ISSN 2398-2969      

Esophagus: perforation

icanis

Introduction

  • Very rare (esophageal mucosa is tough).
  • Cause:
    • Chemical burns.
    • Acid reflux - gastrinoma.
    • Ingestion of sharp foreign bodies, eg needle.
    • Chronic neglected foreign body obstruction (most common).
    • Iatrogenic tears during esophagoscopy (very rare).
    • Bite wounds to cervical region.
    • Intubation of esophagus.
  • Diagnosis: radiography, esophagoscopy.
  • Signs: pain, anorexia, peri-esophageal swelling, crepitation, cervical drainage and abscess development/thoracic mediastinitis, pleurisy, cough, dyspnea, pyrexia.
  • Intra-thoracic perforation much more serious than cervical perforation - very high mortality rate.
  • Treatment: depends on severity and site of lesion: conservative management, primary repair, patch graft, colonic or jejunal transplants, esophageal resection.
  • Prognosis: depends on severity and site of lesion and type of surgical repair needed.

Pathogenesis

Etiology

Specific

  • Esophagoscopy in patients with chronic foreign bodies carries risk of perforation of esophagus if it has suffered pressure or ischemic necrosis.
  • Dilation of strictures.

Pathophysiology

Cervical perforation

  • May cause:
    • Peri-esophageal swelling.
    • Crepitation.
    • Cervical drainage.
    • Infection.
    • Abscess development.

 Thoracic perforation

  • More serious.
  • Mediastinitis results.
  • Mediastinal abscessation or empyema and pleurisy may result if contamination spreads beyond mediastinum.
  • Even when detected at an early stage - very high mortality.

Timecourse

  • Acute signs and rapid death if untreated.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Willard M D, Delles E K & Fossum T W (1994) Iatrogenic tears associated with ballooning of esophageal strictures. JAAHA 30 (5), 431-435 VetMedResource.
  • Flanders J A (1989) Problems and complications associated with esophageal surgery. Prob Vet Med 1 (2), 183-194 PubMed.
  • Kuzma A B, Holmberg D L, Miller C W, Barker I & Roth J (1989) Esophageal replacement in a dog by microvascular colon transfer. Vet Surg 18 (6), 439-445 PubMed.
  • Parker et al (1989) Diagnosis and surgical management of esophageal perforation. JAAHA 25 (5), 587-594 VetMedResource.

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