Esophageal rupture or perforation Perforation A pathological hole in an organ, blood vessel or other soft part of the body, occurring in the absence of external force. Esophagitis is a transmural defect that occurs in the esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus: Anatomy, exposing the mediastinum Mediastinum The mediastinum is the thoracic area between the 2 pleural cavities. The mediastinum contains vital structures of the circulatory, respiratory, digestive, and nervous systems including the heart and esophagus, and major thoracic vessels. Mediastinum and Great Vessels: Anatomy to GI content. The most common cause of esophageal perforation Perforation A pathological hole in an organ, blood vessel or other soft part of the body, occurring in the absence of external force. Esophagitis is iatrogenic Iatrogenic Any adverse condition in a patient occurring as the result of treatment by a physician, surgeon, or other health professional, especially infections acquired by a patient during the course of treatment. Anterior Cord Syndrome trauma by instrumentation or surgical procedures. Perforation Perforation A pathological hole in an organ, blood vessel or other soft part of the body, occurring in the absence of external force. Esophagitis can also be due to foreign body Foreign Body Foreign Body Aspiration ingestion or non- iatrogenic Iatrogenic Any adverse condition in a patient occurring as the result of treatment by a physician, surgeon, or other health professional, especially infections acquired by a patient during the course of treatment. Anterior Cord Syndrome trauma produced by severe vomiting Vomiting The forcible expulsion of the contents of the stomach through the mouth. Hypokalemia. Esophageal perforation Perforation A pathological hole in an organ, blood vessel or other soft part of the body, occurring in the absence of external force. Esophagitis presents with substernal chest pain Chest Pain Chest pain is one of the most common and challenging complaints that may present in an inpatient and outpatient setting. The differential diagnosis of chest pain is large and includes cardiac, gastrointestinal, pulmonary, musculoskeletal, and psychiatric etiologies. Chest Pain that can have a sudden or insidious onset. Diagnosis can be achieved through a CT scan of the chest and neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess, chest X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests, or esophagogram. Management commonly includes surgical repair of the transmural esophageal defect. However, conservative therapy may also be considered for a hemodynamically stable patient with a minor defect. The main complication of esophageal perforation Perforation A pathological hole in an organ, blood vessel or other soft part of the body, occurring in the absence of external force. Esophagitis is acute mediastinitis Acute Mediastinitis Mediastinitis. The mortality Mortality All deaths reported in a given population. Measures of Health Status rate can range from 10%–50%.
Last updated: 15 Apr, 2021
Esophageal perforation Perforation A pathological hole in an organ, blood vessel or other soft part of the body, occurring in the absence of external force. Esophagitis, also called esophageal rupture, is a transmural defect of the esophageal wall that exposes the mediastinum Mediastinum The mediastinum is the thoracic area between the 2 pleural cavities. The mediastinum contains vital structures of the circulatory, respiratory, digestive, and nervous systems including the heart and esophagus, and major thoracic vessels. Mediastinum and Great Vessels: Anatomy to GI content.
The pathogenesis of esophageal perforation Perforation A pathological hole in an organ, blood vessel or other soft part of the body, occurring in the absence of external force. Esophagitis depends on the cause.
Candida Candida Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis esophagitis Esophagitis Esophagitis is the inflammation or irritation of the esophagus. The major types of esophagitis are medication-induced, infectious, eosinophilic, corrosive, and acid reflux. Patients typically present with odynophagia, dysphagia, and retrosternal chest pain. Esophagitis showing white-yellow plaques
Image: “Esophagogastroduodenoscopy” by Department of Medicine (C- HH HH Hereditary hemochromatosis (HH) is an autosomal recessive disorder most often associated with hfe gene mutations. Patients have increased iron intestinal absorption and iron deposition in several organs, such as the liver, heart, skin, and pancreas. The clinical presentation includes the triad of cirrhosis, diabetes, and skin bronzing. Hereditary Hemochromatosis), and Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. License: CC BY 4.0History:
Manifestations:
Exam findings:
Posteroanterior chest X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests showing pneumomediastinum Pneumomediastinum Mediastinitis (black arrows) due to esophageal rupture
Image: “Chest X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source. Pulmonary Function Tests displaying pneumomediastinum Pneumomediastinum Mediastinitis” by Faculty of Medicine, University of Toronto, Toronto, ON, Canada. License: CC BY 4.0Gastrografin Gastrografin Computed Tomography (CT) esophagography showing distal esophageal rupture with contrast leak (green circle)
Image: “Intubated patient showing esophageal rupture” by Rockyview General Hospital, Alberta Health Services, 7007-14th Street SW, Calgary, AB, T2P 1P9, Canada. License: CC BY 2.0Chest CT scan showing distal rupture of the esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus: Anatomy (white arrow) with contrast leak (black arrow) and pneumomediastinum Pneumomediastinum Mediastinitis (asterisk)
Image: “ Chest computed tomography Chest Computed Tomography Hemothorax” by Faculty of Medicine, University of Toronto, Toronto, ON, Canada. License: CC BY 4.0Initial approach:
Obtain surgical (including cardiothoracic) consult, as even stable patients Stable Patients Blunt Chest Trauma can deteriorate and require surgery.
Further intervention determined by:
Indications:
Procedure:
Esophageal
perforation
Perforation
A pathological hole in an organ, blood vessel or other soft part of the body, occurring in the absence of external force.
Esophagitis by
foreign body
Foreign Body
Foreign Body Aspiration (dental prosthesis):
A: esophagotomy
B: removal of dental prosthesis
C and D: suture of the esophageal wall and mediastinal
pleura
Pleura
The pleura is a serous membrane that lines the walls of the thoracic cavity and the surface of the lungs. This structure of mesodermal origin covers both lungs, the mediastinum, the thoracic surface of the diaphragm, and the inner part of the thoracic cage. The pleura is divided into a visceral pleura and parietal pleura.
Pleura: Anatomy