Digestion is the process whereby the food we eat is turned int...
Aphonia Loss Of Voice
This affection requires treatment variously, as it depends on...
Signs Of Heart Weakness
It should be remembered that a normal heart may slow to about...
are: A fetid breath, with ulceration and sloughing of the thr...
Consumption Treatment Of
Turning now to the case when consumption has actually shown it...
Head Massaging The
This is so important in many cases of neuralgia, headache, and...
Strangulation Or Hanging
Often accidentally caused in children or intoxicated persons. ...
Gangrene Of The Lung
Pulmonary gangrene has been followed by recovery after the e...
A Collection Of Gallbladders
Gallbladder cases are rather ho-hum to me; they are quick to ...
is a most efficient remedy applied to old irritable _varicose...
Ankle Twisted Or Crushed
Place the foot as soon as possible in warm water, as hot as ca...
The Lookout Department
Why the Eyes, Ears, and Nose are Near the Mouth. If you had n...
See Baths for Head. ...
There is intense drowsiness and contraction of pupils of eye. ...
For traumatic trismus, use the B D current, of vigorous force...
Cardiovascular Renal Disease
With the strennousness of this era, this disease or conditi...
Rheumatism is the cause of most instances of cardiac disease ...
Nursing Sore Mouth
Sore mouth of nursing women, as the name of the disease indic...
This is a name applied to pain in the region of the heart cau...
Diet For The Chronically Ill
The chronically ill person has a long-term degenerative con...
Unsuccessful Bronchoscopy For Foreign Bodies
Category: FOREIGN BODIES IN THE ESOPHAGUS
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
The limitations of bronchoscopic removal of foreign bodies are usually
manifested in the failure to find a small foreign body which has
entered a minute bronchus far down and out toward the periphery. When
localization by means of transparent films, fluoroscopy, and
endobronchial bismuth insufflation has failed, the question arises as
to the advisability of endoscopic excision of the tissue intervening
between the foreign body and bronchoscope with the aid of two
fluoroscopes, one for the lateral and the other the vertical plane.
With foreign bodies in the larger bronchi near the root of the lung
such a procedure is unnecessary, and injury to a large vessel would be
almost certain. At the extreme periphery of the lung the danger is
less, for the vessels are smaller and serious hemorrhage less
probable, through the retention and decomposition of blood in small
bronchi with later abscess formation is a contingency. The nature of
the bridge of tissue is to be considered; should it be cicatricial,
the result of prolonged inflammatory processes, it may be carefully
excised without very great risk of serious complications. The blood
vessels are diminished in size and number by the chronic productive
inflammation, which more than offsets their lessened contractility.
The possibility of the foreign body being coughed out after
suppurative processes have loosened its impaction is too remote; and
the lesions established may result fatally even after the expulsion of
the object. Pulmonary abscess formation and rupture into the pleura
should not be awaited, for the foreign body does not often follow the
pus into the pleural cavity. It remains in the lung, held in a bed of
granulation tissue. Furthermore, to await the development is to
subject the patient to a prolonged and perhaps fatal sepsis, or a
fatal pulmonary hemorrhage from the erosion of a vessel by the
suppurative process. The recent developments in thoracic surgery have
greatly decreased the operative mortality of thoracotomy, so that this
operation is to be considered when bronchoscopy has failed.
Bronchoscopy can be considered as having failed, for the time being,
when two or more expert bronchoscopists on repeated search have been
unable to find the foreign body or to disentangle it; but the art of
bronchoscopy is developing so rapidly that the failures of a few years
ago would be easy successes today. Before considering thoracotomy
months of study of the mechanical problem are advisable. It is
probable that any foreign body of appreciable size that has gone down
the natural passages can be brought back the same way.
In the event of a foreign body reaching the pleura, either with or
without pus, it should be removed immediately by pleuroscopy or by
thoracotomy, without waiting for adhesive pleuritis.
The problem may be summarized thus:
1. Large foreign bodies in the trachea or large bronchi can always
be removed by bronchoscopy.
2. The development of bronchoscopy having subsequently solved the
problems presented by previous failures, it seems probable that by
patient developmental endeavor, any foreign body of appreciable size
that has gone down through the natural passages, can be
bronchoscopically removed the same way, provided fatal trauma is
At the author's Bronchoscopic Clinics 98.7 per cent of foreign bodies
have been removed.