Acute onset dysphagia and neck pain after eating

• Published in: BMJ (Online) Vol. 372; p. n512
• Main Authors: Balai, Edward, Nieto, Hannah, Molony, Neil
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 18.03.2021
• Subjects: Adult; Batteries; Blood pressure; Deglutition Disorders - etiology; Dysphagia; Edema; Esophagoscopy; Esophagus; Esophagus - diagnostic imaging; Female; Fever; Food; Food - adverse effects; Foreign Bodies - complications; Foreign Bodies - diagnostic imaging; Foreign Bodies - surgery; Humans; Neck Pain - diagnostic imaging; Neck Pain - etiology; Pain; Pharynx - diagnostic imaging; Radiography; Respiration; Smooth muscle; Stricture; Tachycardia
• ISSN: 1756-1833; 1756-1833
• DOI: 10.1136/bmj.n512

Observations on admission were Temperature: 37.2°C Blood pressure: 131/85 mm Hg Pulse rate: 97 beats/min Respiratory rate: 17 breaths/min Pulse oximetry: 99% on room air. Operative management with rigid or flexible oesophagoscopy is required within 24 hours of impaction if the bolus has not passed spontaneously; or sooner (within two hours) if radiography suggests the presence of bone, or if signs of oesophageal perforation develop (chest pain radiating to the back, tachycardia, and pyrexia).12 Oesophageal obstruction with batteries or magnets (more common in children), however, can cause tissue necrosis and perforation within two hours, and requires immediate oesophagoscopy and removal.3 Historically, patients with food bolus obstruction were given intramuscular hyoscine butylbromide to relax oesophageal smooth muscle; and disimpaction rates of 100%,4 80%,5 and 57%6 have been reported in small cohort and case studies when fizzy drinks were given. www.poison.org/battery/guideline. 4 Karanjia ND Rees M. The use of Coca-Cola in the management of bolus obstruction in benign oesophageal stricture.