The Principles And Practice of Surgery V.2

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Hacker") . The religion of the patient is not stated. In a general way, foreign bodies may be divided into those with rough, pointed or sharp surfaces which cause injury, and those that are smooth and cause only obstruction.
The points at which foreign bodies are arrested depends upon the size of the latter. Small pointed objects may be fixed at an}^ point of the gullet ; very large ones rarely pass the isthmus, but remain in the pharynx. However, the former may be caught in the mucosa of the l
...atter. Bodies of moderate size that pass the pharynx are most likely to be arrested at the three points of normal narrowing. By far the largest number of bodies are arrested at the thoracic aperture; those located below are usually forced downward by swallowing firm articles of diet or by the bougie. Those passing farther down are 1792 THE SURGERY OF THE ESOPHAGUS arrested at the hiatus, almost never at the cardiac opening into the stomach. When the hiatus is passed the body enters the stomach.
The symptoms of foreign hodies m the esophagus depend upon their location, the distortion they cause in the ^llet and the degree of con- sequent pressure upon neighboring organs (lar^mx and trachea) and upon whether they provoke ulceration and perforation or not.


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