Clinical Notes;

MEDICAL, SURGICAL, OBSTETRICAL, AND THERAPEUTICAL.
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CASE OF DEFICIENT OESOPHAGUS
BY CHARLES STEELE, M.D., F.R.C.S. 1888

The following case appears to me to be of interest from both a surgical and an anatomical point of view.
I was lately asked to see in consultation an infant twenty-four hours old, who, shortly after being given nourishment, a little of which was taken readily, became very livid, had difficulty in breathing, and then returned the food and appeared to be worse. The gentleman in attendance wisely introduced a sound, and found that it passed about five inches and encountered an impassable obstruction. He then asked me to see the child, and I repeated the sounding with the same conclusion. We diagnosed that there was either a membrane across the oesophagus, or that it ended in blind terminations; and I advised that through the night enemata of dessertspoonfuls of peptonised milk should be given every two hours, and that by daylight the stomach should be opened and the oesophagus explored; if a membrane could be made out across a continuous canal, that it should be perforated in order to give a hope of life; and that, if we found any distance existed between the extremities, we could do no more; the parents however, might feel that every possible endeavor had been made to save their child's life. This was agreed upon, and the father willingly acceded. On the following afternoon I was asked to perform the operation. The infant took chloroform well. I opened the abdomen above the umbilicus in the middle line, exposed the stomach, and stitched it at four points to the skin, having some difficulty to keep the liver from protruding. The stomach was then opened which was perfectly healthy, and of course empty. A bougie was passed down the oesophagus as before, and another upwards from the stomach for a short distance; but they did ot approach each other by what we judged to be an inch and a half. I then cut a gum-elastic catheter in half, and passed it from below, introduced up it a long slender steel probe, and pressed it upwards as much as was justifiable, in case the part of the tube might be twisted or narrowed, and capable of being rendered pervious. All was to no avail, however; so the stomach wound was closed with sutures, also the abdominal wound and we felt sure that the oesophagus was deficient for about an inch and a half. The infant slept for some time, and died twenty-four hours afterwards. The next afternoon we made an examination, and found that the oesophagus terminated above and below in a blind rounded ends an inch and a half apart, and there was no chord or connection between the parts. All the wounded portions were quite healthy, and the appearances led to the conclusion that had there been only a membranous occlusion a happy result might well have been hoped for.