Pathophysiology

Although most objects pass spontaneously, 10 to 20 percent require some intervention, and only 1 percent demand surgical treatment. 2 Ingested foreign bodies may be found anywhere throughout the digestive tract, but there are several physiologic "narrow spaces" where the majority of articles tend to lodge. The pediatric esophagus has five areas of constriction where coins and other objects may become trapped: cricopharyngeal narrowing (C6), the most common site; thoracid inlet (T1); aortic arch (T4); tracheal bifurcation (T6); and hiatal narrowing (T10-11). Most pediatric obstructions occur in the proximal esophagus; the vast majority of adult impactions arise from esophageal disease in the distal esophagus. Because 97 percent of adults presenting with meat impaction harbor pathologic esophageal conditions, barium swallow must be performed to confirm foreign body clearance and evaluate possible underlying disease.

Once an object has traversed the pylorus, it usually continues to the rectum and is passed in the stool. If, however, the object has irregular or sharp edges, it may become lodged anywhere in the gastrointestinal tract. Objects that lodge in the esophagus (not necessarily limited to sharp or irregular contour) can result in airway obstruction, stricture, or perforation with resulting mediastinitis, cardiac tamponade, paraesophageal abscess, or aortotracheoesophageal fistula. Perforation may be the result of direct mechanical erosion, as with bones, or chemical corrosion, as with button batteries.

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