Mechanical Problems Of Esophagoscopic Removal Of Foreign Bodies


Categories: ESOPHAGOSCOPY FOR FOREIGN BODY
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The bronchoscopic problems considered in the previous chapter should

be studied.



The extraction of transfixed foreign bodies presents much the same

problem as those in the bronchi, though there is no limit here to the

distance an object may be pushed down to free the point. Thin, sharp

foreign bodies such as bones, dentures, pins, safety-pins, etcetera,

are often found to lie crosswise in the esophagus, and it is

imperative that one end be disengaged and the long axis of the object

be made to correspond to that of the esophagus before traction for

removal is made (Fig. 92). Should the intruder be grasped in the

center and traction exerted, serious and perhaps fatal trauma might

ensue.



[191] [FIG. 92.--The problem of the horizontally transfixed foreign

body in the esophagus. The point, D, had caught as the bone, A, was

being swallowed. The end, E, was forced down to C, by food or by blind

attempts at pushing the bone downward. The wall, F, should be

laterally displaced to J, with the esophagoscope, permitting the

forceps to grasp the end, M, of the bone. Traction in the direction of

the dart will disimpact the bone and permit it to rotate. The rotation

forceps are used as at K.]



[FIG. 93.--Solution of the mechanical problem of the broad foreign

body having a sharp point by version. If withdrawn with plain forceps

as applied at A, the point B, will rip open the esophageal wall. If

grasped at C, the point, D, will rotate in the direction of F and will

trail harmlessly. To permit this version the rotation forceps are used

as at H. On this principle flat foreign bodies with jagged or rough

parts are so turned that the potentially traumatizing parts trail

during withdrawal.]



The extraction of broad, flat foreign bodies having a sharp point or a

rough place on part of their periphery is best accomplished by the

method of rotation as shown in Fig. 93.





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