Injury or trauma to the oesophagus

oesophagus injury

Trauma to the oesophagus is rare. But if the oesophagus does encounter an injury or trauma, it is best managed with surgical intervention. Injury to the oesophagus can be due to:

  • Blunt injury

  • Iatrogenic injury

  • Laceration this can occur due to the ingestion of a sharp object

Patient presenting with an oesophageal injury experiences the following symptoms:

  • Mild to severe sepsis

  • Empyema or pus collection in the pleural cavity

  • Mediastinal abscess disintegration of tissue and inflammation of the area near the esophagus

  • Physical examination will reveal an oesophageal leak with acute infection

  • Patient experiences chest pain, and upon auscultation of the chest a crunching sound is heard

  • The cervical subcutaneous emphysema (feeling air bubbles under the skin) due to leak of air from the esophagus

A combination of tests are done to establish oesophageal injury:

  • Chest radiographs to check for pleural empyema

  • CT scan

  • Contrast studies with barium

  • Gastrografin swallow oesophagogram

  • Esophagoscopy to detect the site and extent of injury

Perforation of the oesophagus: A hole forms in the oesophagus and is a serious condition and can be treated only with surgery.

The symptoms of oesophageal perforation are:

  • Rapid breathing

  • Low blood pressure

  • Increase in heart rate

  • Fever

  • Chills

  • Vomiting blood

  • If injury is to the top of the oesophagus then patient experiences stiffness of the neck and air bubbles under the skin.

Treatment includes:

  • IV fluids

  • IV antibiotics to prevent infection

  • Drainage of chest cavity to avoid accumulation of infected fluid

  • Thoracoscopy or thoracotomy (surgery of the chest) is usually needed to repair the hole in the esophagus.

  • A feeding tube is kept directly into the small intestine for prolonged post operative feeding.

  • In some cases, esophagus will have to be removed and then replaced by stomach or large intestine.

Dr. Deepak Varma uses a combination of diagnostic methods to evaluate injury to the oesophagus and perform surgical repairs according to the grade of the injury.