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Esophageal rupture

 

The esophageal rupture , ie, drilling the wall of the esophagus may be due to different causes, which will be discussed below, and is a serious problem (mainly by infections that can occur) that accurate diagnosis and treatment as early as possible.

Symptoms of esophageal rupture

The severity of the clinical picture will depend on the location and dimensions of the perforation (as we have already indicated), factors that will depend, in turn, on the cause that originated it.

Intense retrosternal pain appears, which increases with swallowing and breathing (sometimes the only symptom).

The passage of the esophageal content to the mediastinum causes serious complications, such as mediastinitis, infections, pleuropulmonary abscesses, subcutaneous emphysema and pneumothorax ; These lesions will also have their clinical manifestation in the form of dysphagia, fever , chest pain, malaise, dyspnea; the presence of subcutaneous emphysema produces a crepitus in the neck and chest, which can be palpated and auscultated.

Iatrogenic rupture is usually less serious in terms of clinical manifestations and complications. Spontaneous perforation or Boerhaave syndrome is, in general, very serious, to the point that it can be confused with a myocardial infarction , pancreatitis or a ruptured abdominal viscus.

If the trigger is violent vomiting, gastric content is added to the esophageal content discharged into the mediastinum, which will further aggravate mediastinal complications. In this syndrome, tachycardia, hypotension, cyanosis, tachiapnea and, in general, symptoms of cardiorespiratory failure can be added to the symptoms already described; Likewise, pain on palpation, muscle contracture and even a paralytic ileus may appear in the abdomen.

Overall, the condition can be so severe that it causes shock and death within 24 hours, if not diagnosed and treated early.

How is it diagnosed?

It is important to remember the need for an urgent diagnosis due to the possible severity of this condition.

After the medical history, which will collect the symptoms described above (and which can be reported by a companion if the patient is very serious), a physical examination will be carried out, which will reveal, among other things, the presence of subcutaneous emphysema, manifested by crackle on palpation and auscultation (during the latter, and when the patient holds his breath, crackle may accompany the heartbeat, which is called the Hamman’s sign).

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The diagnosis is basically radiological, with signs of suspicion (or evidence) appearing on the chest X-ray, and confirmed with the use of water-soluble radiopaque contrasts (which are non-irritating, unlike barium, which in this case will be contraindicated). Computed tomography (CT) is more sensitive in detecting the presence of air in the mediastinum.

The use of endoscopy (esophagoscopy) is restricted, since it could aggravate the perforation, so that its use is limited to cases caused by a foreign body (it can be used simultaneously for its extraction).

Treatment of esophageal rupture?

Treatment must be as early as possible.

To begin with, parenteral antibiotic therapy will be started.

In mild cases (generally iatrogenic), conservative treatment will suffice, that is, antibiotics and parenteral nutrition, and suppression of oral feeding.

If it has been produced as a result of a foreign body, it will be removed endoscopically.

In more serious cases, the treatment must be surgical (whenever possible, and will be accompanied by antibiotic therapy and parenteral nutrition); if less than 24 hours have elapsed, primary closure of the tear associated with chest drainage will be carried out; otherwise, it will be necessary to perform targeted fistulization and esophageal exclusion (along with discharge esophagostomy and feeding and discharge gastrostomy).

Esophageal resection (with associated esophagostomy and gastrostomy) is used in the case of perforations that occur within an esophageal disease (such as a tumor), or due to the ingestion of caustics.

Iatrogenic perforations generally have a good prognosis.

In Boerhaave syndrome, mortality is usually high and increases the later the treatment.

In the rest of the cases, the prognosis is variable, depending on the cause, the magnitude and the location of the injury and the time it takes to treat them.

 

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Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of ​​Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.

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