Esophageal perforation

Although inhalation is usually of secondary importance, the effects from the dust or mist will vary ftom mild irritation to severe pneumonitis, depending on the severity of exposure. Ingestion produces severe abdominal pain, corrosion of the lips, mouth, tongue, and pharynx, and the vomiting of large pieces of mucosa. In severe cases, circulatory failure, esophageal perforation, and peritonitis may occur. 

As lewisite is a vesicant, emesis is not recommended in those species that can vomit (dogs, cats, swine, and ferrets). Dilution with milk or water is recommended. Activated charcoal is not recommended as severe irritation/vesication of the esophagus or gastrointestinal tract is likely to occur. Endoscopy can be performed very carefully to determine the extent of injury. Esophageal perforation and/or stricture formation may occur. 

Shapira MY et al (1999) Esophageal perforation after transesophageal echocardiogram. Echocardiography 16(2) 151-154. 

B. X-rays of the chest and abdomen will usually reveal impacted button batteries. X-rays may also demonstrate air in the mediastinum from esophageal perforation or free abdominal air from gastric perforation. 

Gastroesophageal Reflux 95 Achalasia 97 Foreign Body Ingestion 98 Caustic Ingestion 100 Esophageal Strictures 101 Esophageal Perforation 102 Epidermolysis Bullosa 104 Infectious and Inflammatory Conditions Esophageal Varices 105... 

Some children find chilled barium more palatable. Barium must not be used if either esophageal perforation or massive aspiration is suspected. Such patients are best studied with water-soluble low osmolar non-ionic contrast media. Gastrografin, due to its high osmolality, should never be used in infants or in any patients lacking adequate airway protection. Its use must be restricted to older, stable and neurologically unimpaired patients. 

Treatment is resection with end-to-end esophageal anastomosis. Dilatation has a high incidence of esophageal perforation, especially in young children, and may be related to the length of the stricture and its transmural involvement (Newman and Bender 1997). The diameter of the lumen increases with age and growth of the patient, and with repeated dilatations, but will never be normal (Newman and Bender 1997). Some patients will benefit from initial dilatation, but most ultimately require surgery (Amae et al. 2003). 

Esophageal perforation can be diagnosed on frontal and lateral chest radiographs. Findings include pneumomediastinum, pneumothorax, hydro-pneumothorax, subcutaneous emphysema and pleural effusions (Fig. 2.30). Chest radiography is not useful... 

Fig. 2.30a,b. Esophageal perforation after orogastric tube malposition, a Frontal chest radiograph with left pleural effusion, left pulmonary atelectasis and mediastinal shift. Free air overlies the cardiac silhouette, b Lateral chest radiograph confirms the traumatic pneumothorax... 

Watkinson AF,Ellul J,Entwistle K,et al. (1995b) Plastic-covered metallic endoprostheses in the management of esophageal perforation in patients with esophageal carcinoma. Clin Radiol 50 304-309... 

Gastrointestinal Esophageal perforation has been attributed to ibuprofen [42 ]. 

An 18-year-old man developed sudden onset, severe, retrosternal pain, dysphagia, and odynophagia after taking ibuprofen capsules. An X-ray and CT scan showed esophageal perforation. 

Early symptoms after paraquat ingestion are a burning sensation in the throat, abdominal pain, vomiting, and diarrhea. The local corrosive effect of paraquat causes ulcerations on the tongue, buccal mucosa, and the esophagus. Esophageal perforation can lead to death before pulmonary toxicity becomes manifest. 

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