Sharp or irregular bodies,—such as chicken-bones, tacks, etc.,—when im pacted only in the cesophagus,—usually at its upper portion and immediately be hind the cricoid cartilage,—only cause marked discomfort and severe pain, espe cially marked during deglutition; but they are attended with little or no im mediate danger. The pain may radiate in various directions. lamorrhage or rather slight bleeding is occasionally produced. After some time, varying with the size and shape of the body, the acute suffering ceases and pain, is only experienced during deglutition.
If the impacted body is low down, which is frequently the case when it is small, it is only at this time that its true location cam sometimes be established. the sensations before this being mislead ing. But the pain even at this time may only indicate the location of a lesion produced by a rough or sharp body dur ing its passage to the stomach.
Left in situ, foreign bodies always tend to create local lesions, unless, as sometimes happens, spontaneous expul sion occurs after the primary local irri tation and the general excitement of the patient has ceased. Local inflammation is caused, the tissues become softened, abscesses arise which may burrow in various directions, sometimes reaching into the pleura, the pericardium, the mediastinum, or the larger vessels, in cluding even the aorta. The foreign body itself may follow either of the channels formed and cause death by reaching any of the organs of the tho racic cavity. Needles particularly are prone to migrate in various directions and sometimes appear at a spot quite re mote from the gullet and totally discon nected with it as to continuity of tissue.
Small bodies that pass into the stom ach seldom give rise to trouble, being usually passed per anunt a day or two later. In one of my eases, a child three years of age, the foreign body was a screw one and a half inches in length. It was passed on the third day without having caused the least discomfort.
Treatment.—It is important to bear in mind, in all such cases, that a scratch or erosion of the mucous membrane pro duced by a passing angular bone—a fish bone, a pin, etc.—gives rise to symptoms simulating the actual presence of such a body. It is quite difficult at times to convince the patient that there is noth ing in his gullet.
Cases in which dysPncea is a symptom demand immediate assistance. I have found this to be afforded most promptly by passing the index and middle fingers of the right hand into the mouth (which makes it possible to reach farther down than when one finger is introduced) and inserting the middle finger into the left pyriform sinus. The middle finger is then passed rapidly behind the larynx. The portion of the foreign body in the oesophagus is thus reached and generally swept aside, drawing out of the larynx the part engaged in it or holding down the epiglottis. If it is impacted, the in dex finger is brought into use, and by closing upon the middle finger a grasp is obtained upon the obstructing substance.
In some cases the larynx is deep-seated and is reached with difficulty, but the mouth of the patient can stand con siderable stretching, if need be, consider ing the imminent danger of death. This procedure is, of course, only applicable in cases in which the foreign body is situated in the upper part of the oesoph agus and close to the larynx, but, as al ready stated, these alone expose the pa tient to immediate death.
When dyspncea is not present, the laryngeal mirror often greatly assists in the examination of the cavities involved, and it is rare, with a good light, that a body situated not far below the larynx cannot be detected. It also assists in properly introducing and directing any instrument or forceps that may be intro duced. Round and smooth articles may be pushed down with a probang when they cannot be extracted with forceps. The horse-hair probang, Graefe's coin catcher, etc., are useful, but they must be used with gentleness. Emetics should never be used, since the contractions of the cesophageal muscles tend to force the. body through the walls of the organ..
When fish-bones, meat, or are impacted, vinegar hastens their dis integration and small quantities may be sipped. Foreign bodies that have passed into the stomach are said to be assisted in their migration through the intestinal tract by the use of mashed potatoes as food.
Irregular large bodies, tooth-plates, large bones, etc., when inaccessibly lo cated, demand cesophagotomy (ride supra) or gastrotomy (see STOMACH, SURGERY OF).