Treatment.—In the presence of impending suffocation, the mouth must be forced open by an extemporised gag, the finger passed into the back of the throat, and the body hooked out. If this is impossible, and if suitable forceps are not at hand, it may be necessary at once to perform laryngotomy, followed by artificial respiration, because, although the patient may appear lifeless, the heart continues to beat after breathing has ceased. The foreign body should then be removed with forceps. Sub-hyoid pharyngotomy, which consists in opening the pharynx by a mesial vertical incision carried through the hyo-thyreoid membrane, may be called for, as in the case of a denture, the hooks of which have penetrated the wall of the pharynx.
In the Œsophagus.—Smaller bodies, such as coins, bones, or pins, usually enter the œsophagus, and the great majority become impacted above the level of the manubrium sterni. Those that pass farther down are liable to stick where the tube is narrowed at the crossing of the bronchus, or at the opening through the diaphragm. In children, coins predominate and are nearly always arrested at the level of the upper end of the sternum; in adults, dentures are the commonest foreign bodies, and may be impacted anywhere.
At the moment of impaction there is pain, which assumes the character of cramp due to spasm of the muscular coat, and which is increased on attempting to swallow, and violent retching and coughing are set up; in many cases, as when bodies are impacted in the pharynx, respiratory distress is again the predominant feature. If the passage is completely obstructed, food and saliva—sometimes blood-stained—are regurgitated with retching soon after being swallowed. When the obstruction is incomplete, fluids may pass into the stomach while solids are regurgitated.
If the mucous membrane is injured, there is severe stabbing pain and choking attacks, both due to spasm, sometimes even after the body has passed on, and the pain is not always referred to the seat of the injury.
The diagnosis is made by the history, and by the use of the fluorescent screen, or X-ray photographs ([Figs. 283], [284]). The œsophagoscope is also of great value, both for diagnostic purposes and as an aid in the removal of the impacted body. Bougies are to be employed with great care, as there is a danger of pushing the foreign body farther down, or of wedging it more firmly in the œsophagus, and the information obtained is often misleading.
Fig. 283.—Radiogram of Safety-pin impacted in the Gullet and perforating the Larynx.
(Professor Annandale's case. Radiogram by Dr. Dawson Turner.)
