The first and second stages of the operation are exactly the same as those above mentioned.
The third stage consists in puncturing the walls of the œsophagus with a straight tenotome immediately behind the foreign body, as in tenotomy. A curved, button-pointed tenotome having next been introduced and passed with the blade flat between the foreign body and the mucous membrane of the œsophagus, it is turned on its axis, and attempts are made to divide the obstruction. A few moments are often sufficient to effect this, after which the substance may be further broken up by the fingers.
These various methods may lead to delayed complications, such as dilatation or contraction of the mucous membrane of the œsophagus, muscular atrophy of the œsophageal walls, œsophageal fistula, and, sometimes, abscess formation.
RUMEN.
Two operations are currently performed on the rumen, puncture and gastrotomy.
Fig. 301.—Trocar for puncture of the rumen.
PUNCTURE OF THE RUMEN.
Puncture of the rumen is essentially an urgent operation for the relief of acute and rapidly progressive tympanites. It is performed in the left flank, at an equal distance between the last rib and the angle of the haunch, and an inch or two beyond the transverse processes of the lumbar region.
First stage. Incision of the skin to the extent of about one inch (not absolutely necessary).