Equis ISSN 2398-2977

Esophagus: trauma

Contributor(s): Graham Munroe, Prof Jonathon Naylor

Introduction

  • Cause: internal or external trauma; rupture due to long-standing obstructions; foreign body penetration.
  • Signs: history of neck trauma, choke, dysphagia, cervical neck swelling; clinical signs: cervical swelling, neck wounds (may drain saliva/ingesta), dysphagia, regurgitation.
  • Diagnosis: esophageal endoscopy, plain/contrast radiography.
  • Treatment: varies depending upon etiology, duration and degree of damage - includes: bypass feeding (essential) and either primary surgical repair (early cases) or drainage and secondary intention healing (more long-standing/severe cases).
  • Prognosis: varies with each case.

Pathogenesis

Etiology

  • External trauma to neck especially kicks.
  • Penetrating wounds.
  • Chronic esophageal obstruction   Esophagus: impaction  .
  • Esophageal foreign body perforation.
  • Extension of infection from peri-esophageal tissues.
  • Repeated or aggressive nasogastric tube passage   Gastrointestinal: nasogastric intubation  .

Pathophysiology

  • Perforations of the oesophagus may occur following various blunt or sharp external trauma.
  • Internal esophageal rupture may be subsequent to long-standing obstructions or foreign body penetration.
  • Esophageal perforations   →   leakage of saliva and ingesta   →   tissues of the neck   →   severe infection, subcutaneous emphysema (swallowed air) and cervical swelling (particularly if drainage is not established to the outside).
  • Systemic illness and extension of infection into the thorax (to produce pleuritis) can occur in severe cases, especially where there is no external drainage.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references fromPubMedandVetMedResource.
  • Whitfield-Cargile C M, Rakestraw P C & Hardy J (2013)Treatment of cervical oesophageal rupture in horses.Equine Vet Educ25(9), 456-460VetMedResource.
  • Hardy J, Stewart R H, Beard W L, Yvorchuk-St-Jean K (1992)Complications of nasogastric intubation in horses - nine cases (1987-1989).JAVMA201(3), 483-486PubMed.
  • Freemak D E (1989)Wounds of the oesophagus and trachea.Vet Clin North Am Equine Pract5(3), 683-693PubMed.
  • Digby N J & Burguez P N (1982)Traumatic oesophageal rupture in the horse.Equine Vet J14(2), 169-170PubMed.
  • DeMoor A, Wouters L, Mouens Y & Verschooten F (1979)Surgical treatment of a traumatic oesophageal rupture in a foal.Equine Vet J11(4), 265-266PubMed.


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