The Extraction Of Tightly Fitting Foreign Bodies From The Bronchi

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Annular Edema

Such objects as marbles, pebbles, corks, etc., are

drawn deeply and with force by the inspiratory blast into the smallest

bronchus they can enter. The air distal to the impacted foreign body

is soon absorbed, and the negative pressure thus produced increases

the impaction. A ring of edematous mucosa quickly forms and covers the

presenting part of the object, leaving visible only a small surface in

the center of an acute edematous stenosis. A forceps with narrow,

stiff, expansive-spring jaws may press back a portion of the edema and

may allow a grasp on the sides of the foreign body; but usually the

attempt to apply forceps when there are no spaces between the

presenting part of the foreign body and the bronchial wall, will

result only in pushing the foreign body deeper.* A better method is to

use the lip of the bronchoscope to press back the swollen mucosa at

one point, so that a hook may be introduced below the foreign body,

which then can be worked up to a wider place where forceps may be

applied (Fig. 89). Sometimes the object may even be held firmly

against the tube mouth with the hook and thus extracted. For this the

unslanted tube-mouth is used.

* The author's new ball forceps are very successful with ball-bearing

balls and marbles.

[FIG. 89.--Schema illustrating the use of the lip of the bronchoscope

in disimpaction of foreign bodies. A and B show an annular edema above

the foreign body, F. At C the edematous mucosa is being repressed by

the lip of the tube mouth, permitting insinuation of the hook, H, past

one side of the foreign body, which is then withdrawn to a convenient

place for application of the forceps. This repression by the lip is

often used for purposes other than the insertion of hooks. The lip of

the esophagoscope can be used in the same way.]