Esophageal Trauma

Excerpt

Esophageal injury (EI) is a rare but challenging clinical finding in the setting of trauma. Esophageal injuries/perforations are transmural disruptions of the esophagus that subsequently lead to leakage of intraluminal contents into the surrounding mediastinum. This causes local inflammation, systemic inflammatory response, and eventually the development of sepsis that results in significant morbidity and mortality. Esophageal injuries can be iatrogenic or traumatic. Examples of iatrogenic mechanisms include endoscopic examinations, nasoenteric tube placement, and surgical procedures. Traumatic mechanisms may be either blunt (e.g., motor-vehicle crash) or penetrating (e.g., gunshot or stab wounds). Other miscellaneous mechanisms include foreign body ingestion, spontaneous rupture (e.g., Boerhaave syndrome), and ingestion of acid/caustic substances. Overall, the most common mechanism of EI is iatrogenic (upper endoscopy), and patients who are at highest risk for iatrogenic perforations also tend to have multiple comorbid conditions.