Spatula-protected Method

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

Safety-pins in children, point upward,

when lodged high in the cervical esophagus may be readily removed with

the aid of the laryngoscope, or esophageal speculum. The keeper end is

grasped with the alligator forceps, while the spatular tip of the

laryngoscope is worked under the point. Instruments and foreign body

are then removed together. Often the pin point will catch in the

light-chamber where it is very safely lod ed. If the pin be then

pulled upon it will straighten out and may be withdrawn through the

tube.



[FIG. 94.--Endogastric version. One of the author's methods of removal

of upward pointed esophageally lodged open safety-pins by passing them

into stomach, where they are turned and removed. The first

illustration (A) shows the rotation forceps before seizing pin by the

ring of the spring end. (Forceps jaws are shown opening in the wrong

diameter.) At B is shown the pin seized in the ring by the points of

the forceps. At C is shown the pin carried into the stomach and about

to be rotated by withdrawal. D, the withdrawal of the pin into the

esophagoscope which will thereby close it. If withdrawn by flat-jawed

forceps as at F, the esophageal wall would be fatally lacerated.]



Double pointed tacks and staples, when lodged point upward, must be

turned so that the points trail on removal. This may be done by

carrying them into the stomach and turning them, as described under

safety-pins.



The extraction of foreign bodies of very large size from the

esophagus is greatly facilitated by the use of general anesthesia,

which relaxes the spasmodic contractions of the esophagus often

occurring when attempt is made to withdraw the foreign body. General

anesthesia, though entirely unnecessary for introduction of the

esophagoscope, in any case may be used if the body is large, sharp,

and rough, in order to prevent laceration through the muscular

contractions otherwise incident to withdrawal.* In exceptional cases

it may be necessary to comminute a large foreign body such as a tooth

plate. A large smooth foreign body may be difficult to seize with

forceps. In this case the mechanical spoon or the author's safety-pin

closer may be used.



* It must always be remembered that large foreign bodies are very

prone to cause dyspnea that renders general anesthesia exceedingly

dangerous especially in children.



[FIG. 95.--Lateral roentgenogram of a safety-pin in a child aged 11

months, demonstrating the esophageal location of the pin in this case

and the great value of the lateral roentgenogram in the localization

of foreign bodies. The pin was removed by the author's method of

endogastric version. (Plate made by George C. Johnston )]



The extraction of meat and other foods from the esophagus at the

level of the upper thoracic aperture is usually readily accomplished

with the esophageal speculum and forceps. In certain cases the

mechanical spoon will be found useful. Should the bolus of food be

lodged at the lower level the esophagoscope will be required.