Contraindications


Categories: ESOPHAGOSCOPY FOR FOREIGN BODY
Sources: 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.





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