Esophageal foreign body removal with foley catheter

Background

Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.

Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.

Esophagus anatomy and nomenclature based on two systems.

• 85-100% success rates
• 0-2% complication rates
• Ideal for coins
• No reports of airway compromise

Indications

• Recently ingested (<24-48h), smooth, blunt, radiographically opaque objects
• Button batteries ingested <2h with no endoscopy available

Contraindications

• Total esophageal obstruction
  • Air-Fluid levels on XR or esophagogram
  • Patient unable to handle secretions
• Presence of FB greater than 24-48h (higher risk of pressure necrosis)
• Evidence of esophageal perforation
• Airway distress
• Multiple FB's
• Sharp FB's
• Button battery present >2 hours

Equipment Needed

• Airway equipment and suction
• Magill and bayonet forceps
• Foley size 10-16F with 5cc to 10cc balloon
• Topical anesthetics
• Sedation meds
• Pediatric restraint devices

Procedure

• Localize FB on XR or Fluoro, if available
• Give sedation as needed (ketamine is ideal in kids)
• Place patient in Trendelenberg, supine, lat decub, or prone
• Check balloon for symmetric inflation
• For a child, advance a 12-16F foley orally with balloon deflated
• Advance tip distal to object (if fluoro is used, inject with contrast to view tip)
• Inflate balloon with 3-5 cc saline
• Stop inflation if patient complains of pain
• Apply gentle traction to bring coin proximally
• Terminate attempt if there is excessive friction
• If the balloon slips past the object, try again with an additional 1-2cc saline in balloon
• Once coin is in mouth grab with forceps or ask patient to expectorate it
• If no FB is removed, obtain another XR to see if the object passed to the stomach or moved.

Complications

• Most are due to passage of foley through nose
  • Nosebleed
  • Displacement of FB to nasopharynx
• Laryngospasm and aspiration
• Failure to remove FB

Disposition

• No follow up needed for pediatric patients, if FB successfully removed and patient remains asymptomatic
• Arrange follow up for gastric FB's
• If unsuccessful, refer for immediate endoscopy
• All adults should be referred for endoscopy to rule out esophageal pathology

See Also

• Esophageal foreign body
• Foreign bodies

External Links

Videos

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