Pathology of a foreign object in eating way

2021-02-01 12:00 AM

Because the oesophagus contracts abnormally: there are abnormal tumours inside or outside the oesophagus that narrow the oesophagus, food will become stuck in the narrow segment.

Outline

The most ingested foreign body, the oesophagus, is a common emergency, an accident, that is dangerous to the patient's life and has a high mortality rate. The most common is animal bones (fish, poultry, pigs ...). Animal bones on Monday onwards can cause mediastinal abscesses, pointed bones that can penetrate large arteries, all dangerous complications.

After being choked, the patient finds it painful and difficult to swallow and cannot eat or drink. In the Central Ear, Nose and Throat Hospital, out of 186 cases of anomalous food, there were 17 cases of the mediastinal abscess with a death rate of 50%. Intestinal foreign bodies cause abscess of the neck, mediastinal abscess due to perforation of the oesophagus, even causing perforation of the aorta, causing death. The foreign oesophagus is most common during Tet, festivals, and adults suffer more than children due to carelessness in eating and drinking.

Oesophagal surgery

The oesophagus (oesophagus ) is a mucous tube, followed by the pharynx in the neck to the chest segment, through the oesophagal opening of the diaphragm and connects to the stomach at the centre of the heart.

Natural narrow segments of the oesophagus.

In fact, if foreign objects are swallowed, they often get caught in narrow sections.

There are 5 narrow passages:

The mouth of the oesophagus: far from the upper arch (15-16 cm).

Loops of the aorta: far from the upper arch (23-24 cm).

Left main bronchus: from the upper arch (26-27 cm).

Diaphragm: distance from the upper arch (35-36 cm).

Mood: the upper teeth (40 cm).

Reason

Due to the eating habits: eating foods that are cut into pieces of meat and bone will cause choking when eating in a hurry, eating without chewing well, while eating and talking to especially pay attention to the elderly.

Because the oesophagus contracts abnormally: there are abnormal tumours inside or outside the oesophagus that narrow the oesophagus, food will become stuck in the narrow segment. Examples: mediastinal tumours pressing on the oesophagus, cancer or spasm of the oesophagus.

Because of the narrow natural segments of the oesophagus: the oesophagus has five naturally narrow segments, and this is where food often gets stuck. The most commonly acquired foreign object is 74% in the neck, the chest is 22%, and the lower chest is 4%.

Symptom

Early-stage

After a foreign body is caught, a patient often feels caught by an object, swallows food or swallows very painful saliva, often can no longer eat, but has to skip meals and pain increases.

If the object is in the chest segment, the patient will have pain behind the sternum, pain slanting behind the back, spreading to the shoulder blades.

Inflammatory stage

Foreign matter causes scratching of the oesophagal lining or perforation of the oesophagus wall. If the foreign body is both bone and meat, the infection will be faster. After 1-2 days, the symptoms of swallowing pain, neck pain, chest pain gradually increase so that the patient cannot swallow water, stagnation of saliva, phlegm, bad breath.

Exam: the lost sound of laryngeal, spinal filter. If there is an abscess under the mucosa, the pus will rupture, drift down the oesophagus and stomach, and then gradually decrease. But often causes inflammation of the oesophagus wall, which worsens and causes severe complications.

Complicated stage

Foreign matter is organic so it is easy to cause superinfection.

Inflammation around the neck oesophagus

Foreign objects pierce the wall of the ancient oesophagus, causing inflammation of the oesophagus wall, causing inflammation of the oesophagus wall, spreading loose connective tissue around the oesophagus.

The patient has a high fever, apparent infection, the general collapse of body, neck pain, unable to eat or drink, watery, bad breath, difficulty turning of neck, swelling on one side of neck, full of pressure on the scene. very painful patients may have air spills under the skin.

X-ray of the tilted neck posture: the spine of the neck loses its normal physiological curvature, the thickness of the oesophagus is visibly thickened, has a pus-shaped shape, has a water-level, vapour level shape.

If the infection is not detected and promptly treated and the pus will spread to the mediastinum, the lungs cause sepsis to the patient and die in a state of infection and poisoning.

The disease cannot go away on its own.

Inflammation of the mediastinum

Due to an inflamed abscess from the neck down.

Because foreign bodies penetrate the chest oesophagus wall, causing inflammation in the mediastinum.

It may be mediastinal spread to the entire mediastinum or focal inflammation of the mediastinum part (anterior mediastinum or posterior mediastinum).

General illness in the situation of infection, poisoning. The patient has a high fever or a drop below normal temperature, accompanied by chest pain, shortness of breath, rapid and weak pulse, low blood pressure, subcutaneous airflow in the neck and chest, and clear chest knocking. Little red urine, albumin in urine, blood count: high leukocytes. Film photography shows that the mediastinum is enlarged, slightly in the mediastinum. Usually, the patient is in very serious condition.

Lung complications

Foreign objects can penetrate the oesophagus wall, puncture the pleura causing purulent bronchitis. Patients with fever, chest pain, shortness of breath and grass all symptoms of pleural effusion.

The photograph shows water in the bronchi, pus is inserted. Some special foreign bodies pass through the oesophagus into the trachea or bronchi, causing oesophagal-tracheal or bronchial leakage. The patient coughs every time he swallows water or food. In the oesophagus with oral contrast, we see that the contrast goes into the bronchial gas.

Perforation of large blood vessels

Sharp, sharp foreign bodies pierce the wall of the oesophagus or poke directly into large blood vessels or necrotic inflammation leading to the rupture of large blood vessels such as the inner carotid artery, the trunk of the first arm artery, and the loops of the arteries. master. This stroke usually occurs 4-5 days or longer after pulling or occurs immediately after the release. The warning signs are to spit or vomit a little bright red blood or suddenly have terrible blood burn: the patient is spitting blood out, swallowing in time, spitting bright red blood in the mouth, choking on the bronchial gas. If you predict it in advance, get help in time, with good resuscitation, it can be saved. If suddenly, without predicting, the patient will die very quickly, fortunately, this complication is rare.

Diagnose

Implementing the quadrants

Based on hormone history, physical and physical symptoms.

X-ray: tilted neck position can see foreign bodies, see a thick inflamed oesophagus or abscesses.

Endoscopy is a method of treatment and for a definitive diagnosis.

Differential diagnosis

Sore throat (or pseudo-osteochondrosis): the patient has a feeling of swallowing pain, swallowing pain, sometimes the patient tells the physician about the actual condition of the bone, but still eating and drinking, no inflammation infection.

This symptom may also be seen in lower throat-laryngeal cancer, early-stage oesophagal cancer.

Examination, X-ray, endoscopy showed no foreign bodies.

Treatment

Early-stage

Taking foreign objects is the best solution. Before scanning, careful examination of the whole patient's body, good resuscitation, pre-anaesthesia and attentive pain relief is required.

Inflammation around the oesophagus, neck oesophagal abscess

It is necessary to open the side of the neck, drain the pus out. If the foreign body is easy to get, take it immediately. If we have not seen it in the pits, we must directly examine the natural way to get the foreign body later.

Medial abscess

Open mediastinum drains pus. Feeding through the sonde.

Purulent bronchitis

Pulmonary aspiration aspirates pus pumps antibiotic solution.

Prevention

It is necessary to educate in the community that a foreign object of the oesophagus is really a surgical emergency, is really dangerous to the patient's life and has a high mortality rate that should be examined and treated promptly.

Need to improve eating habits.