The localization of diseased action in the oesophagus / by Harrison Allen.

  • Harrison Allen
Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: The localization of diseased action in the oesophagus / by Harrison Allen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    The anatomical relations of the oesoph- agus are more varied than those of any portion of the alimentary canal of similar length. Usually ten inches long, one to one and a half inches of this dis- tance lie within the neck, seven inches within the thorax, and one and a half to two inches below the diaphragm. In a state of rest it is slightly flattened as w^ell as contracted, and its mucous membrane is thrown into longitudinal folds, so that its transverse section exhibits a stellated oval. It is slightly narrowed in passing through the diaphragm, and at the beginning of the thoracic portion. Sappey compares the canal to two elongated cones whose apices join at the last-mentioned constriction. The cesophagus describes three curves : one antero-posterior, which answers to the curvature of the vertebral column, and two lateral. The first lateral curve lies a little to the left of the median line, and terminates just below the origin of the left bronchus. The second lateral curve extends from the last-mentioned point to the diaphragm. These curves might with propriety be named the tracheal and the curves, since the first lies behind the trachea, and the second to the left of the descending aorta. The relations of the tracheal portion of the oesophagus are as follows. The canal lies behind the trachea, with a slight inclination to the left. The ])leura is in contact with it on either side. 'The left subclavian artery lies to the left. It is crossed by the left bronchus, and lies behind the pericardium where that mem- brane covers the left auricle. 'Fhe aortic l)ortion of the oesophagus at first lies a little to the right of the aorta, but soon crosses in front and to the left of that ves- sel. To the right and behind lies the azygos vein. Parallel with it pass the jmeumogastric nerves, the left going in front and the right behind. The thoracic duct ascends from right to left posteriorly, while still further in the same direction are the right intercostal arteries and the ver- tebral column. Several lymphatic glands lie on either side of the canal as well as behind it. Instances are on record of hemorrhages into the oesophagus from the superior vena cava, ascending portion of the aorta, the innominate and right subclavian arteries. The heart has also been wounded by a penetrating foreign body lodged in the oesophagus. These structures might be added to the normal relations under the name of indirect or possible clinical re- lations. If the oesophagus possessed much elastic tissue, causing it to maintain the tubular form, the points most likely to be ob- structed in disease or from foreign bodies would be those answering to its narrowest parts, namely, at the beginning of the tho- racic segment and the cardiac extremity. Writers have generally assigned the upper and lower portions of the canal as the most frequent sites for the lodgment of foreign bodies and the occurrence of disease. The oesophagus, however, is not tubular in form ; its walls when at rest are in con- tact, and indifferently resist the tendency to stricture or occlusion of the canal under moderate degrees of extrinsic pressure. The study of the literature of obstruc- tion arising from w'hatever cause has led me to believe that the oesophagus is more often obstructed at the cricoid cartilage, and at the region where the left bron- chus crosses the oesophagus, than at any other place. The first of these localities, it is well known, is frequently the point' of lodgment of a foreign body or the seat of carcinoma. The fact that the tracheal curve or the point crossed by the left bronchus is a locality of great pathological interest has been in great measure over- looked. Systematic writers omit any men- tion of the latter structure as a factor in oesophageal troubles. Thus, Bryant, in his “Practice of Surgery,” says that “ for- 3