Please enable JavaScript.
Coggle requires JavaScript to display documents.
Oesophageal perforation (Management (Options for definitive management…
Oesophageal perforation
Background
-
-
Pathophysiology
Oesophageal perforation permits the passage of gastric contents into the mediastinum - mediastinitis
Perforation of the overlying pleura - negative intrathoracic pressure causes oesophageal contents to enter the pleural space (left pleural effusion)
Assessment
History
Vomiting, dysphagia, pain
Exam
SC emphysema, left pleural effusion, pneumomediastinum is heard as a cracking sound upon auscultation (= Hamman crunch)
Macklers triad - thoracic pain, vomiting, SC emphysema
-
Investigation
-
CT with oral contrast - can reveal a leak, the site of perforation and extent of contamination
Gastrografin swallow - Barium should not be used: may worsen mediastinal inflammation and hinder future assessment of tear resolution (not easily absorbed)
Oesophagoscopy - risk of extending a perforation but permits direct visualisation of perf (useful if unable to swallow and negative imaging)
Pleural fluid from thoracocentesis (pH<6, Amylase, undigested food, MCS)
-
-