CESOFHAGITS, DISEASES OF.
Malformations.—Congenital occlusion, due to the fact that during embryolog ical development the invagination form ing the mouth fails to open into the pos terior end of the primitive intestine; diverticula, of similar origin, and fistula due to incomplete closure of the bran chial clefts represent the main malfor mations met with in this region. Con genital narrowing due to abnormal thick ness of the wall or to the presence of membrane and congenital dilatation are also, though very rarely, witnessed.
Acquired Diverticula (Pharyngo celes).
-A diverticulum may oc cur as the result of inflammation or in jury; the oesophageal wall is weakened, a portion of it bulges out, forming a circumscribed sac, or hernia, through the muscular coat. While small, a pouch thus formed is hardly noticed, but, as small particles of food find their way into it, it is gradually enlarged, projecting downward. It may become several inches deep, is usually elongated, and appears externally as a pear-shaped growth between the larynx and the sterno-mastoid muscle. It may, by its pressure, displace the oesophagus and the larynx, causing violent coughing through pressure upon the superior lar yngeal and dyspnwa. Dysphagia, of the breath, regurgitation of ill-smell ing masses of sodden food, and local pain are experienced in severe cases. Death from inanition has resulted.
—A diverticulum may easily be recognized by palpation, espe cially when the patient is lying on his side, the tremor being upward. When it contains air, pressure upon it causes this to pass out and its size is reduced; when it contains food, pressure either causes marked lateral displacement of the cesophagus or the food is forced up into the oesophagus and mouth. It is often enlarged after meals. The sound may be used; it should be bent so as to enable it to enter the cavity, and be handled with great gentleness.
—Inflammation and injury to the muscular coat are the predominat ing factors. It is usually observed in men, and at the spot where the pharynx ends to become the oesophagus. The congenital forms are usually situated near the inferior constrictor.
- Operative procedures are alone of value. The tumor should be
reached and excised and the margins se cured with catgut sutures. This meas ure. introduced by Wheeler, is usually successful.
Traction Diverticula.
This is a form of diverticulum which presents itself near the bifurcation of the trachea, in the anterior wall of the (esophageal canal. It is generally asso ciated with inflammation of the lymph glands in this locality. Local inflamma tion followed by ulceration gives rise to cicatrices which by their contraction draw on the (esophagus: i.e., exercise traction upon it, forming a cavity open ing into the (esophageal canal by a fun nel-shaped orifice.
SYMPTOMS.—Mechanical irritation is occasionally produced by the retention of food, and ulceration may follow, at tended by its usual complication—per foration. A fistula between the cesoph agus and the bronchial tract may be followed sooner or later by pneumonia.
The pleura and pericardium may also be reached. In the majority of cases the symptoms are slight; it is only on ac count of the possible mortal complica tions that traction diverticula demand attention.
TREATMENT.—Surgical removal alone affords protection against possible com plications.
Foreign Bodies in the (Esophagus.
Foreign bodies frequently become im pacted in the (esophagus, fish-bones, pieces of meat, pins, tacks, artificial teeth, coins, and buttons representing the class of articles found in the ma jority of cases.
Symptoms.—These vary according to the shape, size, and location of the im pacted agent. A large mass, such as a piece of meat, may become engaged be hind the larynx and hold the tip of the epiglottis down, completely closing the laryngeal cavity. Here, intense dyspncea soon comes on and death from asphyxia may promptly follow. Or a part of a bolus may invade the larynx and cause violent spasm; asphyxia again becomes possible from two causes: spasm and re duction or total closure of the respira tory area. Small bodies may produce the same symptoms, but, as is the case with large masses,—meat, bread, etc.,—they seldom give rise to dangerous symptoms. unless the larynx is involved by pressure, puncture, or the epiglottis is held down in some way.