救急処置: 気道食道内視鏡検査事故とその対策

抄録

The author describes some personal views on accidents in bronchoscopy and esophagoscopy by classifying them largely into those occurred at the time of introduction of an endoscope, during and after the endoscopy, taking into consideration chiefly the lessons of previous investigators and the cases experienced by the author himself and others.
1. Among the accidents occurred at the time of introduction of an endoscope, injuries caused by the endoscope included damages to the upper incisors and injuries of the soft tissues along the route of introduction. These accidents may be avoided by maintaining the head of a patient in an elevated extended position and by adequate use of an endoscope.
2. With respect to the accidents occurred during the examination, various accidents were discussed by quoting some examples. The accidents classified into this category included 1) respiratory distress due to tracheal tumors, anterior mediastinal tumor and foreign bodies in the trachea; 2) profuse bleeding from a biopsy in a case with middle lobe syndrome and from esophageal varices; 3) injuries and perforations of the esophageal walls due to extraction of pointed foreign bodies or violent extraction; and 4) the accidents inflicting on the surgeon himself such as loss of sight due to injury of the eye by a foreign body, severe infection by tuberculous bacilli, which was caused by neglecting in taking adequate protective measures.
3. As to the accidents after the procedure, edema of the glottis, difficult expectoration, crust formation after extraction of foreign bodies, accidents caused by tracheal cannula, cervical subcutaneous emphysema, pneumothorax, and mediastinal emphysema. These accidents indicate the importance of adequate post-procedure observations and cares. With respect to sudden death, it is important to investigate and seek after not only the immediate cause but also the conditions which are possible to become predisposing factors.