with Dr. Eugenia Butori
The esophagus is surrounded by vital structures, which means that, even if rare, esophageal injuries are potentially lethal clinical situations. Delay in providing appropriate treatment is the main risk for mortality.
The main esophageal emergencies are associated with foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma.
Foreign body ingestion.
In case of impaction the patient will present with acute onset of dysphagia or inability to swallow saliva. X-Ray only shows radiopaque objects, so a CT scan is recommended if complications are suspected. Flexible endoscopy, in addition to being a potentially therapeutic procedure allowing the extraction of objects, is used for the diagnosis of underlying diseases.
In cases of complications, surgery should be performed. If feasible, esophagotomy, extraction, and primary closure should be carried out.
Corrosive ingestion may be potentially lethal. It will frequently be associated with airway burns and metabolic systemic effects.
X-Ray may show indirect perforation signs.
The CT will detect transmural necrosis. If CT is unavailable, endoscopy can be performed, taking into account its inability to detect transmural necrosis.
If esophageal necrosis presents, emergency surgery is indicated.
Esophageal perforation. 60% are iatrogenic and 15% are spontaneous. The contamination of surrounding spaces with digestive contents may lead to severe sepsis and death. The main predictors for survival are accurate and fast diagnosis and treatment.
Chest x-ray will show indirect signs of perforation. The exam of choice is a contrast-enhanced CT. If the CT yields dubious results, an endoscopy may be performed, taking on the potential risk of increasing the size of the perforations and aggravating contamination.
Endoscopic treatment is the gold standard for these injuries.
Non-operative management can be considered in stable patients with contained perforations. Otherwise, patients should undergo surgery ASAP.
Esophageal trauma:15% of esophageal injuries. It may be associated with other lesions that worsen the prognosis.
Diagnosis requires a high level of suspicion and usually performing a contrast-enhanced CT, CT esophagography and/or endoscopy.
Non-operative management is possible in the same conditions of esophageal perforations. Immediate surgery is indicated in the event of hemodynamic instability, perforation and sepsis
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