Answer:

A careful history is crucial to the management of such patients. More than 80% of swallowed foreign bodies pass through the gastrointestinal (GI) tract without incident. Sharp objects (e.g., bones, needles, wire) may impale the wall of the esophagus, whereas soft objects, such as meat, may obstruct the anatomic points of constriction of the esophagus: the postcricoid area, the aortic arch, and the gastroesophageal junction. Flexible esophagoscopy is the accepted method of removal for sharp, inert, radiopaque, or recently impacted foreign objects and should be performed on patients with foreign body symptoms for more than 12 hours. Balloon catheter retrieval may be effective for removal of nonsharp objects, such as coins, but is controversial. Intravenous glucagon or sublingual nitroglycerin or nifedipine results in smooth muscle relaxation of the distal esophagus and may be useful in relieving obstructions at that level. Gas-forming agents have been used to propel a food-bolus impaction into the stomach from the distal esophagus. This method should not be used in patients with pain suggestive of perforation or prolonged impaction.

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