A PROSPECTIVE-STUDY OF INGESTED FOREIGN-BODIES IN SINGAPORE

Objective: To evaluate the following: the symptoms, physical signs, in vestigation, and treatment of impacted foreign bodies (FBs); the dimen sions of FBs according to site of impaction; and epidemiology, risk fa ctors, and complications of FB ingestion. Designs: Prospective analysi s of 397 patients with a history of FB ingestion. Setting: Department of Otolaryngology, Tan Tock Seng Hospital, Singapore, a referral cente r with institutional practice. Patients: Of the 397 patients treated b etween May and December 1991, ingested FBs were found in 197 patients. Intervention: Foreign bodies were removed with forceps under direct o r indirect vision; if this was impossible, removal was done endoscopic ally. Results: Dysphagia, positive laryngeal rub, and drinking water t ests had high sensitivity and specificity for esophageal FBs. Large an d rigid FBs of various shapes tend to lodge in piriform fossae and eso phagus and might cause complications if not removed early. The risk fa ctors of FB ingestion were use of dentures and Chinese method of cooki ng and eating. The complication rate of impacted FBs was 5.1% and incr eased with the delay in seeking treatment. Flexible esophagoscope was found to be as effective as rigid esophagoscope in retrieving esophage al FBs. Lesions simulating impacted FBs were found in nine patients. I n 162 patients in whom no FB was found, the symptoms resolved spontane ously within 16 days. Conclusions: Dysphagia, positive laryngeal rub, and drinking water tests are indicative of impacted FBs that must be r emoved early to prevent complications. Ability to use both rigid and f lexible esophagoscopes is advantageous in FB retrieval.