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Category: UNSUCCESSFUL BRONCHOSCOPY FOR FOREIGN BODIES
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Bronchoscopy should be done in all cases of chronic
pulmonary abscess and bronchiectasis even though radiographic study
reveals no shadow of foreign body. The patient by assuming a posture
with the head lowered is urged to expel spontaneously all the pus
possible, before the bronchoscopy. The aspirating bronchoscope (Fig.
2, E) is often useful in cases where large amounts of secretion may be
anticipated. Granulations may require removal with forceps and
sponging. Disturbed granulations result in bleeding which further
hampers the operation; therefore, they should not be touched until
ready to apply the forceps, unless it is impossible to study the
presentation without disturbing them. For this reason secretions
hiding a foreign body should be removed with the aspirating tube (Fig.
9) rather than by swabbing or sponge-pumping, when the bronchoscopic
tube-mouth is close to the foreign body. It is inadvisable, however,
to insert a forceps into a mass of granulations to grope blindly for a
foreign body, with no knowledge of the presentation, the forceps
spaces, or the location of branch-bronchial orifices into which one
blade of the forceps may go. Dilatation of a stricture may be
necessary, and may be accomplished by the forms of bronchial dilators
shown in Fig. 25. The hollow type of dilator is to be used in cases in
which the foreign body is held in the stricture (Fig. 83). This
dilator may be pushed down over the stem of such an object as a tack,
and the stricture dilated without the risk of pushing the object
downward. It is only rarely, however, that the point of a tack is
free. Dense cicatricial tissue may require incision or excision.
Internal bronchotomy is doubtless, a very dangerous procedure,
though no fatalities have occurred in any of the three cases in the
Bronchoscopic Clinic. It is advisable only as a last resort.





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