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Medical ArticlesFrictions With Lardwere used already by Caelius Aurelianus, and recently re-intr... Physical Signs Of Bronchial Foreign Body In most cases there will be limitation of expansion on the in... Typhoid Fever Ulcerative lesions in the larynx during typhoid fever are al... Ulcers Case Xxvii Mrs. Wakefield, aged 36, had an extensive ulceration with exc... Demonstrations Of The Origin And Progress Of Femoral Hernia Its Diagnosis The Taxis And The Operation PLATE 45, Fig. 1.--The point, 3, from which an external ingui... Depression This is usually a bodily illness, though often regarded as men... Contraindications To Esophagoscopy In the presence of aneurysm, advanced organic disease, exten... Neck Twisted This arises from the undue contraction of some of the muscles ... Measles _Measles_, which may be easily distinguished from scarlatina,... Troubles Of The Nervous System The Nervous System is not easily Damaged. The nervous system ... Headache Sick The stomach and head affect each other powerfully, and a disor... Cauliflower Growths These begin like warts, and in the earlier stages poulticing a... Snake Bites A snake bite is only one of a large class of injuries which ma... Neuralgia _Aconite_ and _Bell._ are two important remedies in this affe... Tucker Forceps Gabriel Tucker modified the regular side-curved forceps by a... Treatment Of Compression Stenoses Of The Trachea If the thymus be at fault, rapid amelioration of symptoms fo... Diet For The Acutely Ill The acutely ill person experiences occasional attacks of dist... Decompensation To understand the physiology, pathology and the best treatmen... Technic It is essential that the patient on whom the examination is t... Electrical Classification Of Diseases There are two, and only two, primary classes of disease--thos... |
Extraction Of Foreign Bodies From The Strictured EsophagusCategory: ESOPHAGOSCOPY FOR FOREIGN BODY Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery Foreign bodies of relatively small size will lodge in a strictured esophagus. Removal may be rendered difficult when the patient has an upper stricture relatively larger than the lower one, and the foreign body passing the first one lodges at the second. Still more difficult is the case when the second stricture is considerably below the first, and not concentric. Under these circumstances it is best to divulse the upper stricture mechanically, when a small tube can be inserted past the first stricture to the site of lodgement of the foreign body. Prolonged sojourn of foreign bodies in the esophagus, while not so common as in the bronchi is by no means of rare occurrence. Following their removal, stricture of greater or less extent is almost certain to follow from contraction of the fibrous-tissue produced by the foreign body. Fluoroscopic esophagoscopy is a questionable procedure, for the esophagus can be explored throughout by sight. In cases in which it is suspected that a foreign body, such as pin, has partially escaped from the esophagus, the fluoroscope may aid in a detailed search to determine its location, but under no circumstances should it be the guide for the application of forceps, because the transparent but vital tissues are almost certain to be included in the grasp. [197] Complications and Dangers of Esophagoscopy for Foreign Bodies. Asphyxia from the pressure of the foreign body, or the foreign body plus the esophagoscope, is a possibility (Fig. 91). Faulty position of the patient, especially a low position of the head, with faulty direction of the esophagoscope may cause the tube mouth to press the membranous tracheo-esophageal wall into the trachea, so as temporarily to occlude the tracheal lumen, creating a very dangerous situation in a patient under general anesthesia. Prompt introduction of a bronchoscope, with oxygen and amyl nitrite insufflation and artificial respiration, may be necessary to save life. The danger is greater, of course, with chloroform than with ether anesthesia. Cocain poisoning may occur in those having an idiosyncrasy to the drug. Cocain should never be used with children, and is of little use in esophagoscopy in adults. Its application is more annoying and requires more time than the esophagoscopic removal of the foreign bodies without local anesthesia. Traumatic esophagitis, septic mediastinitis, cervical cellulitis, and, most dangerous, gangrenous esophagitis may be present, caused by the foreign body itself or ill-advised efforts at removal. Perforation of the esophagus with the esophagoscope is rare, in skillful hands, if the esophageal wall is sound. The esophageal wall, however, may be weakened by ulceration, malignant disease, or trauma, so that the possibility of making a false passage should always deter the endoscopist from advancing the tube beyond a visible point of weakening. To avoid entering a false passage previously created, is often exceedingly difficult, and usually it is better to wait for obliterative adhesive inflammation to seal the tissue layers together. Next: Treatment Previous: Spatula-protected Method
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