Treatment


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

It is a mistake to try to force a foreign body into the

stomach with the stomach tube or bougie. Sounding the esophagus with

bougies to determine the level of the obstruction, or to palpate the

nature of the foreign body, is unnecessary and dangerous.

Esophagoscopy should not be done without a previous roentgenographic

and fluoroscopic examination of the chest and esophagus, except for

urgent reasons. The level of the stenosis, and usually the nature of

the foreign body, can thus be decided. Blind instrumentation is

dangerous, and in view of the safety and success of esophagoscopy,

reprehensible.



If for any reason removal should be delayed, bismuth sub-nitrate,

gramme 0.6, should be given dry on the tongue every four hours. It

will adhere to the denuded surfaces. The addition of calomel, gramme

0.003, for a few doses will increase the antiseptic action. Should

swallowing be painful, gramme 0.2 of orthoform or anesthesin will be

helpful. Emetics are inefficient and dangerous. Holding the patient up

by the heels is rarely, if ever, successful if the foreign body is in

the esophagus. In the reported cases the intruder was probably in the

pharynx.



External esophagotomy for the removal of foreign bodies is

unjustifiable until esophagoscopy has failed in the hands of at least

two skillful esophagoscopists. It has been the observation in the

Bronchoscopic Clinic that every foreign body that has gone down

through the mouth into the esophagus can be brought back the same way,

unless it has already perforated the esophageal wall, in which event

it is no longer a case of foreign body in the esophagus. The mortality

of external esophagotomy for foreign bodies is from twenty to

forty-two per cent, while that of esophagoscopy is less than two per

cent, if the foreign body has not already set up a serious

complication before the esophagoscopy. Furthermore, external

esophagotomy can be successful only with objects lodged

in the cervical esophagus and, moreover, it has happened that after

the esophagus has been opened, the foreign body could not be found

because of dislodgement and passage downward during the relaxation of

the general anesthesia. Should this occur during esophagoscopy, the

foreign body can be followed with the esophagoscope, and even if it is

not overtaken and removed, no risk has been incurred.



Esophagoscopy is the one method of removal worthy of serious

consideration. Should it repeatedly fail in the hands of two skillful

endoscopists, which will be very rarely, if ever, then external

operation is to be considered in cervically lodged foreign bodies.





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