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2019年7月25日星期四

Upper aerodigestive tract foreign bodies (上呼吸消化道異物)

Oropharynx (口咽)
Fish bones may lodge in the tonsil or tongue base.

Clinical features:
The patient complains of pain on swallowing and points to the suprahyoid region. The bone may only be obvious on palpation: X-rays are unhelpful.

Management:
Removal under direct vision.


Hypopharynx/oesophagus (下咽/食管)
A bone or food bolus usually gets lodged at one of four sites:
  • One piriform fossa
  • The postcricoid region (15cm from the upper incisor)
  • The level of the aortic arch (at 25cm)
  • At the oesophago-gastric junction (40cm)
Clinical features:
Dysphagia may be total, the patient spitting out saliva and pointing to the suprasternal or retrosternal region. A soft tissue lateral X-ray of the neck may delineate a bone.

Management:
Endoscopic removal should be undertaken as soon as possible, to avoid airway oedema, soft tissue infection or oesophageal perforation.


Bronchus (支氣管)
Often a peanut in a young child.

Clinical features:
After an initial coughing fit there is often a latent period before respiratory distress becomes obvious. The chest X-ray may show collapse of the lung distally, if the obstruction is complete, or emphysema of the involved side if the obstruction acts as a one-way valve.

Management:
Bronchoscopic removal is mandatory.


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