Foreign Bodies Which I Have Not Removed

Abstract

The interest in endoscopic procedures is today greater than ever before. The results, particularly in the removal of foreign bodies from the food passages and airways, have been so spectacular that there is scarcely a well organized nose and throat clinic that has not accumulated a collection of weird and common objects of assorted sizes and shapes, which have been removed from these passages.Recently there appeared a review of nearly 1,000 cases in which foreign bodies had been removed, with a mortality of only 1.68 per cent. This is indeed a tribute to the science of endoscopy and to the knowledge and skill of the individual operators.In endoscopy, as in all successful therapeutics, there is always the danger of overenthusiasm. Thinking that a counterweight may not be amiss, I am reporting these somewhat unusual cases.REPORT OF CASES CASE 1.\p=m-\Awhite man accidentally swallowed some loosened upper dental bridgework. On two successive days, with the patient under anesthesia induced with avertin with amylene hydrate, esophagoscopic examination was performed, but the foreign body was not seen by the operator.On the third day following the accident I was called to see the patient. At the hospital I was told that he had swallowed a loosened upper denture as he was taking a tablet. The roentgenogram showed a shadow which was unlike that of any denture I had ever seen ( fig. 1 A) but which could possibly be that of an orthodontic appliance. It seemed to be a little too far to the left to be in the esophagus unless it were in a diverticulum. I passed the esophagoscope down to the cardia, and, having made sure that there was no foreign body in the esophagus, I withdrew the instrument. As the patient was perfectly conscious, I showed him the roentgenogram and asked if the foreign substance in any way resembled the denture he had lost."Is that what you doctors are looking for?" he cried in amazement. "Why, that's the wiring on a collar bone and rib I broke ten years ago." New roentgenograms were made of his chest and abdomen. The denture and loosened clasp were seen lodged in the lower part of the intestinal tract ( fig. 1 B). The next day these were passed per rectum.Comment.\p=m-\This case illustrates the importance, so frequently emphasized by Chevalier Jackson, of taking roentgenograms to include the entire neck, chest and abdomen. Had this been done in the first place, both the denture and the wired clavicle would have been seen and the operator would have been led to elicit the history more accurately. The case also demonstrates the advantage of doing endoscopic work with topical anesthesia, so that if necessary the patient may be questioned.