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[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]

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.