Rupture And Trauma Of The Esophagus


Categories: DISEASES OF THE ESOPHAGUS
Sources: 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

imperative.





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