THE THROAT AND NECK 143 



may be passed gently up and down the oesophagus for a few 

 times. Probangs are made of different sizes, and especial 

 care must be taken to use a sufficiently small one, as other- 

 wise the oesophagus is apt to become injured when violent 

 pressure is put upon it. In inserting it, too, there is 

 occasionally difficulty in guiding it past the larynx. 



CEsophag-otomy. 



When a foreign body becomes so firmly lodged in the 

 oesophagus that it cannot be moved by forceps or probang, 

 the oesophagus must be incised. If this is not done, ulceration 

 and rupture may take place, or the foreign body may cause 

 dilatation and form a pouch for itself, the result usually 

 being great pain, emaciation, and ultimately death. The 

 most common seats at which obstructions occur are just 

 before the gullet passes into the' thorax, and in the thoracic 

 portion just before the oesophagus passes through the 

 diaphragm. In the latter case it is sometimes necessary to 

 perform gastrotomy (see p. 177), and, by the aid of a pair 

 of thin forceps passed through the cardiac orifice of the 

 stomach, to reach the foreign bod^• from behind. 



'b' 



In one case the author removed the foreign body (a large, irregularly- 

 shaped piece of gristle which could not be reached from above) from a 

 fox-terrier bitch, seven months old, which had been in great pain for some 

 days, and was very thin and weak. The probang could distinctly locate 

 the obstruction, and, as the latter could not be felt at all by digital 

 examination of the outside of the neck or chest, it was plain that whatever 

 was there was fixed in the thorax between the first two ribs (through which 

 it had passed) and the foramen sinistrum of the diaphragm, through which 

 it could not pass. 



Unluckily, considerable ulceration had already taken place, and whilst 

 withdrawing the piece of gristle, rupture of the aorta took place. Death 

 speedily ensued, 2, post-mortem examination revealing intense inflamma- 

 tion and extens ve ulceration of the oesophagus for fully an inch above the 

 cardiac orifice. (^Journal of Comparative Pathology and Tl'ierapeiittcs, 

 vol. xii., p. 262.) 



In the case illustrated by Fig. 1 14, and reported by Mr. H. G. Simpson 



