730 DIGESTIVE Al'PAUATITS. 



the opposite side with a Kttle wooden mallet. Whatever precautions 

 may be taken, however, this method cannot be recommended. 



The same remark applies to the use of forceps, the jaws of which 

 are so fashioned as to escape pressing on the trachea whilst they grasp 

 directl}^ the foreign body through the walls of the crsophagus. 



CESOPHAGOTOMY. 



(Esophagotomy, or incision of the oesophagus, is an operation which, 

 though sometimes necessary, should only be regarded as a last resort 

 after all other methods have failed. Unfortunately it can be per- 

 formed only in the region of the neck, and even then the most 

 favourable point (viz., the lower third of the jugular furrow) cannot 

 always be selected, the operation having to be performed directly 

 over the foreign body. 



The animal may be either standing or lying down. The seat of 

 operation should be thoroughly cleansed and disinfected. 



First stage. Incision through the skin and subcutaneous connective 

 tissue above the level of the jugular vein and opposite the foreign body. 



Second stage. Isolation of the cesophagus by dissection and tear- 

 ing through of the connective and fibro-aponeurotic tissue at the base 

 of the jugular furrow. 



Third stage. Incision through the oesophagus for a distance just 

 sufficient to enable the foreign body to be extracted. 



Fourth stage. Suturing of the mucous membrane, suturing of 

 the muscular walls of the oesophagus, suturing of the skin, precautions 

 being taken to allow of drainage at the lower part of the operative 

 wound. 



SUB-MUCOUS DISSECTION OF THE FOKEIGN BODY. 



As oesophagotomy, despite every precaution, often leads to fistula 

 formation, Nocard has recommended sub-mucous dissection of the 

 obstructive body, such body being usually semi-solid. This method 

 has considerable advantages. 



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 oesophagus 

 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 meml)rane of the oesophagus, 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. 



