1999 Volume 50 Issue 4 Pages 470-475
Most esophageal ruptures may be ascribed to instrumental lesions, and the rise in the number of esophageal ruptures in recent years is due to the increasing use of diagnostic endoscopy. Rupture of the hypopharynx and esophagus is a hazardous disorder which is generally lethal if untreated.
We recently surgically treated a case of parapharyngeal abscess caused by hypopharyngeal injury during flexible fiberesophagoscopy. Early diagnosis and treatment are of decisive importance to the prognosis. The triad pain, fever and emphysema are disorder's most important symptoms. Plain radiography and a CT of neck and chest are mandatory to reveal the site, extent and nature of any mediastinal abscess secondary to neck infection. A CT scan is also useful for postoperative observation.
Perforation of the cervical esophagus is often treated surgically, but conservative management under strict supervision provides equally good results. In its early stage, perforation of the thoracic esophagus should be treated with emergency surgery involving suturing of the perforation and trans-thoracic drainage of the mediastinum. Suturing is impossible in the later stages. Trans-thoracic drainage of the mediastinum and pleura should be sufficiently carried out.
Irrespective of the local treatment, all forms of esophageal rupture should be treated with a large dose of antibiotics, fasting, introduction of a gastric tube and the sufficient administration of fluids, electrolytes and calories.
