CICATRICIAL STRICTURE of this kind in children, with the exception of rare eases clue to necrotic proeesses folloning scarlet fever, and diphtheria, are produced by corrosive injuries just described.
Pathological Anatomy. —The kincl and severity of the stricture depends upon the extent of the injury. Superficial lesions produce the membranous strictures. Deeper destruction. involving the muscular layer or even the perkesophageal tissue, produces the ring- or tube-like, very firm stricture. The situation of the stricture Trill depend upon the amount of the caustic substance swallowed, and the way it oecurred. When large swallows are taken, the fluid reaches the eardia at onee and causes deep burns, but when only a few drops are taken the fluid does not go down very far. In children the lesions are usually situated in the upper third of the cesophagus. Torday saw 54 per cent. in this situation, as compared to 19 and 27 per cent. in the middle and lower third, Above the stricture there is usually dilatation nith hypertrophy' of the wall.
The symptoms are those produced by the inability to swallow, and if the stricture is tight, rapid inanition may result. They begin two or three weeks after the poison is taken.
is made by passing solid bougies of whale bone with olive-shaped metal tips.
is better in children than in adults. With proper treatment from 54 to 66 per cent. are cured. Reeurrenees play take place. Tube-like strictures are the most unfavorable.
Treatment eonsists iu the gradual dilatation with bougies. For this purpose flexible bougies, such as Phillips' uretheral bougies, answer very well. For tight strictures conical, and for wider strictures, eylin drieal instruments may be used. In very tight strictures the passage may be found by the eareful use of thin guides contained in a hollow bou0e. A drainage tube carried clown with a fine probe will be useful in
some eases. It may be carried through the nose with the Bellocque can nulit. and left in place some time. It may be used for feeding the patient. Gradual dilatation of the stricture results from the use of con stantly larger instruments, which when the parts become tolerant may be left in plaee for a half hour. Great care should be exercised in using instruments. Every second or third day a little of a 15 per cent.
thiosinamin solution (alcoholic) may be used. The treatment may be started about the third week after the poisoning. If the bougies are used three times a week, the treatment usually takes about six months. In order to avoid recurrences the bougies should be passed The dangers in using the bougies consist in producing a false passage, or perforation.
If nothing is accomplished by the gradual dilatation bougies a gastrotomy may have to be performed.
Congenital occlusion of the cesophagus, a rare defect, is situated slightly below the larynx or at the bifurcation. Sometimes there is a communication with the air-passages. Such children regurgitate,— with symptoms of suffocation,—the smallest amount of food. The bougie will strike an impassible barrier. Children with this condition usually die during the first two weeks. There is no treatment. Cases of congenital stricture also occur. They differ from the cicatricial strictures by the history of the case, and anatomically by the presence of normal tissue. Difficult deglutition, and a tendency to regurgitation, are the symptoms of this rare condition.