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Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery

There is no absolute contraindication to careful
esophagoscopy for the removal of foreign bodies, even in the presence
of aneurism, serious cardiovascular disease, hypertension or the like,
although these conditions would render the procedure inadvisable.
Should the patient be in bad condition from previous ill-advised or
blind attempts at extraction, endoscopy should be delayed until the
traumatic esophagitis has subsided and the general state improved. It
is rarely the foreign body itself which is producing these symptoms,
and the removal of the object will not cause their immediate
subsidence; while the passage of the tube through the lacerated,
infected, and inflamed esophagus might further harm the patient.
Moreover, the foreign body will be difficult to find and to remove
from the edematous and bleeding folds, and the risk of following a
false passage into the mediastinum or overriding the foreign body is
great. Water starvation should be relieved by means of proctoclysis
and hypodermoclysis before endoscopy is done. The esophagitis is best
treated by placing dry on the tongue at four-hour intervals the
following powder:
Rx. Anesthesin...gramme 0.12
Bismuth subnitrate...gramme 0.6
Calomel, gramme 0.006 to 0.003 may be added to each powder for a few
doses to increase the antiseptic effect. If the patient can swallow
liquids it is best to wait one week from the time of the last attempt
at removal before any endoscopy for extraction be done. This will give
time for nature to repair the damage and render the removal of the
object more certain and less hazardous. Perforation of the esophagus
by the foreign body, or by blind instrumentation, is a
contraindication to esophagoscopy. It is manifested by such signs as
subcutaneous emphysema, swelling of the neck, fever, irritability,
increase in pulsatory and respiratory rates, and pain in the neck or
chest. Gaseous emphysema is present in some cases, and denotes a
dangerous infection. Esophagoscopy should be postponed and the
treatment mentioned at the end of this chapter instituted. After the
subsidence of all symptoms other than esophageal, esophagoscopy may be
done safely. Pleural perforation is manifested by the usual signs of
pneumothorax, and will be demonstrated in the roentgenogram.

Next: Esophagoscopic Extraction Of Foreign Bodies

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