- Usually children under 5 yrs or adults with intellectual impairment
- Impact in oesophagus at
- cricopharyngeus (C6)
- aortic arch (T4) and
- OG sphincter (T11)
- Pylorus of stomach
- Ileocaecal valve (rarely at colonic flexures)
- If an FB passes cricopharyngeus (C6) [narrowest part of GI tract], excellent chance it will rest of the tract.
- Fish bones usually scratch the mucosa occasionally lodge in the tonsil .
- Larger FB more likely to impact in oesophagus and cause erosion / perforation or lower GI obstruction.
Depends of location / type of the FB and symptoms
Priority AIRWAY, B and C
- If a FB in the throat, directly visualise. Check tonsils and valleculae.
- If in oesophagus, need AP and lateral x-rays to determine level. Proximal FB is more of an airway threat.
- Oesophageal FBs need to be removed endoscopically (urgently if button batteries or sharp objects).
- Once past duodenum, clinical obstruction warrants removal, asymptomatic requires wait and see.
- Are dangerous if left in the oespphagus (corrosive, can burn and release toxic metals) . They are benign onve past the stomach.
Specific Paediatric Cases
Please see paediatric FB ingestion