Extraction Of Open Safety-pins From The Esophagus

Sources: 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.