7. Esophageal injuries

Question 1

Esophageal perforation - etiology

Answer 1

• Iatrogenic due to upper endoscopy
• Foreign body
• Trauma
• Malignancy
• Boerhaave syndrome

Question 2

Boerhaave syndrome

Answer 2

• Intake of large amount of alcohol, repeated episodes of vomiting and prolong coughing
• severe vomiting and increased intraabdominal pressure leading to transmural rupture of esophageal wall, mostly in distal part of esophagus

Question 3

Esophageal perforation - cervical symptoms

Answer 3

pain, dysphagia, dysphonia

Question 4

Esophageal perforation - thoracic symptoms

Answer 4

retrosternal pain radiates to back, Hamman sign (abnormal sound in chest from heart beating against air filled mediastinum)

within hours -> odynophagia, dyspnea, fever, tachypnea, tachycardia, sepsis

Question 5

Esophageal perforation - abdominal symptoms

Answer 5

epigastric pain and abdominal defense

Question 6

Esophageal perforation - diagnosis

Answer 6

1. Chest x-ray
   - air filled mediastinum
2. Contrast esophography (NOT BARIUM SWALLOW - irritable to mediastinum!)
3. CT (if inconclusive)
4. Endoscopy for diagnosis and therapy

Question 7

Esophageal perforation - management

Answer 7

• Initial: fluid, electrolytes, AB
• Surgical: primary suture, resection with delay reconstruction
• Non- surgical: SEMS implantation (self expanding medical stent)

Question 8

Mallory Weiss syndrome

Answer 8

bleeding from a laceration in the mucosa at the junction of the stomach and esophagus

due to severe vomiting, usually from alcohol intake

Diagnosed by endoscopy

Supportive treatment, persistent bleeding uncommon