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Rules For Endoscopic Foreign Body Extraction
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Foreign Bodies In The Bronchi For Prolonged Periods
Category: FOREIGN BODIES IN THE BRONCHI FOR PROLONGED PERIODS
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
The sojourn of an inorganic foreign body in the bronchus for a year or
more is followed by the development of bronchiectasis, pulmonary
abscess, and fibrous changes. The symptoms of tuberculosis may all be
presented, but tubercle bacilli have never been found associated with
any of the many cases that have come to the Bronchoscopic Clinic.* The
history of repeated attacks of malaise, fever, chills, and sweats
lasting for a few days and terminated by the expulsion of an amount of
foul pus, suggests the intermittent drainage of an abscess cavity, and
special study should be made to eliminate foreign body as the cause of
the condition, in all such cases, whether there is any history of a
foreign body accident or not. Bronchoscopy for diagnosis is to be done
unless the etiology can be definitely proven by other means. In all
cases of chronic chest disease foreign body should be eliminated as a
matter of routine.
* One exception has recently come to the Clinic. 12
The time of aspiration of a foreign body may be unknown, having
possibly occurred in infancy, during narcosis, or the object may even
enter the lower air passages without the patient being aware of the
accident, as happened with a particularly intelligent business man who
unknowingly aspirated the tip of an atomizer while spraying his
throat. In many other cases the accident had been forgotten. In still
others, in spite of the patient's statement of a conviction that the
trouble was due to a foreign body he had aspirated, the physician did
not consider it worthy of sufficient consideration to warrant a
roentgenray examination. It is curious to note the various opinions
held in regard to the gravity of the presence of a bronchial foreign
body. One patient was told by his physician that the presence of a
staple in his bronchus was an impossibility, for he would not have
lived five minutes after the accident. Others consider the presence of
a foreign body in the bronchus as comparatively harmless, in spite of
the repeated reports of invalidism and fatality in the medical
literature of centuries. The older authorities state that all cases of
prolonged bronchial foreign body sojourn died from phthisis
pulmonalis, and it is still the opinion of some practitioners that the
presence of a foreign body in the lung predisposes to the development
of true tuberculosis. With the dissemination of knowledge regarding
the possibility of bronchial foreign body, and the marvellous success
in their removal by bronchoscopy, the cases of prolonged foreign body
sojourn should decrease in number. It should be the recognized rule,
and not the exception, that all chest conditions, acute or chronic,
should have the benefit of roentgenographic study, even apart from the
possibility of foreign body.
Often even with the clear history of foreign-body aspiration, both
patient and physician are deluded by a relatively long period of
quiescence in which no symptoms are apparent. This symptomless
interval is followed sooner or later by ever increasing cough and
expectoration of sputum, finally by bronchiectasis and pulmonary
abscess, chronic sepsis, and invalidism.
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