Acute food bolus ingestion: ten-year experience at a tertiary pediatric hospital

Eugene Wong, Alan T Cheng, Shiv Aggarwala, Daron Cope, Jessica Chong, Marin Duvnjak, Narinder Singh

Abstract

Background: Acute food bolus impaction (AFBI) is an uncommon problem in children. In many cases, AFBI is associated with a pre-disposing condition, such as oesophageal stenosis, dysmotility or reflux disease. We review the management and underlying aetiology of children presenting with AFBI at a tertiary paediatric hospital.
Methods: Records of all children who presented to a tertiary pediatric hospital with AFBI over a 10-year period from 1994–2004 were retrospectively examined. Information regarding demographics, presenting symptoms, investigations, management and underlying pathology were assessed from hospital records.
Results: Forty-six children (mean age 6 years, 28.3% female) with suspected AFBI were identified. All 46 patients were symptomatic, most commonly with vomiting (54.3%, n=25), drooling (34.8%, n=16), dysphagia (32.6%, n=15), refusal to eat (23.9%, n=11) and foreign body sensation (17.4%, n=8). Most (73.9%) children had impacted food bolus at the time of intervention, usually at the lower oesophagus. All identified food boluses were retrieved or dislodged successfully using either direct laryngoscopy or oesophagoscopy. About 47.8% of children had previous oesophageal surgery for trachea-oesophageal fistula (43.4%, n=20) or oesophageal atresia (4.3%, n=2). A small proportion had a known history of eosinophilic oesophagitis (EoE) (4.3%, n=2). Oesophageal biopsy for EoE was not routinely performed during the study period analysed.
Conclusions: AFBI is uncommon and often associated with underlying pathology. Endoscopy is a useful tool for diagnosis and treatment, as well as to identify any underlying pre-disposing pathology. In all children presenting with AFBI without clear cause, investigation for EoE with oesophageal biopsy should be considered.