A patient with dysphagia
A 19 year old man presented to the accident and emergency department with acute onset inability to swallow and a feeling of a lump in his throat after having a meal. On examination he was distressed and was drooling saliva. The patient showed marked dysphagia when asked to take sips of water.
A lateral neck radiograph was taken to confirm the diagnosis (figure).
Food bolus impaction is usually secondary to inadequate mastication. It can also be the first presenting symptom of oesophageal dysmotility syndromes or strictures. Conservative management is started, which consists of antispasmodics along with opioids. If the food bolus does not pass spontaneously, the patient will require oesophagoscopy.2
Meat and fish bones are the commonest type of sharp foreign bodies.1 In such cases the patient should be taken to theatre at once, without a trial of conservative management.