Esophageal Perforation Flashcards

1
Q

Why is intrathoracic esophageal perforation so lethal?

A

Leakage of gastric contents into mediastinum, leading to chemical burns, tissue destruction and sepsis.

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2
Q

How does a cervical esophageal perforation typically present?

A

Neck tenderness, odynophagia, and subcutaneous emphysema.

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3
Q

How does an intrathoracic esophageal perforation typically present?

A

Dysphagia, pain, tachycardia and fever

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4
Q

Name the major causes of esophageal perforations.

A

Iatrogenic (endoscopy/surgery), trauma (penetrating/blunt injury, foreign body, caustic ingestion), malignancy, inflammation, and infection.

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5
Q

Spontaneous perforation (not iatrogenic) is usually associated with what?

A

Emesis

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6
Q

What is the best way to visualize an esophageal perforation?

A

With a contrast swallow (gastrograffin, then thin barium if none seen with water soluble contrast).

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7
Q

Surgical treatment option for a patient with an intra-abdominal perforation and severe reflux disease?

A

Esophageal preservation, repair of perforation, and an antireflux procedure.

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8
Q

What is the surgical approach for intra-abdominal perforations?

A

Laparotomy or laparoscopy

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9
Q

What is the surgical approach for mid (middle third) intrathoracic esophageal perforations?

A

Right thoracotomy, debridement of necrotic tissue, drainage and closure of injury. Esophageal muscle layers are opened above and below injury, and closed 2 layers, and repair buttressed.

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10
Q

What is the surgical approach for lower (intrathoracic) esophageal perforations?

A

Left thoracotomy, debridement of necrotic tissue, drainage and closure of injury. Repair performed in two layers, and buttressed.

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11
Q

Can esophageal injuries be repaired primarily after 24-48 hours?

A

Yes.

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12
Q

Surgical approach in a patient with achalasia and perforation after dilatation.

A

Two layer closure and myotomy on opposite side of perforation with partial fundoplication to cover site of perforation.

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13
Q

When can nonoperative management be employed in patients with esophageal perforations?

A

If leak is contained, and patient has no signs of sepsis. Also, intraluminal dissection, transmural perforations that drain back into esophagus, no distal obstruction, and perforations not in abdominal cavity.

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14
Q

How are cervical perforations unique?

A

Often can be successfully treated nonoperatively and will heal after a short course.

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15
Q

What is the leading cause of esophageal perforations?

A

Instrumentation (endoscopy, dilatation, etc)

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