222 THE LARYNX, BRONCHI AND OESOPHAGUS
embarrass the airway, especially in children, and this is prevented by intuba-
tion; oesophagoscopy under local anaesthesia is uncomfortable for the
patient, who, should he struggle, may precipitate damage to the wall of the
oesophagus by the forceps, the oesophagoscope or the foreign body itself.
Disc-shaped objects or those with smooth edges are easily withdrawn after a
little experience. Sharp-edged objects require considerable dexterity to
disimpact them from the walls of the oesophagus and to remove them without
Fig, 112. Coin arrested in the lower part of the oesophagus.
further scratching. Large masses of unchewed meat tend to be friable and to
come away in pieces, so that the procedure is prolonged. It may be tempting to
push some of this through into the stomach, but the bolus may be held up by
an undiagnosed carcinoma or hiatus hernia with oesophagitis, and such a
manoeuvre may traumatize or perforate the oesophageal wall, and it is
therefore to be condemned.
Any scratch or tear of the oesophageal wall calls for a course of antibiotics
and for feeding by sterile fluids for 24 hours. The danger of infection spreading
through the oesophagus into the mediastinum must always be borne in mind
if the wall has been damaged by a foreign body or by attempts at its removal.
Rarely a sharp object may have perforated the wall of the oesophagus to lie
partly within and partly outside the lumen. In this case removal is best made
by an external incision and dissection to the oesophagus, when the tear may be
sutured after the object has been removed.