he cervical esophagus and, moreover, it has happened that after
the esophagus has been opened, the foreign body could not be found
because of dislodgement and passage downward during the relaxation of
the general anesthesia. Should this occur during esophagoscopy, the
foreign body can be followed with the esophagoscope, and even if it is
not overtaken and removed, no risk has been incurred.

Esophagoscopy is the one method of removal worthy of serious
consideration. Should it repeatedly fail in the hands of two skillful
endoscopists, which will be very rarely, if ever, then external
operation is to be considered in cervically lodged foreign bodies.

[187] CHAPTER XIX--ESOPHAGOSCOPY FOR FOREIGN BODY

_Indications_.--Esophagoscopy is demanded in every case in which a
foreign body is known to be, or suspected of being, in the esophagus.

_Contraindications_.--There is no absolute contraindication to careful
esophagoscopy for the removal of foreign bodies, even in the presence
of aneurism, serious cardiovascular disease, hypertension or the like,
although these conditions would render the procedure inadvisable.
Should the patient be in bad condition from previous ill-advised or
blind attempts at extraction, endoscopy should be delayed until the
traumatic esophagitis has subsided and the general state improved. It
is rarely the foreign body itself which is producing these symptoms,
and the removal of the object will not cause their immediate
subsidence; while the passage of the tube through the lacerated,
infected, and inflamed esophagus might further harm the patient.
Moreover, the foreign body will be difficult to find and to remove
from the edematous and bleeding folds, and the risk of following a
false passage into the mediastinum or overriding the foreign body is
great. Water starvation should be relieved by means of proctoclysis
and hypodermoclysis before endoscopy is done. The esophagitis is best
treated by placing dry on the tongue at four-hour intervals the
following powder:
Rx. Anesthesin...gramme 0.12
Bismuth subnitrate...gramme 0.6
Calomel, gramme 0.006 to 0.003 may be added to each powder for a few
doses to increase the antiseptic effect. If the patient can swallow
liquids it is best to wait one week from the time of the last attempt
at removal before any endoscopy for extraction be done. This will give
time for nature to repair the damage and render the removal of the
object more certain and