Ayşenur CELAYİR, Olga Devrim AYVAZ, Bekir ERDEVE

Foreign body in esophagus of children with previous esophageal surgery history

Objective: In cases with esophageal atresia, foreign bodies can be impacted in the anastomotic area due to both the family’s efforts to feed solid food and anastomotic stenosis or fibrosis. Admittions of foreign body ingestions in cases with a history of esophageal surgery were evaluated in this study. Material and Methods: The demographic features of esophageal atresia cases operated between January 2004 and January 2019 who underwent esophagoscopy for foreign body ingestion were evaluated retrospectively. Results: During the 15-year study period, esophagoscopy was performed 21 times due to foreign body ingestion to 10 of 137 surviving cases (7.3%) who underwent repair of esophageal atresia. The mean age of the patients was 32 months (10–72 months), and 7 (70%) were male and 3 (30%) were female. Six (60%) had undergone primary esophageal repair with fistula ligation and two (20%) had undergone gastric tube replacement. Three (30%) required esophageal dilatation; one had resection + anastomosis after 6 dilatations and one had antireflux surgery. Nine (90%) patients presented with dysphagia, 4 (40%) with vomiting, 1 with retching, and 1 with hypersalivation. Five (50%) patients had a history of ingesting foreign bodies (juice bag, money, carrot, plum seed, gum), three of which had complaints for 1 month, and 7 presented in an average of 2 days (1–5 days). In one of the patients, direct X-ray showed a coin in the esophagus. Esophagography showed foreign body in 4 of 6 cases. One was not effective due to incompatibility in a patient with cerebral palsy, and he vomited the plum core as soon as the opaque solution was administered orally. Esophagoscopy revealed no foreign body in two patients, organic food in five, shell of peanut in one, money in one, and chunks of gum and paper in one. In seven patients, the foreign body was lodged at the site of the anastomosis; dilatation was performed in 4 due to anastomotic strictures. In the follow-up period, five patients were admitted for the same reason. No foreign bodies were detected in re-esophagoscopy in three patients. Apple-plum seeds were removed twice from one patient, and various organic and inorganic materials [food, watermelod seed, gum, piece of paper (thrice)] were removed six times from another patient. The mean length of stay was 2.8 days (2–5 days). Conclusion: Although it was thoroughly explained to the parents of cases with esophageal atresia that the transition to semi-solid/solid foods should occur after the age of five years, when the children learned to chew and swallow, the patients were not fed with suitable food for their age.

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