Foreign bodies lodged in the aerodigestive tract are a common surgical emergency presenting to the Accident & Emergency department in many centres and contribute significantly to high morbidity and occasionally mortality . Children aged between 1 and 3 years are commonly affected [1, 4]. In the present study, the majority of patients were children aged two years and below which is in agreement with other studies [1, 4, 14, 15]. Several factors contribute to high incidence of aerodigestive tract foreign bodies in this age group including social factors (e.g. carelessness of parents, children's habit of putting objects in their mouth, crying/playing during eating) and anatomical factors (e.g. absent of molar teeth, inadequate control of deglutition) have been mentioned [16–18].
In our study, males were slightly more affected than females with a male to female ratio of 1.1:1 which is in agreement with other studies [15, 19, 20]. The reasons for the male preponderance in our study may be attributed to the overactive nature of male babies as compared to the females.
In the present study, a positive history of foreign body in the aerodigestive tract was recorded in 93.9% of cases and 69.4% of these were found to be asymptomatic on admission which is comparable to other studies [1, 8, 9, 16]. Cohen  has strongly advocated that all patients presenting with positive history of foreign body in the aerodigestive tract, even when the physical finding and radiological examinations is negative must be subjected to endoscopic evaluation. In the present study, all patients with a positive history of foreign body in the aerodigestive tract were subjected to endoscopic removal.
The commonest foreign bodies found in our study were coins and groundnuts in the esophagus and airways respectively, which is similar to findings reported by other studies [22, 23]. The reason for high incidence of these foreign bodies in our study is due to the fact that these commodities are widely used in this area. The preponderance of the coins may also be attributed to the free access children have to coins in our environment, which are usually given as gifts.
The trachea was the most common site of foreign body's lodgment in the airways and cricopharyngeal sphincter was the commonest site in the esophagus. Similar foreign body's lodgment pattern was also reported by others [1, 22, 23]. In the bronchus, the majority of foreign bodies in our study come to rest in the right bronchus which is agreement with other authors [1, 16, 24]. This observation is attributed to the fact that the right bronchus is more vertical and wider than the left ones.
The majority of our patients presented to the A & E department within 24 hours of inhalation/ingestion of foreign which is similar to other reports [22, 23]. Our experience shows that early presentation is common with very young children, and when there are more serious symptoms of respiratory distress and swallowing difficulty, thus compelling the frightened patients or parents to seek medical attention. Late presentation is more common in asymptomatic cases.
Radiography plays a vital role in the diagnosis of radio-opaque foreign body in the aerodigestive tract. In agreement with other series [2, 22, 23], the plain radiography of chest/neck in our study detected foreign bodies in the aerodigestive tract in 56.1% of cases. This percentage is high enough to warrant radiographic surveillance of all patients presenting with history of foreign body in the aerodigestive tract. However, a negative radiographic result does not exclude the presence of foreign bodies in the aerodigestive tract as radio-lucent objects like rubber materials, groundnuts and bolus of meat are not easily detected by plain radiography.
Endoscopic removal of foreign bodies in the aerodigestive tract using rigid scopes under general anesthesia has been reported to be a golden standard procedure [22–28]. Rigid endoscopy, as compared to flexible endoscopy is a useful method to diagnose and remove foreign bodies in the aerodigestive tract as it has a large lumen and allows better visualization of the potential anatomic sites of foreign body impaction in the aerodigestive tract . However, the procedure is not without risks especially perforation which has a high morbidity and potential mortality. Besides the surgical risks the patients is also subject to anesthetic risks. Other treatment modalities in the removal of foreign bodies in the aerodigestive tract include use of Magill forceps and Foley's catheter in the removal of foreign bodies in the esophagus [30, 31]. In the present study, rigid endoscopy (oesophagoscopy and bronchoscopy) with forceps removal under general anesthesia was the main treatment modality performed which conforms with others studies [22–28]. In the view of potential complications resulting from rigid endoscopic procedures and the use of general anesthesia, our patients required at least an overnight hospitalization so as to monitor these complications. Magill forceps extraction and Foley's catheter without fluoroscopic control were used to remove esophageal foreign bodies in 9.2% and 3.1% of cases respectively. It is therefore recommended that in places where rigid endoscopy is not available like in most peripheral hospitals, Magill forceps and Foley's catheter without fluoroscopic control can safely be used in the removal of foreign bodies in the esophagus.
In our study, the foreign bodies were successfully removed without complications in 90.8% of cases which is similar to other studies reported elsewhere [22–28]. However, the complication and mortality rates in our study were found to be higher than that reported in other studies [28–31]. The reasons for this observation could be as a result of either of the two reasons. First, the removal of foreign bodies in the aerodigestive tract were often performed or attempted by the inexperienced resident doctors who were the first on call. This observation calls for urgent training of our resident doctors on how to perform these procedures and that only experienced endoscopist should be allowed to perform endoscopic procedures for the removal of foreign bodies in the aerodigestive tract. Secondarily, some patients presented for the foreign body removal only after a failed, traumatic attempts in peripheral hospitals in hands of inexperienced operators. However, it should be kept in mind that rigid endoscopic procedures (oesophagoscopy and bronchoscopy) are difficult procedures even in experienced hands.