Primary Management in General, Vascular and Thoracic Surgery by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783031125638
Publisher: Springer International Publishing

12.1 Spontaneous Esophageal Injuries

Esophageal injuries (EI) are an uncommon but potentially lethal event. A multidisciplinary approach involving all the relevant actors (thoracic and general surgeons, endoscopists, anesthesiologists, and radiologists) has proven to reach better outcomes.

EI are characterized by transmural disruptions of the esophageal wall. The leakage of esophageal contents into the surrounding structures leads to local and systemic inflammation, and increases the risk of sepsis [1].

Overall incidence is unclear but esophageal perforation presents high mortality rate ranging from 4% to 40%. The outcome depends on several factors, but essentially on early diagnosis and proper treatment.

Esophageal injuries are mainly iatrogenic (e.g., naso-enteric tube placement, endoscopic exams, surgical procedures), traumatic (e.g., blunt or penetrating trauma), or spontaneous (e.g., Boerhaave syndrome) [2].

Spontaneous rupture, or Boerhaave syndrome from the name of the doctor who first described it in 1729, represents 15% of all injuries, estimated in 3.1 cases per 1,000,000 per year [3].

It most commonly occurs in connection with vomiting, as a consequence of an increase in intraluminal esophageal pressure, and less frequently with childbirth, or seizure [4].

It appears usually among patients aged 50–70 years and chronic alcohol consumption is a risk factor.

Although injuries can occur along the entire esophagus, the perforation is most commonly observed in the left posterior aspect of the distal esophagus [5].

Esophageal rupture may be followed by serious complications such as mediastinitis, abscess formation, and multiple organ dysfunction. It is therefore important to obtain a proper picture of the clinical condition.

EI can be misdiagnosed as cardio-pericardial (e.g., myocardial infarction, pericarditis, acute aortic syndrome, pulmonary embolism), respiratory (e.g., spontaneous pneumothorax, pneumonia), or abdominal pathological conditions (e.g., perforated peptic ulcer).

It is a rare life-threatening condition and requires urgent diagnosis and treatment: patient outcomes are directly related to the timing.

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