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Mechanical Problems Of Esophagoscopic Removal Of Foreign Bodies





Category: ESOPHAGOSCOPY FOR FOREIGN BODY
Source: 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 If withdrawn with plain forceps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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