What to do if a patient accidentally ingests a foreign body, such as a plastic fork, and experiences a sensation of it being lodged in the throat?

Management of Ingested Foreign Body Stuck in the Throat

For a patient who has accidentally swallowed a piece of plastic fork and feels it's stuck in the throat, urgent endoscopic evaluation and removal is recommended as the first-line treatment. 1

Initial Assessment and Management

Clinical Evaluation

• Assess for critical symptoms requiring immediate intervention:
  • Inability to swallow saliva
  • Respiratory distress (choking, stridor, dyspnea)
  • Signs of airway obstruction
  • Drooling, retching, or vomiting

Diagnostic Approach

1. Imaging studies:

   • Plain radiographs (neck, chest, abdomen) should be obtained first, though plastic objects have high false-negative rates (up to 85%) 1
   • CT scan is recommended for accurate assessment due to its high sensitivity (90-100%) and specificity (93.7-100%) for foreign body detection 1, 2
   • Avoid contrast swallow studies as they may delay intervention and are not recommended 1

2. Laboratory tests:

   • Complete blood count (CBC)
   • C-reactive protein (CRP)
   • Blood gas analysis for base excess and lactate 1

Definitive Management

Endoscopic Intervention

• Flexible endoscopy is the treatment of choice with success rates up to 90% 2
• Should be performed with adequate anesthesia and airway protection 2
• Two main techniques:
  • "Push technique" - advancing the object into the stomach if safe
  • "Extraction technique" - removing the foreign body 2

Special Considerations

• Use of protective devices (latex protector hood or overtube) may facilitate safer extraction of sharp objects 3, 4
• Combined flexible and rigid endoscopy approach may be helpful for visualization and retrieval in complex cases 2
• Fluoroscopic guidance can enhance safety during intervention for high-risk cases 2

Post-Procedure Care

• Monitor patient for at least 2 hours after the procedure 2
• Watch for signs of potential perforation:
  • Pain
  • Breathlessness
  • Fever
  • Tachycardia 2
• Provide clear written instructions regarding:
  • Fluid intake
  • Diet progression
  • Medications
  • Contact information for the on-call team if symptoms develop 2

Common Pitfalls and Caveats

1. Delayed diagnosis: Foreign body sensation may mimic other conditions, leading to delayed proper intervention
2. Missed underlying conditions: Up to 25% of patients with food bolus impaction have underlying esophageal disorders 2
3. Inadequate imaging: Relying solely on plain radiographs for plastic objects is insufficient due to high false-negative rates
4. Conservative measures: Avoid ineffective conservative treatments like fizzy drinks, baclofen, salbutamol, or benzodiazepines as there is no evidence supporting their efficacy 2

Follow-up Care

• Arrange elective endoscopy if sufficient biopsies were not obtained during the initial procedure or to rule out underlying esophageal pathology 2
• Consider evaluation for predisposing conditions such as eosinophilic esophagitis, strictures, or anatomical abnormalities that may have contributed to the foreign body impaction 2