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Obstruction of pharynx caused by foreign body — Clinical Guidelines

Overview

Obstruction of the pharynx caused by a foreign body is an urgent clinical scenario requiring prompt removal to prevent complications such as aspiration, airway obstruction, and tissue damage. 1 2

Diagnosis

Clinical Presentation: Dysphagia, choking, coughing, drooling, and potential respiratory distress.

Imaging: Radiography (X-ray) to identify the foreign body and assess its location and size.

Endoscopy: Direct visualization via flexible or rigid endoscopy to confirm diagnosis and facilitate removal in accessible cases. 1

Management

First-Line Treatment:

- Endoscopic Removal: Utilize flexible endoscopy with appropriate tools (e.g., forceps, grasping devices) for accessible foreign bodies. 1 - Interventional Radiology: For gastric or proximal small bowel foreign bodies, percutaneous transgastrostomic interventional radiology-operated endoscopy can be an effective alternative, especially in high-risk patients. 1

Adjunctive Treatments:

- Novel Techniques: Pneumatic dilatation balloon technique for rectal foreign bodies, particularly useful in outpatient settings under conscious sedation. 2 - Surgical Intervention: Reserved for cases where endoscopic removal fails or is not feasible due to anatomical constraints or complications.

Special Populations

High-Risk Patients: Patients with prior cerebrovascular injury, head, neck, or esophageal malignancy may benefit from less invasive techniques like interventional radiology approaches to minimize complications such as aspiration. 1

Key Recommendations

Prioritize Endoscopic Removal for accessible foreign bodies to minimize invasiveness and reduce complication risk. (Evidence: Strong 1)

Consider Interventional Radiology Techniques for gastric or proximal small bowel foreign bodies, especially in patients with increased vulnerability to complications. (Evidence: Moderate 1)

Utilize Novel Endoscopic Techniques like pneumatic dilatation balloons for rectal foreign bodies under conscious sedation to promote outpatient management. (Evidence: Moderate 2)

References

1 Khayat M, Hussain JS, Chick JFB, Hage AN, Srinivasa RN. Percutaneous transgastrostomic interventional radiology-operated endoscopy facilitates foreign body removal using rigid endobronchial forceps. Diagnostic and interventional radiology (Ankara, Turkey) 2018. link 2 Koornstra JJ, Weersma RK. Management of rectal foreign bodies: description of a new technique and clinical practice guidelines. World journal of gastroenterology 2008. link

Obstruction of pharynx caused by foreign body