Oesophageal Injury

Oesophageal InjuryTreatment of this injury is shared by the ENT dept. at King Edward VIII Hospital and The Department of Cardiothoracic Surgery at Wentworth Hospital. Injuries of the cervical oesophagus are treated by the ENT Dept., injuries within the thoracic cavity or complicated by abscess spread within the thoracic cavity are treated by the cardiothoracic surgeons. Common causes of trauma are iatrogenic, knife and gun shot wounds. Any cervical knife or gunshot wound regardless of whether dysphagia is present or not and any endoscopic procedure complicated by pain or surgical emphysema should be urgently investigated by contrast swallow. Additionally endoscopy may be performed.

Oesophageal rupture as a result of vomiting against a closed glottis is a catastrophic medical emergency often leading to tension pneumothorax and collapse and death within minutes or hours if not recognised. Insertion of a chest drain usually is diagnostic with stomach contents being evacuated through the drain. Early exploration after rapid resuscitation with drainage, occasionally repair or even primary resection is necessary.

Minor leaks associated with endoscopy may respond satisfactorily to conservative management with intravenous or jejeunal feeding with antibiotics. Most other injuries require exploration of the wound either via a cervical or thoracic incision. Early wounds (<24hrs) are usually treated by primary closure usually reinforced with a local muscle flap. Later wounds are usually treated by laying open the affected mediastinal or cervical collections and prolonged drainage with triple antibiotics, healing often taking many weeks.