Sunil Kumar K. P1, Sabin B. B2, S. Muneeruddin Ahmed3
INTRODUCTION: A foreign body is an endogenous or exogenous substance incongruous with the anatomy of the site where it is found. Foreign body ingestion can affect persons of any age. Despite major advances in diagnostic and therapeutic modalities, foreign body ingestion still causes significant dilemmas in the diagnosis and treatment. Multiple factors play role in the lodgment of these foreign bodies in the food passage. They are diet factor, dental factor, and inebriation and age factors to name a few. Preexisting strictures of esophagus is another local cause of impaction of F.B. The signs and symptoms of foreign body ingestion are quite diverse and often very non-specific. They include complete esophageal obstruction with overflow of secretions and aspiration, to mild odynophagia or dysphagia. Esophageal foreign bodies are most frequently located at the narrowest portion of the esophagus, the level of the crico-Pharynx sphincter. Rarely serious complications of such as mediastinitis, Pneumothorax, plural effusion, lung or mediastinal abscess, or massive hemorrhage due to a vascular fistula may occur before a thorough investigation is launched. Digital X-rays in two dimensions are useful in the diagnosis. CT scanning and MRI are rarely used in the evaluation of foreign bodies in the aero digestive tract, but are indicated in the event that the object is not found during endoscopic examination and migration from the airway or esophagus is suspected. In 1936 Chevalier Jackson described endoscopic techniques for the removal of foreign bodies. Since then this has remained the safest and most trusted method of treatment. Techniques for foreign body removal employing fiber optic endoscopes have been described. The treatment of choice for foreign bodies of the upper aero digestive tract is reasonably prompt endoscopic retrieval in the operating suite under anesthesia. Endoscopy is performed as an emergency in case ingestion of disc batteries with esophageal lodging and signs or symptoms of esophageal perforation to avoid further complications and strictures. AIM: To evaluate the sensitivity and specificity of digital X-ray in detecting all foreign bodies impacted in throat and esophagus. To assess the factors leading to false positive findings in Digital X-rays in the study subjects; to evaluate the role of digital X-ray in detecting complications.
MATERIALS AND MEHODS: 208 patients attending Government Hospital of Kozhikode with history of foreign body ingestion are included in the study. Thorough history taking, clinical examination followed by radiography with the help of Digital X-rays to locate the foreign body is done. Fish bones being common in this part of Kerala, emphasize is made to find the specificity and sensitivity of using digital X-rays in locating fish bones in food passage. Conservative management in patients showing minimal symptoms is studied. The incidence of Complications among the patients is studied.
OBSERVATIONS: The sensitivity of digital X-ray in detecting fish bone foreign bodies is 42%. The specificity is 79%. The sensitivity of digital X-ray is detecting complications was 77% in the study. Conservative management of complications is 100% in the present study.
CONCLUSIONS: The value of digital X-ray for assessment of a patient with suspected foreign body impaction is vital considering the sensitivity, specificity and easy accessibility. Although digital X-ray has its own limitations due to typical and atypical physiologic calcifications in the neck, it is still an important first line investigation with a suspected foreign body impaction in throat and esophagus.