Tuberculosis Of The Esophagus

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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