Introduction

Foreign body ingestion is a common and serious medical problem. Annually in the United States, 1500 people die of complications related to ingestion of foreign bodies (1). Although most swallowed objects pass spontaneously, 10% to 20% have to be removed by an interventional procedure, and approximately 1% require surgery (1-3).

Infants and children typically swallow such things as coins, button batteries, and small toys (3,6). Conversely, adults usually have problems with food impactions and bones. Children rarely have a problem with food unless they have a congenital or surgical stricture of the esophagus (6).

In adults, meat accounts for 70 - 80% of food impactions (6-9). Underlying pathology in the esophagus is a predisposing factor in most cases (6,8,10-13):
1. The most commonly associated esophageal lesions are benign rings, strictures, or areas of spasm; cancer rarely causes food impaction (8,11,12,14,15-17).
2. Other contributing factors may be the wearing of dentures, careless chewing, eating too rapidly, and alcohol intoxication (5,18,19,20).

In 1963, Norton and King (16) coined the term "steakhouse syndrome" to describe the clinical manifestations of esophageal obstruction occurring when a large piece of food (commonly steak) becomes impacted in the esophagus.
1. The patient may present with a history of choking during eating, an inability to swallow saliva properly, drooling, and a persistent foreign body sensation in the throat or chest (3,5).
2. The food lodges in the distal 1/3 of the esophagus in the majority of cases (65%-83%) (8,9,11,15).
3. Although most adult patients with esophageal foreign bodies describe a clear history of foreign body ingestion or symptoms of impaction, clinical evidence is often inconclusive or absent in pediatric patients (3).