Esophageal perforation

Esophageal perforation

    * Introduction
    * Pathophysiology
    * Causes and Risk Factors
    * Signs and symptoms
    * Diagnosis
    * Treatment
Most cases are iatrogenic esophageal perforation. Rapid diagnosis and therapy provide the best chance of survival. However, delay of diagnosis is often caused substantial morbidity and mortality.
Iatrogenic causes include more than 50-70% of esophageal perofratiile. Actual incidence depends on the procedure, rigid endoscopy has a perforation rate of 0. 1-0. 4%, while flexible endoscopy varies from 0. 01-0. 06%. Rate increases rapidly when pneumatic balloon dilatation is performed in 2-6% achalasia, or other procedure involving radiation secondaries strictures or tumors, 10%. Perforation rate is increased in the presence of a large hiatal hernia or esophageal diverticulum.
Penetrating trauma of the neck has a perforation rate of 2-9%, membrane thinning after esophageal variceal sclerotherapy, and 1-3% of toxin or ingestion of foreign bodies of 5-15%. Boerhaave syndrome is rare number 15% of all cases of esophageal perforation. Patients with abdominal or thoracic perforation may have severe vomiting, acute epigastric or back pain, cough, odynophagia, dysphagia, dysphonia, or dyspnea.
Mortality varies with aetiology and location of the perforation. Highest rates are attributed Boerhaave syndrome-up to 72%, partly because of the difficulty in making the diagnosis, followed by 19% and perforation-iatrogenic traumatic-7%. Cervical perforation has a low mortality compared with abdominal or thoracic perforation and contamination due to its fascial. Mortality and morbidity in esophageal perforation is most often an inflammatory response in gastric contents of the mediastinum, pleural space and adjacent tissues, and the spread of infection in paraesofagiene structures. Negative intrathoracic pressure can draw content exacerbate esophageal injury. Mortality is due mediastinitei, pneumonia, empyema, polymicrobial sepsis and multiorgan failure.
Any patient with esophageal injury should be immediately transported to the emergency access roads providing a venous oxygen supplementation and secure airway and administration of anlgezice. Therapy for patients with esophageal lesions depends on the severity of the fracture. It will administer antibiotics widely spctru action, wound drainage, the stabilization of hemodynamics. Specific surgical techniques include primary repair, stenting, resection or drainage tube placement. Adopt one will depend on the location and extension of the lesion.
Pathogenesis
Anatomy and physiology of the esophagus. Esophagus lacks serous layer is therefore more vulnerable to rupture and perforation. The esophagus is the muscular tube that serves food from the oropharynx across the stomach. Payment is configured and round the upper and the lower middle. There is no mesentery and serous layer, thus being unique in the gastrointestinal tract. Connective tissue of the esophagus and trachea are maintained is surrounded by longitudinal bands along fibrolamelare that covers and connects the muscles, bones and vessels of the neck and chest. Arterial blood supply include the superior and inferior thyroid arteries, direct aortic branches, left gastric artery and splenic artery. Besides missing serous layer construction of the esophagus is similar to other organs in the gastrointestinal tract. Consisting of four layers: external fibrous muscle intermediate intermediate and internal submucous mucous.