Esophageal emergencies: WSES guidelines

Abstract

The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified as foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma. These lesions can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs. Early diagnosis and timely therapeutic intervention are the keys of successful management.

Keywords: Caustic ingestion; Emergency management; Esophageal perforation; Esophageal trauma; Foreign body ingestion.

Fig. 1

Endoscopic view of esophageal injury from button battery ingestion (at 6 h) in a 5-year old with intellectual disability

Fig. 2

CT classification of corrosive injuries of the esophagus. a Grade I—homogenous enhancement of the esophageal wall while wall edema and mediastinal fat stranding are absent. b Grade IIa—internal enhancement of the esophageal mucosa and hypodense aspect of the esophageal wall which appears thickened, concomitant enhancement of the outer wall confers a “target” aspect. c Grade IIb—fine rim of external wall enhancement, the necrotic mucosa does not enhance anymore and fills the esophageal lumen which shows liquid density. d Grade III injuries show the absence of post-contrast wall enhancement

Fig. 3

Axial CT showing a right pleural effusion, mediastinal air and esophageal wall disruption in a patient with spontaneous EP (Boerhaaves). Patient managed by right thoracotomy and laparotomy

Fig. 4

Coronal CT showing mediastinal air but minimal pleural reaction in a patient with spontaneous EP (Boerhaaves). The patient was successfully managed via laparotomy alone and transhiatal repair. Primary suture repair with interrupted full-thickness single-layer polyglycolic acid and fundoplication healed without a leak