Instrumental esophageal injury
Introduction
Introduction to deviceic esophageal injury Instrumental esophageal injury: also known as iatrogenic perforation, refers to the iatrogenic injury of the esophagus. The patient developed pain during swallowing after microscopic examination and had neck tenderness and subcutaneous emphysema. After the expansion, there are signs of infection of the back of the sternum or back pain or elevated body temperature. In severe cases, cyanosis, shock and death may occur. The damage caused by esophagoscopy is more common in the cervical esophagus, which is often unskilled. The perforation often occurs in the posterior pharyngeal wall or the pharyngeal esophageal diverticulum of healthy tissue, causing damage to the esophageal diverticulum. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: peritonitis
Cause
Causes of device-induced esophageal injury
(1) Causes of the disease
The damage caused by esophagoscopy is more common in the cervical esophagus. It is often technically unskilled. The perforation site often occurs in the posterior pharyngeal wall or the pharyngeal esophageal diverticulum. The hazard factors causing damage to the esophageal diverticulum include short and wide neck. Cervical spine stiffness, bone and bone spurs and poor dentition, the perforation rate of hard esophageal injury is high, and the esophageal wall, which occurs mostly in the pharyngeal muscle, changes from vertical to horizontal when the esophagus is advanced in the pharynx. Position, the posterior vertebral body, causing compression of the posterior wall of the esophagus and tearing, endotracheal intubation and insertion of double lumen can also damage the posterior wall of the esophagus at the distal end of the pharyngeal muscle. The tracheal cuff can also be perforated by long-term compression of the esophagus. In patients with esophageal stenosis and achalasia, the use of probes or balloon dilatation can cause perforation of the stenosis or distal esophagus. Esophageal rupture caused by balloon dilatation occurs first in the muscular layer, followed by linear perforation of the mucosal layer, and mercury expansion. The safety is the safest, the risk of esophageal perforation is low, the dilator enters too fast or the frequency of expansion is too frequent, and the incidence of complications can be increased. Each expansion should be separated by 1 to 2 weeks. The second expansion is no more than 3, and the esophagus with lesions is easy to perforate during expansion. For example, the degree of esophageal fibrosis and the presence or absence of a combined esophageal diverticulum or hiatal hernia. The esophagus is prone to perforation after performing biopsy. Do not immediately Row expansion, but if you use a shallow clamp, there is no such danger.
The type of perforation caused by esophageal dilation is shown.
(two) pathogenesis
There is currently no relevant information.
Prevention
Deviceic esophageal injury prevention
Regularly drink some diet drinks that are good for pharyngeal and fluid, the following two examples for reference:
Green tea honey drink: 5 grams of green tea, honey amount. Place the green tea in a cup, rinse into boiling water, add honey to drink, 1 dose per day. It can clear away heat and swallow, and moisten the lungs and produce fluid.
Lily mung bean soup: 20 grams of lily, 50 grams of green beans, the amount of crystal sugar. Add the appropriate amount of lily and mung bean to the water, add the rock sugar drink, 1 dose per day. It can clear the heat and moisten the lungs, nourish yin and fluid.
Complication
Deviceic esophageal injury complications Complications peritonitis
Can be complicated by purulent inflammation in the chest, peritoneal inflammation.
Symptom
Symptoms of device-induced esophageal injury Common symptoms Abdominal pain Subcutaneous emphysema, shock, fistula between the airway and esophagus
The patient developed pain during swallowing after microscopic examination, and had neck tenderness and subcutaneous emphysema. The use of balloon dilatation and achalasia can cause perforation of the distal esophagus and post-thoracic or back pain or elevated temperature. In severe cases, cyanosis, shock and death may occur.
Examine
Examination of instrumental esophageal injury
X-ray examination of cervical esophageal rupture on the lateral side of the neck showed emphysema between the fascia, widening of the posterior pharyngeal space, normal cervical curvature disappeared, thoracic esophageal rupture on the chest X-ray showed mediastinal shadow widening, emphysema And the pleural effusion on the affected side.
Diagnosis
Diagnosis and diagnosis of instrumental esophageal injury
diagnosis
X-ray photographs of the neck or chest can be used for diagnosis. X-ray contrast esophagography can help diagnosis in most cases, but negative angiography cannot completely exclude perforation.
Differential diagnosis
Perforation of the esophagus in the upper abdomen showed symptoms of peritoneal inflammation, and suspected acute abdomen. The contrast was used to confirm the perforation site. The perforation occurred in the retroperitoneal space, and the symptoms were not obvious. Acute abdominal pain due to other causes, such as an inter-wall aneurysm, myocardial infarction or pulmonary embolism should be identified.
