foreign body esophageal perforation
Introduction
Introduction to foreign body esophageal perforation Foreign body esophageal perforation is a complication of esophageal perforation caused by foreign body of esophagus, which may occur due to the nature of the foreign body and the time of existence, and may also occur when the foreign body is removed. basic knowledge Sickness ratio: 5% Susceptible people: no special people Mode of infection: non-infectious Complications: retropharyngeal abscess mediastinal emphysema atelectasis lung abscess
Cause
Foreign body esophageal perforation
(1) Causes of the disease
Foreign bodies cause more pervasive males than females, but the difference is not significant, generally more common in the elderly and children, the elderly tongue is dull, the vision is unclear, the potential foreign bodies such as bone spurs in the food are not visible, and the other is the esophagus. Cancer may cause perforation based on the stenosis of the tumor.
1. Foreign body types of foreign bodies caused by perforation of esophagus are common in three types: sharp foreign body puncture, long-term corrosion perforation of smooth foreign bodies and giant foreign body tearing. Among them, perforated people are more common with sharp foreign bodies, and the types of foreign bodies that are swallowed are related to the area. In the south and coastal areas of China, fish and poultry bones are more common. Most of the northern areas are jujube nucleus. Most of the Xinjiang Uygur farmers are meat and sheep bones. Large non-food foreign bodies are patients attempting suicide or mental disorders. , a bunch of keys, watches, bamboo chopsticks, toothbrushes, etc.
2. The foreign body in the perforation site is often easy to get stuck in the first narrow part of the esophagus, so the perforation of the esophagus in the neck is more common. Most cases are accidentally slipped into the lower pharynx and enter the esophagus during mouth or chewing, sometimes for children. Swallowing, foreign body can also stay in the second narrow aortic arch of the thoracic region to cause perforation of the esophagus, or in the upper part of obstructive esophageal lesions.
3. Strong swallowing After swallowing foreign bodies, patients have a history of forced swallowing of food or rice balls in the stomach. The consequences are to promote perforation of the esophagus or other complications. Foreign bodies can exist in the esophageal lumen or through the esophageal cavity. In the stomach, but it can also be squeezed outside the esophageal cavity.
4. Delayed foreign body insertion and foreign body intrusion or foreign body intrusion compression when the foreign body is taken, and the trachea or aorta adjacent to the esophagus is damaged when the foreign body is not taken out in time, and esophageal-tracheal bronchospasm, esophageal-main pulse, aorta occur. Perforation is the most serious and can cause fatal bleeding.
(two) pathogenesis
The foreign body that can pass through the esophageal cavity only scratches the esophageal mucosa or forms a small local hematoma, erosive and other inflammatory reactions, and will not cause serious consequences. If the mucosa is torn without damage to the muscular layer, it can be formed by infection of the oral cavity. Abscess in the wall, puncturing the entire esophagus causes a small extent of perforation of the esophagus, due to inflammation of the surrounding tissue, forming an esophageal inflammation or a limited peri-abdominal abscess. A common deep neck abscess is formed. If the perforation range is large, the infection may be Extending to the periphery to form a mediastinal infection, thoracic esophageal perforation not only causes mediastinal infection, but also involves adjacent trachea, bronchus or aorta, and perforation, or direct compression of foreign body to force the muscle wall and elastic layer of the arterial wall to be destroyed and thinned. Pseudoaneurysm, gradually increased, to the esophageal perforation to form aortic esophageal fistula and major bleeding death.
Prevention
Foreign body esophageal perforation prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Foreign body esophageal perforation complications Post-pharyngeal abscess, mediastinal emphysema, atelectasis, abscess
1. Deep neck infection or abscess foreign body penetrates the cervical esophagus wall and there will be an abscess around the esophagus. It is located in the thyroid gland and esophageal space. If the posterior wall of the esophagus is worn, a posterior pharyngeal abscess is formed, and the throat or trachea is compressed. It can spread to the mediastinum and cause a mediastinal infection or abscess.
2. Mediastinal infection of the thoracic esophageal perforation can occur immediately with mediastinal emphysema, gas upswing occurs in the subcutaneous emphysema of the neck, followed by mediastinal infection or abscess formation, there are also esophageal tears caused by pushing and pulling foreign bodies when taking foreign bodies Perforation causes the mediastinum to be infected.
3. Bronchopulmonary and thoracic infection complications. Foreign body directly penetrates or compresses the esophagus and damages the trachea or bronchus. It can cause trachea or bronchospasm. The contents of the esophagus can be inhaled into the respiratory tract through the fistula. Pulmonary inflammation, atelectasis, lung abscess, etc. Symptoms, mediastinal infection that is not treated in time may involve the pleura or foreign body directly through the mediastinal pleura to contaminate the chest cavity, forming an empyema.
4. Damage to the large blood vessels caused by the esophagus-arterial sacral esophagus anatomically adjacent to the aortic arch and the left bronchus to form a physiological stenosis, which is easy to allow foreign bodies to stay, if the fish, crab, shell, poultry and other sharp bone fragments penetrate the esophagus Wall, due to swallowing and swallowing of the esophagus, large blood vessels pulsing, swallowing food, vomiting and coughing, etc., can cause foreign bodies to break through the esophageal wall, causing injury or penetration into the aorta, forming aortic fistula after infection, and blunt foreign bodies remaining due to oppression Esophageal necrosis after esophagus, infection, etc., the inflammatory reaction is chronic, fibrous tissue hyperplasia, small pupil, can provide favorable conditions for surgery, if the inflammatory response is heavy, repair is more difficult, esophageal foreign body damage after the aorta The clinical manifestations have different degrees of acute hematemesis, generally less vomiting, called signal vomiting, due to aortic wall contraction, blood pressure after bleeding, blood clots blocked mouth and other reasons, bleeding can be suspended, afterwards Fatal bleeding occurs again due to infection or clot movement, and the time from signal bleeding to fatal bleeding has been reported from 2h to 3 days. An average of one day, comprehensive domestic coverage of esophageal foreign body complicated by aortic fistula more than 80 cases were cured only four cases.
Other vascular injuries include common carotid artery, subclavian artery, jugular vein, and innominate vein. After perforation of the neck vein, there may be pulsating or conductive pulsatile mass on the side of the neck. Local puncture may extract blood, and time should be taken for surgical treatment. Patients with esophageal aortic fistula should be closely observed and surgically treated in a prepared condition.
Symptom
Foreign body esophageal perforation symptoms common symptoms swallowing pain dysphagia difficult to eat persistent cough above the glottis subcutaneous emphysema leukopenia lung infection
After the perforation of the esophagus, it can be manifested as swallowing pain, difficulty in eating, inflammation around the esophagus or further inflammation of the mediastinal inflammation can occur, white blood cells increase, children swallow foreign body, the date of misuse is more unclear, chronic perforation of esophageal foreign body, can Symptoms occur only after a few weeks to several months. Foreign body corrosion passes through the esophageal wall, and there is a tight fibrotic reaction around it, or perforation develops into a trachea or bronchospasm, which is characterized by fever and persistent cough, but not necessarily dysphagia. Subcutaneous emphysema in the neck suggests perforation of the cervical esophagus.
Examine
Foreign body esophageal perforation
1. X-ray examination is the main method for examining foreign body of esophagus, and an important means for diagnosing perforation of the esophagus. The neck and chest position should be used as routine examination. X-ray examination can find foreign bodies, but it is often negative, because foreign bodies are mostly low. Density, dry-plate photography may be helpful. Other X-ray examinations depend on the extent and extent of inflammation of the esophageal wall. The cervical esophageal perforation shows free gas on the lateral radiograph. After the inflammation spreads, the anterior soft tissue shadow Widening, tracheal advancement, gas-liquid surface with abscess, chest perforation of the esophagus, more than half of the pleural, lung and mediastinum abnormalities.
If the perforation is obvious, the contrast examination should not be performed. For cases with suspected perforation, it is safer to apply the water-soluble contrast agent diatrizoate or 50% solution. The diatrizoate is absorbed quickly and will not deteriorate. The existing inflammation, but the expectorant is clearer than the diatrizoate when observing the small perforation, because the expectorant can be hung on the mucous membrane and attached to the leaking part outside the cavity. If the infiltration can be absorbed in the mediastinum during surgery For tinctures, it is also possible to use tinctures, so it is preferred to use diatrizoate, such as negative and repeated use of barium angiography.
2. Endoscopy unless X-ray examination and contrast agent examination are negative, clinically highly suspected esophageal perforation, rarely need endoscopy, endoscopy can also be used for therapeutic purposes to remove swallowed foreign bodies, perforation has caused abscess around the esophagus It is feasible to drain the lumen to achieve therapeutic purposes.
Diagnosis
Diagnosis and differentiation of foreign body esophageal perforation
diagnosis
The medical history should be asked in detail according to the clinical manifestations. Parents of adults and most children can remember the time of swallowing foreign bodies and point out the location of foreign bodies. The nature, shape, pain, vomiting, fever, chest and back pain of foreign bodies should be asked in detail. The symptoms of pulmonary infection can be diagnosed by X-ray and endoscopy.
Differential diagnosis
Generally not confused with other diseases.
