Stricture And Carcinoma Of The Esophagus

In diseases of the oesophagus which render swallowing difficult all food must be given in semisolid or fluid form. Many vegetable substances can be made into purees, which can be strengthened by meat extracts, peptonoids, or beef meal. Milk, in its various forms, is always soothing, and it may be the only food which the patient can take.

Richardson states that in oesophageal stricture cold food relaxes the circular fibres of the oesophagus and dilates its lumen, whereas hot food has an opposite effect. In some hysterical patients this may prove true, but in most cases of genuine stricture or occlusion the temperature of the ingested food makes but little difference. When the occlusion or the difficulty or pain in deglutition becomes so great that the patient suffers from inanition - as, for example, after corrosive poisons have been swallowed - he must be fed by nutrient enemata. Should the trouble not be overcome, a gastric fistula must be made, and the patient is to be fed by this means.

Feeding Through A Gastric Fistula

When a gastric fistula is made the wound may be left open with a drainage tube, or, what is better, a permanent hard-rubber or metallic tube is inserted, having a double flange, like a spool. The tube is nickel-plated to prevent erosion by the acid gastric juice. The lumen may be a third of an inch in diameter, and when not in use it is kept closed by a cork. When the patient is to be fed he must lie upon his back. The cork is removed, the tube cleansed with a syringeful of warm water, and through a glass funnel, to which is attached an inch or two of rubber tubing, fluid food and water is poured directly through the fistulous opening into the stomach. If desirable, lavage may be performed in a similar manner. Any kind of food may be given which the patient is able to digest. Even small pieces of chopped meat can be pushed into the stomach with a glass rod or forceps. Medicines are conveniently given through the same opening. When the fistula has been made for other cause than, malignant disease the tube may be worn indefinitely with no other inconvenience than that attending the peculiar process of feeding.

I have seen several patients who have worn such tubes for several years, and who go about like other men, excepting that they take their meals in private and feed themselves while lying on the back. One of these patients, who was operated upon in Bellevue Hospital by F. S. Dennis for a benign stricture of the pylorus following typhoid fever, first masticates his food, then expectorates it and pushes it into the tube with a glass rod. He maintains robust health.