FOREIGN BODIES The foreign bodies which are found in the accessible cavities of the body in children, with their diagnosis, prognosis, and treatment have been exhaustively described under the diseases of the respective organs— nose, trachea, bronchi. (E. Feer, Foreign bodies in the nose, vol. iii; E. Feer, Foreign bodies in the trachea and in the bronchi, vol. iii; D. Galatti, Foreign bodies in the larynx, vol. ill.) The demonstration of these foreign bodies in the skiagrarn is of great surgical importance. Taking plates in the different planes we may be able to gain much valuable information as to their size and exact loca tion, provided they are impervious to the Röntgen rays.
Foreign bodies in the trachea or in the bronchi may cause us con siderable difficulty, but modern bronchoscopy through the mouth or tracheotomy will make even these accessible (v. Hacker).
Foreign bodies, such as pieces of bone, fish bones, buttons, coins, etc., will more frequently get stuck in the cesophagus. The impossibility to swallow or pains with it and difficulty in breathing from protrusion of the foreign body against the trachea are the most frequent symptoms, to which may be added that for mothers an important symptom is the missing of the suspected article, which, however, may be unearthed from its hiding place in a corner of the room a few days later.
The skiagram usually gives us the necessary information about the nature, size and location of the foreign body.
A considerable number of instruments, coin-catchers, probangs, etc., have been constructed for their removal (Weiss, Kirmisson). Nowa days we will usually succeed with the ccsophagoseope and with properly constructed instruments in removing foreign bodies, and only rarely will we have to resort to operative procedures (cesophagotomy).
The location of the foreign body will naturally determine the proper procedure in every individual case. In deep-lying ones we will have to do a gastrotomy, in higher ones an cesophagotomy either at the edge of the sternomastoid or in the median line, with or without opening the cesophagus (Hans, V. Hacker).
The burning of the (esophagus with caustic solutions deserves our special attention owing to its frequency in childhood (see Finkelstein, Qsophagitis corrosiva, vol. ii.) (Fig. 150).
The eicatricial stricture following it demands long-continued treat ment with sounds. Early treatment (Bass) with sounds is dangerous. At first we order absolute rest, anodynes, rectal feeding or through a gastric fistula; only after three or four weeks may we begin our treatment with sounds. After the stricture has been made pervious for filiform
sounds, we proceed to dilate it gradually with thicker ones. V. Hacker recommends introducing a tube down to the stricture and to fill the tube with filiform boogies; by careful probing one of these will find the right passage, but we must always remember the ampulla-like dilatations and the deep diverticula which are frequently found in the half-macerated ulcerations above the stricture, and that the Av a 11 separating it from the pleura may be extremely thin. Breaking through this wall will usually be followed within a short time by death from purulent pleurisy and pneumothorax. (By letting the patient swallow bismuth paste we may show the diverticula on the skiagram.) Even after long-continued treatment with an cesophageal sound, at a time when the children have learned to introduce it themselves, a false passage or a diverticulum which hail been deepened through the act of swallowing may perforate, because ulcers with a friable base form in the bottom of the divertieula.
We must, therefore, always remember the recommendation of v. Hacker, to make a gastric fistula whenever the introduction of the Bougie is in the least difficult and institute from here endless retrograde bouginage.
Through the mouth we introduce the thread down to the gastric fistula and with this we run bougies, increasing in size, from the gastric fistula, through the stricture without running any danger of perforating a diverticulum. As soon as the dilatation is sufficient for the child to swallow solid food, then the fistula, which had been made tubular accord ing to the advice of Witzel, closes quickly, and we can maintain the dila tation through the introduction of large bougies by the mouth (v. Hacker, Lot heisen). This method is easier and safer than a difficult bouginagc through the mouth, and we can also give these starved youngsters sufficient food through the gastric fist Ma and thus increase their strength.
The reports about fibrolysin are very contradictory; we personally have always waited with its administration until after the treatment with sounds, on account of the softening effect it is supposed to have on sear-tissues, and we have then used it in cycles of ten injections; we must confess, however, that we have never been able to notice any remark able results from this treatment.