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Foreign bodies of the esophagus
The ingress of foreign bodies into the esophagus is random and the predisposing moments are considered in the description of the physiology of the esophagus.
Foreign bodies linger in places of physiological constriction, most often (50 - 60%) - in the area of cricopharyngeal constriction, which has powerful striated muscles. The second place in the frequency of fixation of foreign bodies is occupied by the thoracic region - aortic-bronchial narrowing (25 - 45%); the third is the diaphragmatic-cardial part of the esophagus (10 - 15%).
In older people with weakened muscles of the esophagus, foreign bodies are more likely to get stuck in the thoracic region. With organic lesions caused by cicatricial narrowing of the lumen of the esophagus after chemical burns, a tumor process, etc., foreign bodies can linger in various parts of the esophagus.
The clinic is determined by the nature of the foreign body, the presence of sharp edges, the place of its fixation. If a foreign body gets stuck in the cervical part of the esophagus, then the patient clearly localizes the pain, restricts movement of the head and neck; local pain is determined by palpation, and with laryngoscopy, saliva accumulation in the pear-shaped sinus of the corresponding side is detected (the symptom is not strictly specific).
When a foreign body with sharp edges is stuck in the middle and lower parts of the esophagus, patients cannot accurately localize the pain. The pain is usually felt behind the sternum, widely radiating to the chest, to the spine, neck, jaw, epigastric region. Due to intense pain, patients occupy a forced position, restricting the movement of the neck and trunk. The appearance of such a patient is very characteristic: a suffering face expression, fright, pallor, cold sweat, when walking, he “carries a foreign body” (Khilov KL, 1931).
A very valuable diagnostic technique is a sample with a sip of water. During swallowing, in the presence of a foreign body, one can observe the appearance of a grimace of pain and a number of protective reflexes at the moment of movement of the larynx. With a complete obstruction of the esophagus (meat blockage), regurgitation of the drunk water occurs at the moment when it rises from the site of blockage of the esophagus to the beginning of the pharynx ("esophageal vomiting"). By the amount of water drunk, one can judge the level of obstruction. Fig. 5.10 shows radiographs of patients with foreign bodies of the esophagus.
The diagnosis of a foreign body of the esophagus is based on a carefully collected and critically meaningful history, appearance of the patient, examination and palpation of the neck, pharyngo-laryngoscopy data and the results of X-ray examination, which despite the advent of modern methods of radiation research (CT and MRI) continues to be the leading research method in diagnosis of this type of pathology.
The most effective x-ray examination is when there are radiopaque foreign bodies in the esophagus: a dense compact meat bone, dentures, metal objects, etc. Low-contrast foreign bodies (spongy and fish bones, etc.) require the use of contrasting preparations (the most common is barium suspension).
The use of a large amount of barium suspension can interfere with the detection of a foreign body during subsequent esophagoscopy. The following technique is often used for diagnostic purposes: a small lump of cotton wool is moistened with a barium suspension of medium density. When swallowed, it usually gets stuck at the level of a foreign body as a result of a circular spasm of the esophagus. However, at the same time, as in any business, it is necessary to observe a sense of proportion. In our practice, there was an unfortunate case when an inexperienced retgenlaborant gave the patient to take a sip of barium suspension with a large piece of cotton wool, the delay of which in the thoracic esophagus simulated a foreign body. With subsequent esophagoscopy, only abrasion was found after removal of the cotton wool, which caused a local reflex spasm of the esophagus.
In the diagnosis of foreign bodies of the esophagus, a flexible elastic fibroscope can also be used. The danger of using a rigid esophagoscope for the diagnosis of foreign bodies of the esophagus was mentioned above, when considering methods for studying the esophagus
Treatment. As soon as the presence of a foreign body has been established in the esophagus, the latter should be removed under stationary conditions, - in the words of one of the first esophagoscopists - Hacker - "as soon as possible and in the most gentle and safe way." As already mentioned, a flexible fiberscope can only remove very small foreign bodies. Therefore, to remove the bulk of the foreign bodies of the esophagus, a rigid esophagoscope continues to serve. To reduce the risk of esophagoscopy, in most cases, it is performed under general anesthesia using muscle relaxants.
When a foreign body is localized in the lower esophagus, especially in people of an older age group, the main tube of an esophagoscope 25 cm long is not enough and an insertion extension tube is needed. With the introduction of the latter, the feeling of natural resistance of the esophagus wall may be lost, which is fraught with damage. In these cases, we use a long tube from the bronchoscope, although its lumen is narrower.
After esophagoscopy and removal of a foreign body, a control x-ray is shown to exclude damage to the esophagus and the penetration of gas into the tissues surrounding the esophagus.
When the esophagus is clogged with a piece of uncooked meat (meat blockage), you can try to restore its patency by prescribing antispasmodics and painkillers to the patient and several tablespoons of sunflower (olive) oil inside. Some foreign authors in these cases recommend taking a marinade containing papaya extract, the active principle of which is the proteolytic enzyme papain. 1/2 hour after swallowing several tablespoons of meat softener, the patient takes several sips of a solution of soda. Such measures can facilitate the passage of a lump into the stomach and avoid esophagoscopy. Attempts to push through a foreign body with a bougie or other instrument are unacceptable because of the danger of severe damage to the esophagus and have long been abandoned.
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Foreign bodies of the esophagus
- FOREIGN BODIES IN THE FIELD OF THE MOUTH, THROAT, AND ESOPHAGUS
The reasons for the entry of foreign bodies into the esophagus in dogs may be the habit of playing various objects and, hasty food, accidentally swallowing toys. In cats, the cause of foreign bodies (most often these are sewing needles with or without thread) is the special structure of the villi of the tongue. When trying to free itself from a randomly captured foreign body, a cat pushes it with tongue movements
- Damage and foreign bodies of the esophagus
Damage to the esophagus is external and internal. External, rarer ones include a breakthrough in the esophagus of abscesses of the lymph nodes, a tumor growing in it. Military injuries and incised wounds of the esophagus are possible in combination with damage to the pharynx and trachea. Internal damage - all cases of damage to the mucous membrane or the entire wall of the esophagus by foreign bodies, chemical agents,
- Foreign bodies in the throat and esophagus
Sometimes not only kittens, but also excessively curious adult cats swallow foreign objects. Some of these items are so small that they easily slip through the throat and esophagus, and then safely pass the stomach and intestines, and go out naturally, while others can get stuck. Often, for example, fish bones are stuck between the teeth, or stuck in the back of the throat
- Foreign bodies in the mouth, pharynx, larynx, trachea, esophagus, stomach and intestines
Foreign bodies can be sharp, damaging and obstructing (clogging) the pharynx, larynx and esophagus. In case of suffocation, an urgent tracheotomy is necessary. The dog is fixed in the dorsal position, the hair is quickly removed from the ventral surface of the anterior third of the neck, twice the skin is lubricated with a 3% alcohol solution of iodine. Through a needle inserted strictly along the midline of the ventral surface
- Injuries, foreign bodies of the esophagus, trachea and bronchus
Injuries, foreign bodies of the esophagus, trachea and
- Foreign bodies in the digestive tract
Esophagus obstruction 1. What is the most common cause of esophageal obstruction? At what level is obstruction more common? In most cases, foreign bodies (such as cartilage, fishing hooks) cause esophageal obstruction. Symptoms of obstruction can occur with stenosis and tumors of the esophagus. More often, obstruction occurs at the level of the base of the heart and lower sphincter of the esophagus. Foreign bodies in
- Alien bodies of the digestive tract
Foreign bodies of the pharynx Foreign bodies almost always enter the pharynx with food. Hasty food, lack of teeth, diseases of the masticatory apparatus, sudden cough, laughter, talking with food contributes to their ingestion. In addition, foreign bodies can enter the pharynx through the nose, as well as from the larynx and esophagus. Of particular danger are large foreign bodies. They are stuck in the larynx.
- Foreign bodies
Foreign bodies of the ear, nose, pharynx, and less commonly, the larynx, trachea, and bronchi, are more common. Foreign bodies of the ear are more common in children (paper, pencils, fruit bones), in adults - foreign bodies with sharp edges (fragments of matches) and insects. Rinsing with water is contraindicated during perforation of the tympanic membrane and complete obstruction of the lumen by a foreign body. Insects are killed before removal,
- Foreign bodies of the pharynx
Foreign bodies of the pharynx often come with food (fish and meat bones, glass fragments, pieces of wire, pieces of meat, lard). Foreign bodies can also be objects that accidentally fall into the mouth (pins, nails, buttons), dentures. Less common are living foreign bodies (leeches, roundworms). The ingestion of foreign bodies in the throat can be caused by such predisposing moments as fast food,
- ASPIRATION OF A FOREIGN BODY
Definition Foreign body aspirated into the respiratory tract. Etiology Foreign body aspirated by a child. Entry into the trachea of teeth displaced during manipulations in the upper respiratory tract. Surgical material remaining in the respiratory tract after surgery. Typical cases In children aged 7 months to 4 years: foreign body aspiration