RISK FACTORS, CLINICAL PRESENTATION AND ENDOSCOPY FINDINGS OF HYPOPHARYNGO-ESOPHAGEAL FOREIGN BODY IMPACTION AMONG PATIENTS ADMITTED TO MULAGO HOSPITAL

Abstract

Introduction: Hypopharyngo-Esophageal foreign bodies (HEFBs) are most commonly inorganic matter with coins being the most common object found. Patients who have a foreign body (FB) lodged in the esophagus present with highly variable symptoms that include; dysphagia, odynophagia, FB sensation, and vomiting although some of these foreign bodies (FBs) may remain asymptomatic. Complications of HEFBs include mucosal ulceration, mucosal lacerations, esophageal perforations, neck abscess, respiratory obstruction, and tracheo-esophageal fistula. Objective: To determine risk factors, clinical presentation and endoscopy findings of Hypopharyngo-esophageal foreign body impaction (HEFBI) among patients admitted to Mulago Hospital(MH) Methodology: It was a case-control study which recruited participants from MH. Patients were recruited using simple consecutive sampling. A pre-tested questionnaire used to collect demographic data, clinical history, examination findings, radiologic investigation, and rigid endoscopy findings. Rigid endoscopy was performed under inhalation general anesthesia on cases. Results: There were more male cases (66%) compared to female cases (34%). There was a significant relationship between age of guardian and risk of HEFBI, Patients with guardians of age ≤25 or 26-35yrs had a P value of 0.003 and 0.027 respectively. There was a significant relationship between the number of siblings and risk of HEFBI, Patients with 2 siblings had a P value of 0.015. The commonest symptoms were dysphagia (62%), odynophagia (60%) and vomiting/retching (60%). The commonest FBs retrieved were coins (76%) and disk battery (6%). We observed abnormal endoscopic findings of slight mucosal bleeding (18%), and mucosal laceration (12%). . Conclusion and Recommendation: This study found; Male patients below 5yrs who are cared for by young mothers or guardians and have two siblings or less are more at risk of HEFB ingestion. The commonest symptoms were dysphagia and odynophagia. Pointing sign and pooling saliva were the commonest signs. Coins were the commonest HEFB. The commonest abnormal endoscopy findings were mucosal bleeding and laceration, these were seen in cases where FBs like disk batteries or fish bones were ingested. Education campaigns focused on groups at risk should be undertaken to reduce the danger of HEFBI.