however, become impacted in a perfectly
normal esophagus.

Carelessness is the cause of over 80 per cent of the foreign bodies in
the esophagus (see Bibliography, 29).

_Site of Lodgement_.--Almost all foreign bodies are arrested in the
cervical esophagus at the level of the superior aperture of the
thorax. A physiologic narrowing is present at this level, produced in
part by muscular contraction, and mainly by the crowding of the
adjacent viscera into the fixed and narrow upper thoracic aperture. If
dislodged from this position the foreign body usually passes downward
to be arrested at the next narrowing or to pass into the stomach. The
esophagoscopist who encounters the difficulty of introduction at the
cricopharyngeal fold expects to find the foreign body above the fold.
Such, however, is almost never the case. The cricopharyngeus muscle
functionates in starting the foreign body downward as if it were food;
but the narrowing at the upper thoracic aperture arrests it because
the esophageal peristaltic musculature is feeble as compared to the
powerful inferior constrictor.

_Symptoms_.--_Dysphagia_ is the most frequent complaint in cases of
esophageally lodged foreign bodies. A very small object may excite
sufficient spasm to cause aphagia, while a relatively large foreign
body may be tolerated, after a time, so that the swallowing function
may seem normal. Intermittent dysphagia suggests the tilting or
shifting of a foreign body in a valve-like fashion; but may be due to
occlusion of the by-passages by food arrested by the foreign body.
_Dyspnea_ may be present if the foreign body is large enough to
compress the trachea. _Cough_ may be excited by reflex irritation,
overflow of secretions into the larynx, or by perforation of the
posterior tracheal wall, traumatic or ulcerative, allowing leakage of
food or secretion into the trachea. (See Chapter XII for discussion of
symptomatology and diagnosis.)

_Prognosis_.--A foreign body lodged in the esophagus may prove quickly
fatal from _hemorrhage_ due to perforation of a large vessel; from
_asphyxia_ by pressure on the trachea; or from _perforation_ and
_septic mediastinitis_. Slower fatalities may result from suppuration
extending to the trachea or bronchi with consequent edema and
asphyxia. Sooner or later, if not removed, the foreign body causes
death. It may be tolerated for a long period of time, causing abscess,
cervical cellulitis, fistulous tracts, and ultimate