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Tuberculosis Of The Esophagus
Category: DISEASES OF THE ESOPHAGUS
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
Esophageal tuberculosis is not commonly met, but is probably not
infrequently associated with the dysphagia of tuberculous laryngitis.
It may rarely occur as a primary infection, but usually the esophagus
is involved in an extension from a tuberculous process in the larynx,
mediastinal lymphatics, pleura, bronchi, or lungs.
Primary lesions appear as superficial erosions or ulcerations, with a
surrounding yellowish granular zone, or the granules may alone be
present. The mucosa in tuberculous lesions is usually pallid, the
absence of vascularity being marked. Invasion from the periesophageal
organs produces more or less localized compression and fixation of the
esophagus. The character of open ulceration is modified by the mixed
infections. Healed tuberculous lesions, sometimes resulting from the
evacuation of tuberculous mediastinal lymph nodes into the esophagus
may be encountered. The local fixation and cicatricial contraction may
be the site of a traction diverticulum. Tuberculous esophago-bronchial
fistulae are occasionally seen.
Diagnosis, to be certain, requires the demonstration of the
tubercule bacilli and the characteristic cell accumulation of the
tubercle in a specimen of tissue removed from the lesion.
Actinomycosis must be excluded, and the possibility of mixed luetic
and tuberculous lesions is to be kept in mind. Post-tuberculous
cicatrices have no recognizable characteristics.
Treatment.--The maintenance of nutrition to the highest degree, and
the institution of a strict antituberculous regime are demanded. Local
applications are of no avail. Gastrostomy for feeding should be done
if dysphagia be severe, and has the advantage of putting the esophagus
at rest. The passage of a stomach-tube for feeding purposes may be
done, but it is often painful, and is dangerous in the presence of
ulceration. Pain is not marked if the lesion be limited to the
esophagus, though if it is present orthoform, anesthesin, or
apothesin, in powder form, swallowed dry, may prove helpful.
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