Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Transmural tears can lead to peritoneal contamination and acute peritonitis.
Diagnostic Evaluation:
Diagnosis involves plain radiography, contrast esophagography, and computed tomography scans of the chest and abdomen. These imaging techniques detect air escape from the perforated esophagus, confirm the diagnosis, and identify intrathoracic or intra-abdominal collections needing drainage.
Management Approaches:
Initial management includes ICU admission for monitoring, volume resuscitation, and stabilization. Treatment typically involves broad-spectrum antibiotics, antifungals, and intravenous proton pump inhibitors. Percutaneous drainage is performed if fluid collection is present. Management decisions between operative and nonoperative approaches are critical.
From Chapter 9:
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