PA/Lat CXR
 PA/Lat neck films
• Most airway foreign bodies are radiolucent
(~80%).
• Only patients with a stable airway should be
taken for x-ray
Treatment of AFB
• Heimlich maneuver
• Respiratory support
• Removal of object with
laryngoscopy/bronchoscopy
DX of esophageal FB
• Chest/Neck/Abdomen xray
AP/Lateral
Look for object
Signs of perforation-subcutaneous emphysema,
retroesophagealabscess, extraluminalportion of
the foreign body
25% of x rays are within normal limit.
Treatment of EFB
• Removal of object with oesophagoscopy or
Magillis forceps
• Observation
Complications
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Bleeding
Accidental extubation
Perforation
Mediastinitis
Aspiration
Challenges at BMC
• ?????????
Thanks for listening.
Discussion