Oesophagus

Oesophagus (Gr. of a w =I will carry, and (Payeiv, to eat), in anatomy, the gullet; see Alimentary Canal for comparative anatomy. The human oesophagus is peculiarly liable to certain accidents and diseases, due both to its function as a tube to carry food to the stomach and to its anatomical situation (see generally Digestive Organs). One of the commonest accidents is the lodgment of foreign bodies in some part of the tube. The situations in which they are arrested vary with the nature of the body, whether it be a coin, fishbone, toothplate or a portion of food. An impacted substance may be removed by the oesophageal forceps, or by a coin-catcher; if it should be impossible to draw it up it may be pushed down into the stomach. When it is in the stomach a purgative should never be given, but soft food such as porridge. Should gastric symptoms develop it may have to be removed by the operation of gastrotomy. Charring and ulceration of the oesophagus may occur from the swallowing of corrosive liquids, strong acids or alkalis, or even of boiling water. Stricture of the oesophagus is a closing of the tube so that neither solids nor liquids are able to pass down into the stomach. There are three varieties of stricture; spasmodic, fibrous and malignant. Spasmodic stricture usually occurs in young hysterical women; difficulty in swallowing is complained of, and a bougie may not be able to be passed, but under an anaesthetic will slip down quite easily. Fibrous stricture is usually situated near the commencement of the oesophagus, generally just behind the cricoid cartilage, and usually results from swallowing corrosive fluids, but may also result from the healing of a syphilitic ulcer. Occasionally it is congenital. The ordinary, treatment is repeated dilatation by bougies. Occasionally division of a fibrous stricture has been practised, or a Symond's tube inserted. Mikulicz recommends dilatation of the stricture by the fingers from inside after an incision into the stomach or a permanent gastric fistula may have to be made. Malignant strictures are usually epitheliomatous in structure, and may be situated in any part of the oesophagus. They nearly always occur in males between the ages of 40 and 70 years. An X-ray photograph taken after the patient has swallowed a preparation of bismuth will show the situation of the growth, and Killian and Brunig have introduced an instrument called the oesophagoscope, which makes direct examination possible. The remedy of constant dilatation by bougies must not be attempted here, the walls of the oesophagus being so softened by disease and ulceration that severe haemorrhage or perforation of the walls of the tube might take place. The patient should be fed with purely liquid and concentrated nourishment in order to give the oesophagus as much rest as possible, or if the stricture be too tight rectal feeding may be necessary. Symond's method of tubage is well borne by some patients, the tube having attached to it a long string which is secured to the cheek or ear. The most satisfactory treatment, however, is the operation of gastrotomy, a permanent artificial opening being made into the stomach through which the patient can be fed.