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Extraction Of Open Safety-pins From The Esophagus
Category: ESOPHAGOSCOPY FOR FOREIGN BODY
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
An open safety
pin with the point down offers no particular mechanical difficulty in
removal. Great care must be exercised, however, that it be not
overridden or pushed upon, as either accident might result in
perforation of the esophagus by the pin point. The coiled spring is to
be sought, and when found, seized with the rotation forceps and the
pin thus drawn into the esophagoscope to effect closure. An open
safety-pin lodged point upward in the esophagus is one of the most
difficult and dangerous problems. A roentgenogram should always be
made in the plane showing the widest spread of the pin. It is to be
remembered that the endoscopist can see but one portion of the pin at
a time (except in cases of very small safety-pins) and that if he
grasps the part first showing, which is almost invariably the keeper,
fatal trauma will surely be inflicted when traction is made. It may be
best to close the safety pin with the safety-pin closer, as
illustrated in Fig. 37. For this purpose Arrowsmith's closer is
excellent. In other cases it may prove best to disengage the point of
the pin and to bring the pointed shaft into the esophagoscope with the
Tucker forceps and withdraw the pin, forceps, and esophagoscope, with
the keeper and its shaft sliding alongside the tube. The rounded end
of the keeper lying outside the tube allows it to slip along the
esophageal walls during withdrawal without inflicting trauma; however,
should resistance be felt, withdrawal must immediately cease and the
pin must be rotated into a different plane to release the keeper from
the fold in which it has probably caught. The sense of touch will aid
the sense of sight in the execution of this maneuver (Fig. 87). When
the pin reaches the cricopharyngeal level the esophagoscope, forceps,
and pin should be turned so that the keeper will be to the right, not
so much because of the cricopharyngeal muscle as to escape the
posteriorly protuberant cricoid cartilage. In certain cases in which
it is found that the pointed shaft of a small safety pin has
penetrated the esophageal wall, the pin has been successfully removed
by working the keeper into the tube mouth, grasping the keeper with
the rotation forceps or side-curved forceps, and pulling the whole pin
into the tube by straightening it. This, however, is a dangerous
method and applicable in but few cases. It is better to disengage the
point by downward and inward rotation with the Tucker forceps.
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