fter vomiting blood, and at the autopsy it was demonstrated that
a needle had perforated the posterior wall of the esophagus and wounded
the aorta. Poulet has collected 31 cases in which ulceration caused by
foreign bodies in the esophagus has resulted in perforation of the
walls of some of the neighboring vessels. The order of frequency was as
follows: aorta, 17; carotids, four; vena cava, two; and one case each
of perforation of the inferior thyroid artery, right coronary vein,
demi-azygos vein, the right subclavicular artery (abnormal), and the
esophageal artery. In three of the cases collected there was no autopsy
and the vessel affected was not known.

In a child of three years that had swallowed a half-penny, Atkins
reports rupture of the innominate artery. No symptoms developed, but
six weeks later, the child had an attack of ulcerative stomatitis, from
which it seemed to be recovering nicely, when suddenly it ejected two
ounces of bright red blood in clots, and became collapsed out of
proportion to the loss of blood. Under treatment, it rallied somewhat,
but soon afterward it ejected four ounces more of blood and died in a
few minutes. At the autopsy 3/4 pint of blood was found in the stomach,
and a perforation was discovered on the right side of the esophagus,
leading into a cavity, in which a blackened half-penny was found. A
probe passed along the aorta into the innominate protruded into the
same cavity about the bifurcation of the vessel.

Denonvilliers has described a perforation of the esophagus and aorta by
a five-franc piece. A preserved preparation of this case, showing the
coin in situ, is in the Musee Dupuytren. Blaxland relates the instance
of a woman of forty-five who swallowed a fish bone, was seized with
violent hematemesis, and died in eight hours. The necropsy revealed a
penetration of the aorta through the thoracic portion of the esophagus.
There is also in the Musee Dupuytren a preparation described by
Bousquet, in which the aorta and the esophagus were perforated by a
very irregular piece of bone. Mackenzie mentions an instance of death
from perforation of the aorta by a fish-bone.

In some cases penetration of the esophagus allows the further
penetration of some neighboring membrane or organ in the same manner as
the foregoing cases. Dudley mentions a case in which fatal hemorrhage
was caused by penetration of the esophagus and lung by a chicken-bone.
Buist speaks of a patient who swallo