Oesophageal Tears Flashcards
Oesophageal perforation
Full thickness rupture of the oesophageal wall
- spontaneous
- Boerhaave’s syndrome
Complications of Oesophageal perforation
Surgical emergency
Leakage of stomach contents into the mediastinum and pleural cavity - triggers a severe inflammatory response which can lead to death
Aetiology of oesophageal perforation
Iatrogenic - endoscopy
Severe forceful vomiting
Common site of perforation
Above the diaphragm in the left postero-lateral position
Clinical features of oesophageal rupture
Severe sudden-onset retrosternal chest pain
Respiratory distress
Severe vomiting or retching
Investigations
Routine bloods and group and save
CXR - do not delay treatment due to CXR
Gold standard - CT CAP with IV + oral contrast
High clinical suspicion - urgent endoscopy
Management
A-E
Sepsis 6
IV fluids
High flow oxygen
Broad spectrum abx are given immediately
Surgery:
- thoracotomy
- feeding jejunostomy
Principals of management
- Control of the oesophageal leak
- Eradication of mediastinal and pleural contamination
- Decompress the oesophagus (typically via a trans-gastric drain or endoscopically-placed NG tube)
- Nutritional support
When can oral intake recommence
10-14 days after CT scan with contrast
Non-operative treatment
- Resuscitation and transfer to ITU/HDU
- Appropriate abx and anti-fungal cover
- NBM for 1-2 weeks, with endoscopic insertion of an NG tube on drainage
- Large-bore chest drain insertion
- Total Parenteral Nutrition (TPN) or feeding jejunostomy insertion
Mallory-Weiss Tears
Lacerations in the oesophageal mucosa
Cause of Mallory-Weiss Tears
Period of profuse vomiting
Mx of mallory Weiss tear
Conservative
A suitable fluid regime for an otherwise well 50 year-old patient with a suspected oesophageal perforation who is tachycardic in the emergency department is?
1 litre of Hartmann’s crystalloid stat, followed by reassessment
