A prospective study of ingested foreign bodies in Singapore.

OBJECTIVE: To evaluate the following: the symptoms, physical signs, investigation, and treatment of impacted foreign bodies (FBs); the dimensions of FBs according to site of impaction; and epidemiology, risk factors, and complications of FB ingestion.

DESIGN: Prospective analysis of 397 patients with a history of FB ingestion.

SETTING: Department of Otolaryngology, Tan Tock Seng Hospital, Singapore, a referral center with institutional practice.

PATIENTS: Of the 397 patients treated between May and December 1991, ingested FBs were found in 197 patients.

INTERVENTION: Foreign bodies were removed with forceps under direct or indirect vision; if this was impossible, removal was done endoscopically.

RESULTS: Dysphagia, positive laryngeal rub, and drinking water tests had high sensitivity and specificity for esophageal FBs. Large and rigid FBs of various shapes tend to lodge in piriform fossae and esophagus and might cause complications if not removed early. The risk factors of FB ingestion were use of dentures and Chinese method of cooking and eating. The complication rate of impacted FBs was 5.1% and increased with the delay in seeking treatment. Flexible esophagoscope was found to be as effective as rigid esophagoscope in retrieving esophageal FBs. Lesions simulating impacted FBs were found in nine patients. In 162 patients in whom no FB was found, the symptoms resolved spontaneously within 16 days.

CONCLUSION: Dysphagia, positive laryngeal rub, and drinking water tests are indicative of impacted FBs that must be removed early to prevent complications. Ability to use both rigid and flexible esophagoscopes is advantageous in FB retrieval.