Esophageal rupture
Introduction
Introduction to esophageal rupture Esophageal rupture can occur in blunt, sharp, and firearm injuries, as well as spontaneous esophageal rupture due to severe vomiting. Due to the food containing various bacteria and the reflux of the digestive juice in the stomach into the mediastinum, it can cause serious mediastinal infection. Early stage may have sudden chest pain or upper abdominal pain, and radiate to the shoulder and back, and have fever, shortness of breath and difficulty breathing. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: difficulty swallowing
Cause
Cause of esophageal rupture
Causes of esophageal rupture include the following:
(1) Knife gun injury and firearm injury and esophagus.
(2) chest blunt contusion.
(3) accidental swallowing of foreign bodies can pierce the esophagus.
(4) The esophagus can be accidentally injured during esophagoscopy.
(5) Severe vomiting or other factors can cause spontaneous esophageal rupture when the pressure in the abdomen and esophagus increases sharply.
Prevention
Esophageal rupture prevention
The prognosis of this disease depends on the time of diagnosis, the location of the rupture, the underlying disease, the esophageal basis, and the presence or absence of spontaneous parietal pleural rupture, although the mortality of Boerhaaves syndrome has been greatly reduced since Barrett first successfully sutured the gap in 1947 (31). %), but delayed diagnosis can significantly increase complications, increase the difficulty and cost of treatment, and is the main cause of high mortality. Clinicians must be highly vigilant about this disease, comprehensive observation, thinking, early diagnosis, correct treatment, can save More patients.
Complication
Esophageal rupture complications Complications, difficulty swallowing
Cases of complication after rupture of the esophagus are often reported, including infection with poisoning failure, postoperative anastomotic aortic fistula, and hematemesis. For patients with a long history, it is more likely to have mediastinum, severe chest infection, and then death from poisoning failure. In some cases, after the implantation of the esophagus with a metal stent, there is a granulation hyperplasia at the upper end of the stent, which may manifest as mild dysphagia, and the laser can be used to treat the improvement.
Symptom
Esophageal rupture symptoms Common symptoms Difficulty breathing Dysphagia Upper abdominal pain Severe pain Neck pain Subcutaneous emphysema
Early stage may have sudden chest pain or upper abdominal pain, and radiate to the shoulder and back, and have fever, shortness of breath and difficulty in breathing. The symptoms after esophageal injury are related to the injury site:
(1) When the cervical esophagus ruptures, it mainly presents neck pain, difficulty swallowing and hoarseness.
(2) When the thoracic esophagus ruptures, it mainly manifests severe pain in the posterior sternum or upper chest; when the perforation of the esophagus enters the pleural cavity, it can cause liquid pneumothorax, and thus there may be chest pain, dyspnea and purpura on the affected side.
(3) When the esophagus ruptures in the abdomen, there may be symptoms of peritoneal inflammation in the upper abdomen.
Examine
Esophageal rupture
1. Laboratory examination: patients with esophageal rupture can have no fever in the early stage, and white blood cells do not rise; later, there may be fever, chills, and white blood cells.
2. X-ray examination: X-ray chest fluoroscopy has important value. Many patients find a side of the liquid pneumothorax through emergency chest fluoroscopy, and cause attention. The X-ray chest radiograph can be seen in the mediastinal emphysema and the subcutaneous emphysema in the neck. Later, the posterior anterior position can be seen on the posterior mediastinal side of the emphysema shadow, a triangle, considering the esophageal rupture, should be taken as a swallowing oil to make a clear diagnosis.
3. Diagnostic puncture: After the current liquid pneumothorax, diagnostic puncture is simple and necessary. If the extract is a bloody sour liquid, or if the food dregs are found, the diagnosis can be confirmed. For example, a small amount of methylene blue solution can be clearly displayed before puncture. The amylase value of the puncture fluid can be very high.
4. Esophageal angiography with absorbable contrast agent, the diagnosis rate is 90% to 95%, and there is a false negative of 5% to 10%. Therefore, the positive result (seeing the contrast agent overflowing the esophageal lumen), but the negative result SRE can not be ruled out, iodized oil has a certain viscosity, can use diatrizoate as a contrast agent, allowing patients to use left, right and flat position three posture angiography, increase the chance of mouthwash display.
5. CT scan can more clearly show the mediastinal emphysema and pleural effusion, the extent of esophageal abscess and mediastinal contamination, and the value of the treatment is also valuable.
6. Fiber endoscopy should be avoided in the acute phase of SRE, in order to prevent the endoscopic examination operation to make the small esophageal perforation which can be conservatively treated into a large esophageal perforation, and must be treated surgically. Endoscopic inflation will aggravate the chest cavity and mediastinal contamination. And subcutaneous emphysema, for coma, can not swallow and easy to aspiration, can be placed into the nasogastric tube, into the esophageal cavity into the absorption of contrast agent or methylene blue injection to help SRE diagnosis, only in the absence Fiber endoscopy was performed when endoscopy was not possible for the next treatment.
Diagnosis
Diagnosis of esophageal rupture
diagnosis
(1) A history of esophageal rupture, such as trauma, vomiting or esophagoscopy.
(2) Early stage may have sudden chest pain or upper abdominal pain, and radiate to the shoulder and back, and have fever, shortness of breath and difficulty in breathing, neck and subcutaneous emphysema.
(3) Symptoms after perforation of the esophagus.
(4) Peripheral blood white blood cell count increased.
(5) X-ray examination showed widening of the mediastinum or accumulation of gas and accumulation of pleural effusion on one or both sides.
(6) The rupture site can be determined when esophageal lipiodol is performed.
(7) Thoracentesis can be diagnosed when the liquid containing food (mostly acidic liquid) is taken out; or blue liquid can be taken after oral administration of methylene blue, and it can also be diagnosed.
Differential diagnosis
1, because the physical examination is more manifested as acute abdomen, may have the corresponding signs of liquid pneumothorax, upper abdominal tenderness, muscle tension, and even plate, so it is necessary to pay attention to the differential diagnosis of gastroduodenal perforation, X-ray examination can confirm the diagnosis .
2, esophagus, stomach contents into the chest, peritoneal cavity can cause chemical chest, peritonitis, can have acute suppurative mediastinal inflammation and chest, peritonitis performance, so in the diagnosis should pay attention to prevent missed diagnosis.
3, should pay attention to the differential diagnosis with liquid pneumothorax, X-ray chest fluoroscopy has important value, many patients through the emergency chest fluoroscopy found a side of the liquid pneumothorax, and caused attention, X-ray chest radiograph can be seen in the mediastinal emphysema, neck Subcutaneous emphysema, the posterior anterior position can sometimes be seen on the posterior mediastinal side of the emphysema shadow, a triangle, taking into account the esophageal rupture, should be taken iodine oil film, clear diagnosis.
4, in addition, it is necessary to identify with angina pectoris, empyema, etc., similar misdiagnosis is often reported.
