Oesophageal perforation
why does this keep coming up in passmed?
Quoted mortality rates:
- Abdominal perforations 30%
- Thoracic 35%
- Cervical 5-10%
| Etiology | Boerhaave syndrome; erosive oesophagitis, caustic substance ingestion; malignancy; deceleration injury |
| Clinical presentation | Chest pain, surgical emphysema |
| Diagnostic investigations | CXR: pneumomediastinum (still might miss 15% of patients) CT chest with contrast Gastrograffin swallow |
| Management | Surgical: patch over, resection and reconstruction... often will have drain for collections Endoscopic: stenting e.g. from malignancy Conservative: TPN, broad spectrum antibiotics, |
critical care considerations
airway/breathing
- any positive pressure will worsen pneumomediastinum
- they need intubation with RSI-style apneic oxygenation