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Rupture And Trauma Of The Esophagus
Category: DISEASES OF THE ESOPHAGUS
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
These may be spontaneous or may ensue from the passage of an
instrument, or foreign body, or of both combined, as exemplified in
the blind attempts to remove a foreign body or to push it downwards.
Digestion of the esophagus and perforation may result from the
stagnation of regurgitated gastric juice therein. This condition
sometimes occurs in profound toxic and debilitated states. Rupture of
the thoracic esophagus produces profound shock, fever, mediastinal
emphysema, and rapid sinking. Pneumothorax and empyema follow
perforation into the pleural cavity. Rupture of the cervical esophagus
is usually followed by cervical emphysema and cervical abscess, both
of which often burrow into the mediastinum along the fascial layers of
the neck. Lesser degrees of trauma produce esophagitis usually
accompanied by fever and painful and difficult swallowing.
The treatment of traumatic esophagitis consists in rest in bed,
sterile liquid food, and the administration of bismuth subnitrate
(about one gramme in an adult), dry on the tongue every 4 hours.
Rupture of the esophagus requires immediate gastrostomy to put the
esophagus at rest and supply necessary alimentation. Thoracotomy for
drainage is required when the pleural cavity has been involved, not
only for pleural secretions, but for the constant and copious
esophageal leakage. It is not ordinarily realized how much normal
salivary drainage passes down the esophagus. The customary treatment
of shock is to be applied. No attempt should be made to remove a
foreign body until the traumatic lesions have healed. This may require
a number of weeks. Decision as to when to remove the intruder is
determined by esophagoscopic inspection.
Subcutaneous emphysema does not require puncture unless gaseous, or
unless pus forms. In the latter event free external drainage becomes
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