Choking: Forcing food down the throat is dangerous
<br>FOR Boniface Wabwire, 48, a meal was always incomplete without fish. Fish was his delicacy but it ended his life. Many locals in Busiu village, Tororo district, think he could have been bewitched.<br>
By Irene Nabusoba
FOR Boniface Wabwire, 48, a meal was always incomplete without fish. Fish was his delicacy but it ended his life. Many locals in Busiu village, Tororo district, think he could have been bewitched.
“I don’t believe a simple fish bone could kill someone his age,†says Petunila Wabwire, the widow, adding, “I vividly remember the events that led to Bonnie’s eventual death. We were having supper when he said that a bone had stuck in his throat.
“Our eldest son gave him a few blows on the back to propel the bone out in vain. When this method failed, I gave him a big chunk of kalo (millet bread) to swallow, as is commonly done. Everyone here will tell you to swallow a big lump of food in the event of an obstacle in the throat,†she says, holding her left cheek.
Wabwire says her husband kept trying to swallow big portions of different foods for two days until the throat started hurting and got swollen like that of a person suffering from goitre.
“When we took him to hospital, doctors told us it was too late to save his life. He died shortly after admission,†she recalls.
Dr. Gregory Tumweheire, a specialist at the Ear, Nose and Throat (ENT) department, Mulago Hospital, says patients with foreign bodies in the throat should be taken seriously.
Occurence
“These are common occurrences,†says Tumweheire.
“On average, we receive two cases a week. The majority of these come after trying crude methods like swallowing bananas, kalo, posho or irish potatoes. The idea here is to form a bolus strong enough to push the foreign body down the throat, but it’s dangerous. This practice is the most common cause of death in such cases,†he says.
Tumweheire says that method poses so many health risks and should never be used.
Common foreign bodies among adults include fish and chicken bones and toothpicks and coins, buttons, marbles and crayons among children.
While one can succeed in pushing the bone down the throat using lumps of food, Tumweheire says this method is unreliable and when one succeeds, more harm would have been done.
“Potential risks are higher than the benefits. Pushing the foreign body down may tear the oesophagus,†he explains.
Complications
An Internet site on health, e-medicine, says even relatively smooth, rounded objects that remain impacted in the throat may cause serious problems, and a fish bone can perforate the oesophagus within a few days.
It explains that the oesophagus is a tubular structure, approximately 20-25 cm, with three narrowings: the upper oesophageal sphincter; the crossover of the aorta; and the lower oesophageal sphincter. These areas are where most oesophageal foreign bodies become entrapped.
Oesophageal foreign bodies can cause abrasions, punctures, and perforations, with resultant injuries or infections to surrounding structures.
“Chronic foreign bodies or perforations can cause infections in surrounding soft tissues of the throat and neck. But once a foreign body has reached the stomach, it has an 80-90% chance of passage.
“However, an estimated 1,500 deaths occur annually from foreign bodies in the upper throat,†it says.
Symptoms
Tumweheire says patients may have variable degrees of discomfort, from minor to severe, such as drooling or inability to swallow.
“Patients may have airway compromise, typically in delayed presentations with subsequent infection or perforation as is the case with most deaths,†he says.
Children with oesophageal foreign bodies may have vague symptoms such as irritability, poor feeding or pulmonary symptoms. Therefore, parents or caretakers are urged to maintain high suspicion for any oesophageal foreign body.
“When a parent sees a child with an object in his or her mouth and suspects the child might have swallowed it, such reports must be investigated. Gagging, vomiting, and neck or throat pain are common signs,†he says.
Tumweheire says bones are most dangerous and if handled crudely, may go down, leaving a wound that could later develop into abscess or tears through the oesophageal wall and get stuck there. Some of the food could go through the torn wall to the surrounding soft tissues, leading to bacterial infection.
“We have inborn bacteria that aid food digestion but should they go where they are not meant to, they become dangerous and may result into infection, leading to swelling, sucking the fish bone further inside to the extent of concealing it,†Tumweheire says.
He adds that with the nature of its position close to the heart, infection in the oesophagus may affect blood vessels leading to inflammation, which is also very dangerous.
“The infection softens the blood vessels and may burst or the bone could prick the heart, leading to bleeding and death,†Tumweheire says.
Treatment
“Stop eating first of all, calm anxiety and if you must take something, take water in small amounts using a spoon probably. The idea is if the fish bone is not heavily-impacted, the gentle movement of the throat could dislodge it,†Tumweheire says.
He adds that if there is no improvement, one should go to hospital. There are specialised facilities in endoscopy in Mbale, Arua, Mbarara and Kampala, offering free treatment.
“If the hospital is far, one should go to the nearest health facility. Expect painkillers and sleeping pills. They are meant to kill pain and calm anxiety. When we sleep, we tend to swallow saliva and this may accidentally re-align the bone,†he says. In hospital, an X-ray to locate the bone, its size, how anchored it is in the muscles will be conducted before the endoscopy. If the area has formed pus, it will have to be drained.
“If the complication is in advanced stages, it may call for a surgical procedure. The operation is a bit complicated; one may survive but with some permanent damages. Some of the nerves may be damaged. There may be damage to the voice and if one earns from the voice, one may have to consider giving up the career,†he says.
Ends
FOR Boniface Wabwire, 48, a meal was always incomplete without fish. Fish was his delicacy but it ended his life. Many locals in Busiu village, Tororo district, think he could have been bewitched.
“I don’t believe a simple fish bone could kill someone his age,†says Petunila Wabwire, the widow, adding, “I vividly remember the events that led to Bonnie’s eventual death. We were having supper when he said that a bone had stuck in his throat.
“Our eldest son gave him a few blows on the back to propel the bone out in vain. When this method failed, I gave him a big chunk of kalo (millet bread) to swallow, as is commonly done. Everyone here will tell you to swallow a big lump of food in the event of an obstacle in the throat,†she says, holding her left cheek.
Wabwire says her husband kept trying to swallow big portions of different foods for two days until the throat started hurting and got swollen like that of a person suffering from goitre.
“When we took him to hospital, doctors told us it was too late to save his life. He died shortly after admission,†she recalls.
Dr. Gregory Tumweheire, a specialist at the Ear, Nose and Throat (ENT) department, Mulago Hospital, says patients with foreign bodies in the throat should be taken seriously.
Occurence
“These are common occurrences,†says Tumweheire.
“On average, we receive two cases a week. The majority of these come after trying crude methods like swallowing bananas, kalo, posho or irish potatoes. The idea here is to form a bolus strong enough to push the foreign body down the throat, but it’s dangerous. This practice is the most common cause of death in such cases,†he says.
Tumweheire says that method poses so many health risks and should never be used.
Common foreign bodies among adults include fish and chicken bones and toothpicks and coins, buttons, marbles and crayons among children.
While one can succeed in pushing the bone down the throat using lumps of food, Tumweheire says this method is unreliable and when one succeeds, more harm would have been done.
“Potential risks are higher than the benefits. Pushing the foreign body down may tear the oesophagus,†he explains.
Complications
An Internet site on health, e-medicine, says even relatively smooth, rounded objects that remain impacted in the throat may cause serious problems, and a fish bone can perforate the oesophagus within a few days.
It explains that the oesophagus is a tubular structure, approximately 20-25 cm, with three narrowings: the upper oesophageal sphincter; the crossover of the aorta; and the lower oesophageal sphincter. These areas are where most oesophageal foreign bodies become entrapped.
Oesophageal foreign bodies can cause abrasions, punctures, and perforations, with resultant injuries or infections to surrounding structures.
“Chronic foreign bodies or perforations can cause infections in surrounding soft tissues of the throat and neck. But once a foreign body has reached the stomach, it has an 80-90% chance of passage.
“However, an estimated 1,500 deaths occur annually from foreign bodies in the upper throat,†it says.
Symptoms
Tumweheire says patients may have variable degrees of discomfort, from minor to severe, such as drooling or inability to swallow.
“Patients may have airway compromise, typically in delayed presentations with subsequent infection or perforation as is the case with most deaths,†he says.
Children with oesophageal foreign bodies may have vague symptoms such as irritability, poor feeding or pulmonary symptoms. Therefore, parents or caretakers are urged to maintain high suspicion for any oesophageal foreign body.
“When a parent sees a child with an object in his or her mouth and suspects the child might have swallowed it, such reports must be investigated. Gagging, vomiting, and neck or throat pain are common signs,†he says.
Tumweheire says bones are most dangerous and if handled crudely, may go down, leaving a wound that could later develop into abscess or tears through the oesophageal wall and get stuck there. Some of the food could go through the torn wall to the surrounding soft tissues, leading to bacterial infection.
“We have inborn bacteria that aid food digestion but should they go where they are not meant to, they become dangerous and may result into infection, leading to swelling, sucking the fish bone further inside to the extent of concealing it,†Tumweheire says.
He adds that with the nature of its position close to the heart, infection in the oesophagus may affect blood vessels leading to inflammation, which is also very dangerous.
“The infection softens the blood vessels and may burst or the bone could prick the heart, leading to bleeding and death,†Tumweheire says.
Treatment
“Stop eating first of all, calm anxiety and if you must take something, take water in small amounts using a spoon probably. The idea is if the fish bone is not heavily-impacted, the gentle movement of the throat could dislodge it,†Tumweheire says.
He adds that if there is no improvement, one should go to hospital. There are specialised facilities in endoscopy in Mbale, Arua, Mbarara and Kampala, offering free treatment.
“If the hospital is far, one should go to the nearest health facility. Expect painkillers and sleeping pills. They are meant to kill pain and calm anxiety. When we sleep, we tend to swallow saliva and this may accidentally re-align the bone,†he says. In hospital, an X-ray to locate the bone, its size, how anchored it is in the muscles will be conducted before the endoscopy. If the area has formed pus, it will have to be drained.
“If the complication is in advanced stages, it may call for a surgical procedure. The operation is a bit complicated; one may survive but with some permanent damages. Some of the nerves may be damaged. There may be damage to the voice and if one earns from the voice, one may have to consider giving up the career,†he says.
Ends