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Medical ArticlesChildren's ClothingAn infant's clothing should be soft, warm, and light in weight... Cancers Cancers take on a variety of forms, distinguished by differen... Influenzal Laryngotracheobronchitis Influenzal infection, not always by the same organism, sweep... Treatment Acute esophagitis calls for rest in bed, sterile liquid food... Carbuncle See Boil. ... Bowels Locking Of Sometimes when one part of the bowels is much more active than... About Christmas THERE was once a family who had a guest staying with ... Hay Fever A most effective preventive and cure for this is the inhaling ... Paralysis Take the B D current, medium force. If the paralysis be in a ... Bronchial Stenosis Stenosis of one or more bronchi results at times from cicatr... Punctures Case Xii A servant maid was bitten by a dog in four places--severely o... Difficulties In The Introduction Of The Bronchoscope The beginner may enter the esophagus instead of the trachea:... Pleuroscopy Foreign bodies in the pleural cavity should be immediately re... Blisters The destruction of the skin over any painful part, by means of... Bronchoscopes The regular bronchoscope is a hollow brass tube slanted at i... Malaria Is now known to be conveyed by the bite of a certain kind of m... Treatment Of Endocarditis As mild endocarditis rarely occurs primarily but is almost al... Heartburn This peculiar burning and distressed feeling at the stomach d... Removal Of Growth From The Laryngeal Ventricle After exposing the larynx in the usual manner, if the head i... Biscuits And Water The biscuits referred to are manufactured in Saltcoats.[A] The... |
Esophagoscopic Extraction Of Foreign BodiesCategory: ESOPHAGOSCOPY FOR FOREIGN BODY Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery It is unwise to do an endoscopy in a foreign-body case for the sole purpose of taking a preliminary look. Everything likely to be needed for extraction of the intruder should be sterile and ready at hand. Furthermore, all required instruments for laryngoscopy, bronchoscopy or tracheotomy should be prepared as a matter of routine, however rarely they may be needed. Sponging should be done cautiously lest the foreign body be hidden in secretions or food accumulation, and dislodged. Small food masses often lodge above the foreign body and are best removed with forceps. The folds of the esophagus are to be carefully searched with the aid of the lip of the esophagoscope. If the mucosa of the esophagus is lacerated with the forceps all further work is greatly hampered by the oozing; if the laceration involve the esophageal wall the accident may be fatal: and at best the tendency of the tube-mouth to enter the laceration and create a false passage is very great. Overriding or failure to find a foreign body known to be present is explained by the collapsed walls and folds covering the object, since the esophagoscope cannot be of sufficient size to smooth out these folds, and still be of small enough diameter to pass the constricted points of the esophagus noted in the chapter on anatomy. Objects are often hidden just distal to the cricopharyngeal fold, which furthermore makes a veritable chute in throwing the end of the tube forward to override the foreign body and to interpose a layer of tissue between the tube and the object, so that the contact at the side of the tube is not felt as the tube passes over the foreign body (Fig. 91). The chief factors in overriding an esophageal foreign body are: 1. The chute-like effect of the plica cricopharyngeus. 2. The chute-like effect of other folds. 3. The lurking of the foreign body in the unexplored pyriform sinus. 4. The use of an esophagoscope of small diameter. 5. The obscuration of the intruder by secretion or food debris. 6. The obscuration of the intruder by its penetration of the esophageal wall. 7. The obscuration of the intruder by inflammatory sequelae. [FIG. 91.--Illustrating the hiding of a coin by the folding downward of the plica cricopharyngeus. The muscular contraction throws the beak of the esophagoscope upward while the interposed tissue prevents the tactile appreciation of contact of the foreign body with the side of the tube after the tip has passed over the foreign body. Other folds may in rare instances act similarly in hiding a foreign body from view. This overriding of a foreign body is apt to cause dangerous dyspnea by compression of the party wall.] The esophageal speculum for the removal of foreign bodies is useful when the object is not more than 2 cm. below the cricoid in a child, and 3 cm. in the adult. The fold of the cricopharyngeus can be repressed posteriorward by the forceps which are then in position to grasp the object when it is found. The author's down-jaw forceps (Fig. 22) are very useful to reach down back of the cricopharyngeal fold, because of the often small posterior forceps space. The speculum has the disadvantage of not allowing deeper search should the foreign body move downward. In infants, the child's size laryngoscope may be used as an esophageal speculum. General anesthesia is not only unnecessary but dangerous, because of the dyspnea created by the endoscopic tube. Local anesthesia is unnecessary as well as dangerous in children; and its application is likely to dislodge the foreign body unless used as a troche. Forbes esophageal speculum is excellent. Next: Mechanical Problems Of Esophagoscopic Removal Of Foreign Bodies Previous: Contraindications
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