Esophageal foreign bodies in Yemen.

oreign body (FB) impaction in the esophagus is a common and serious health problem. Foreign bodies can lead to many complications such as esophageal perforation, mucosal erosions1 and fistulizations.2 Complication from esophageal FB can include death.3 The maximum incidence of esophageal FB occurs among children under 5 years old.4 The most common kind of the esophageal FBs in Oman are mutton bones (29.5%), fish bones (20.5%), and coins (20.5%).5 In Saudi Arabia, these are fish bones (27%), meat bones (23%), and coins (12%).6 In Jordan, coins (55.5%), bones (13.9%), and metallic objects (6.7%).7 The general objective of this study is to describe the distribution of the esophageal FB among patients presenting at AlThawra Teaching Hospital. Specifically, to classify the kinds of common FB in the esophagus, identify duration, clinical presentation and diagnosis, outcome of the interventions and to correlate the incidence of FBs with age and gender. A total of 224 patients with FB in the esophagus attended the General Emergency Room and ENT clinic at Al-Thawra Teaching Hospital. Cases were collected prospectively from January 1st 2003, to August 31st 2004. Routine cervical and chest x-ray were obtained in most of the cases. For patients with negative x-ray, further radiographic investigations were performed (barium swallow and CT scan). All patients with a history of esophageal FB were considered emergencies, and interventions were performed in the operating theater. The vast majority of the coins were removed under direct laryngoscopic vision and McGill forceps using maintenance anesthesia with 2-3% halothane and 100% oxygen inhalation in the operating room. For other patients, the FBs were removed by rigid esophagoscopy under general anesthesia. Patients with postoperative complications like esophageal perforation and tracheo-esophageal fistula were referred to the general surgery department. Control x-rays were carried out in some cases. The most common age group was under 5 years old, accounting for 68.6% of the cases and the youngest patients were 3 months old, while the oldest one was 70 years old. There were 120 males (53.6%) and 104 females (46.4%). As for duration, 128 (57.1%) of the patients reached the hospital on the same day of FB swallowing, while 35 (15.6%) do not know about the presence of the FB and presented with another complaints and were discovered accidentally. Some (47 [21.1%]) patients F arrived between the 2nd and 4th day of FB ingestion, and only 14 (6.3%) patients came after more than 5 days. Regarding symptoms, the most common presenting symptoms for patients with esophageal FB were dysphagia 180 (80.4%), followed by odynophagia 132 (58.9%) then hypersalivation 72 (32.1%). The x-ray findings were positive in 184 (82.1%) cases, barium swallow was performed in 2 (0.9%), and CT scan in 2 (0.9%). The vast majority of FBs, 178 (79.5%), were located in the upper esophagus below the cricopharyngeus, 30 (13.4%) in the middle esophagus, and 13 (5.8%) in the lower esophageal sphincter. We found 2 (0.9%) FBs in the stomach and could not identify the exact location in 3 (1.3%) cases. Out of 145 coins removed, 132 (91%) were under direct laryngoscopic vision and McGill forceps, maintenance anesthesia was accomplished with 2-3% halothane and 100% oxygen inhalation. The diameter of the coins were between 2.2-2.5 cm. We used rigid esophagoscopy under general anesthesia in 92 (41%) cases and were successful in 86 (93.5%) cases. Four patients (1.8%) had complications, one (0.4%) patient with esophageal perforation with mediastinitis, one (0.4%) with tracheoesophageal fistula, and 2 (0.9%) with erosions without perforation. None underwent surgical removal and no death. As for the kinds of the FBs;