Felis ISSN 2398-2950

Esophagus: perforation

Contributor(s): Ed Hall, Cheryl Hedlund, Philip K Nicholls

Introduction

  • Cause: ingestion of sharp foreign bodies Esophagus: foreign body, eg needle, chronic neglected foreign body obstruction (more common), iatrogenic tears during esophagoscopy Esophagoscopy  or intubation Nasoesophageal intubation, bite wounds to cervical region.
  • Signs: pyrexia, pain, anorexia, peri-esophageal swelling, crepitation, cervical drainage and abscess development/thoracic mediastinitis Mediastinal disease, pleurisy Pleurisy, cough, dyspnea.
  • Thoracic perforation much more serious than esophageal perforation - very high mortality rate.
  • Treatment: depends on severity and site of lesion: conservative management, primary repair, patch graft, colonic or jejunal transplants, esophageal resection.
  • Prognosis: depends on severity and site of lesion and type of surgical repair needed.

Pathogenesis

Etiology

  • Trauma: ingestion of sharp foreign body, chronic/neglected foreign body obstruction (most common), iatrogenic tears during esophagoscopy, bite wounds to cervical region, intubation of esophagus.

Pathophysiology

Cervical perforation

  • May cause: peri-esophageal swelling, crepitation, cervical drainage and abscess development.

Thoracic perforation

  • More serious, results in mediastinitis.
  • Mediastinal abscessation or empyema and pleurisy may result if contamination spreads beyond mediastinum.
  • Even when detected at an early stage - very high mortality.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Flanders J A (1989) Problems and complications associated with esophageal surgery. Probl Vet Med (2), 183-194 PubMed.


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