Esophageal injuries

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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[edit | edit source]

X-ray passage through the esophagus using a barium contrast suspension.
  • = 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 [Fever (pediatrics)|[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[edit | edit source]

  • 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[edit | edit source]

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)
  • diagnosis:
    • x-ray : either the body is directly contrasted or we examine the passage through the esophagus

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).

  • 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

Links[edit | edit source]

Related Articles[edit | edit source]

Source[edit | edit source]

References[edit | edit source]

  • KLOZAR, Jan, et al. Speciální otorinolaryngologie. 1. edition. Galén, 2005. 224 pp. ISBN 80-7262-346-X.