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H. Complications

1. Esophageal Perforation

Esophageal perforation may lead to mediastinitis, sepsis, and ultimately

death. Patients with esophageal perforations should be monitored

closely and treated as discussed previously.

2. Esophageal Strictures

Esophageal strictures most commonly occur at the level of the crico-

pharyngeus, aortic arch, or lower esophageal sphincter. Strictures from

caustic ingestion tend to be longer and tighter than benign strictures

and may be refractory to and have a higher rate of complications with

dilation.

3. Esophageal Carcinoma

Esophageal carcinoma may develop after caustic ingestion. One in

seven patients may develop malignancy, leading some physicians to

advocate for regular esophageal surveillance, although the latent period

for development may be as long as 50 years. Nodularity or ulceration in

the region of a previously smooth stricture suggests malignant

transformation.

IV. Conclusion

Foreign body aspiration or ingestion and caustic ingestion are serious,

potentially life-threatening emergencies. In the course of trauma, foreign

bodies, such as chewing gum, teeth, dentures, and other detritus of

impact, can be ingested or aspirated, complicating the evaluation and

treatment of traumatic injuries. Any difficulties with airway and breath-

ing after traumatic events should raise the specter of possible foreign

bodies in the aerodigestive tract, in addition to the other possible

etiologies. Caustic ingestions, while not as common as foreign body

aspiration/ingestion, can also occur during traumatic episodes, particu-

larly burns and by-products of combustion engines, batteries, and

industrial equipment.

The most dangerous conditions exist when these emergencies are seen

in pediatric patients, as their airways are small and susceptible, and their

functional reserves are quite restricted. The otolaryngology–head and

neck surgery resident must be highly suspicious for these injuries and

understand the evaluative and therapeutic procedures to rescue the

patients. This includes knowledge about the historical information,

findings on physical examination, appropriate use of imaging studies,

and the proper selection of endoscopic equipment and technology to

clear the aerodigestive tract. This chapter provides the fundamental

knowledge to care for patients with foreign bodies and caustic ingestion.