Esophageal injuries

Esophageal injuries occur most often per vias naturales from the lumina, but also as part of neck tissue injuries

According to the mechanism, we divide esophagus injuries into:
 * chemical (etch)
 * thermal (scalding)
 *  mechanical

According to the degree of damage, we divide esophageal injuries into:
 * penetrating
 * non-penetrating

Esophageal cauterization

 * = oesophagitis corrosiva
 * they most often occur in households by ingesting cleaning, hygiene or disinfectant products
 * often in children and adults, as a result of  confusion  or  suicidal intent 
 * the extent of damage depends on the amount and concentration of the ingested substance
 * types:
 * after ingestion of acid – formation of coagulation necrosis
 * after ingestion of lye – colliculating necrosis, more poorly defined
 * symptoms:
 * severe shocking pain occurs immediately after ingestion
 * development of dysphagia and odynophagia 
 * with swelling of the aditus laryngis – suffocation and stridor


 * there is a risk of  mediastinitis  in case of perforation of the esophagus - suspicion of perforation of the esophagus is appropriate if there is a sudden rise in temperature, shivering, pain between the shoulder blades or under the sternum , or if subcutaneous emphysema develops on the neck
 * substances can also have an overall effect in the sense of  alkalosis or acidosis  (alkalosis is rarer, the alkali is usually neutralized by HCl in the stomach)
 * examination:
 * we notice signs of cauterization in the throat and in the oral cavity
 * an X-ray of the act of swallowing and a rigid esophagoscopy are commonly performed
 * we introduce a nasogastric tube during perforation
 * First aid:
 * dilution of the harmful substance - rinsing the mouth, drinking water or milk (do not drink lye after swallowing acid!)
 * do not induce vomiting, further damage to the esophagus would occur
 * anti-shock measures and transport to the ENT department
 * there is a risk of stenoses - we administer corticoids (the effect on stenoses has not been directly confirmed)
 * pain relief and coverage with broad-spectrum antibiotics
 * mediastinitis: external surgical revision
 * indoor environment monitoring

Scalding

 * most often in children
 * damage usually does not reach the extent of etch damage
 * symptoms:
 * dysphagia, odynophagia
 * swelling of the laryngeal entrance (inspiratory dyspnea, stridor)
 * there is hyperemia and swelling of the mucous membrane in the pharynx (rarely even necrosis)
 * first aid:
 * ingestion of cold liquids or sucking on ice cubes
 * analgetics, ATB, rarely corticoids

Mechanical injury, foreign bodies

 * Mechanical injuries
 * most often when  accidentally falling  with open mouth on foreign bodies (toothbrush, cutlery, branch, etc.), or  iatrogenically  during endoscopy or swallowing sharp objects
 * Foreign bodies
 * they are common in the swallowing tract


 * in children – toy parts, buttons
 * in adults – seeds, bones
 * in the elderly – dental prostheses
 * in psychiatric patients – often various artificially created bodies modified to make extraction difficult (so-called anchors)
 * symptoms:
 * mechanical damage: bleeding, dysphagia, odynophagia, swelling
 * in case of perforation: emphysema, parapharyngeal or retropharyngeal  abscess  or mediastinitis
 * in the case of a foreign body, it depends on its location and current injury
 *  as a rule ,  dysphagia or aphagia  occurs
 *  small foreign bodies  (fish bones) often get stuck already in the pharynx – in the tonsils, at the base of the tongue, etc.
 *  larger bodies  are most often stuck in the upper esophageal opening (they are not visible during a laryngoscopy examination - we only find saliva stagnation in the piriform recesses)

if the fluid flows freely across and around the body, let the patient swallow a cotton swab soaked in  contrast  → the contrast material must be absorbable from the mediastinum (not barium).
 * diagnosis:
 *  x-ray  : either the body is directly contrasted or we examine the passage through the esophagus
 * therapy:
 * minor mechanical injuries - conservative therapy:
 * we disinfect locally, or administer ATB
 * we prescribe corticoids for laryngeal edema, and analgesics for pain
 * for larger lacerations, we perform a suture
 * foreign bodies in the oropharynx are directly removed under local anesthesia
 * in the hypopharynx using direct laryngoscopy
 * in the esophagus using rigid esophagoscopy under general anesthesia
 * we perform the removal as soon as possible so that pressure necrosis does not occur

Related Articles

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 * Tumors of the esophagus
 * Esophageal disease