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The most common cause of esophageal injury is foreign bodies, as well as damage caused by instruments during esophagoscopy for various purposes, including the removal of a foreign body. Instrumental damage to the esophagus is also described with its bougieurage, cardiodilation, intubation and insertion of the probe. Other causes, such as compression and wounding of the neck and chest organs with firearms and knives, surgery, compressed gas damage, hydraulic injuries and spontaneous (pressure) ruptures are much less common. It should be noted that the number of observations of spontaneous ruptures of the esophagus continues to increase steadily. More than 80% of spontaneous gaps occur in men aged 50-60. They occur with a sharp increase in intra-esophageal pressure during vomiting and coordination of the esophageal sphincter as a result of severe alcohol intoxication or central nervous system disease (Komarov B.D. et al., 1981). Very rarely, a spontaneous rupture of the esophagus occurs when coughing, sneezing, laughing and during stress during an act of defecation. In the vast majority of cases, the gap is localized directly above the diaphragm on the left, where the oblique smooth muscle layer is the thinnest and, in general, the esophagus wall is weak. With a pressor rupture of the esophagus, the muscular membrane is first torn. If the gap is limited to it, an intramural exfoliating hematoma occurs. In these cases, subsequent rupture of the mucous membrane is possible. With a simultaneous rupture of all layers of the esophagus, the mediastinal pleura is usually damaged.
Esophagitis probably predisposes to an isolated rupture of the mucous membrane. The gap is usually linear, with a length of 1 to 4 cm. Very rarely, it spreads to the subphrenic part of the esophagus with a breakthrough into the abdominal cavity.
Esophageal ruptures associated with an increase in intra-esophageal pressure occur in the form of casuistic observations when a strong stream of gas and water gets into the oropharynx, which causes an involuntary opening of the pharyngeal-esophageal pulp with closed esophagocardial sphincter. They are also observed with closed blunt trauma to the neck and chest.
Gunshot wounds of the esophagus, like injuries with knives, are rare, since simultaneous injuries of the spine, aorta, large venous trunks and heart lead the victim to death at the site of the injury.
It is appropriate to note that such a seemingly innocent and often used in self-help technique, such as swallowing bread crusts or pieces of dense food when stuck in the esophagus and pharynx of foreign bodies, can lead to their penetration into the wall of the esophagus and the development of serious consequences (Rozanov B .C, I960).
The complications arising from an esophageal injury, according to the clinical course, can be divided into moderate to severe complications. The first include esophagitis and an abscess of the wall of the esophagus, which opens into its lumen; the second group includes periesophagitis, mediastinitis, sepsis, damage to the bronchi and blood vessels, as well as osteomyelitis of the cervical vertebrae with the development of cerebrospinal meningitis.
A foreign body that has been in the lumen of the esophagus for a more or less long time, and even more so has invaded its wall, inevitably causes progressive complications. The development of complications is directly dependent on the length of stay of a foreign body. The longer the foreign body remains in the esophagus, the more often and more dangerous the complications. It follows from this that it is impossible to procrastinate with the removal of a foreign body, despite the described individual casuistic observations, when foreign bodies remained in the esophagus for a long time and without serious consequences.
The clinical picture. Gaps (perforations) of the esophagus caused by firearms or cold steel, as well as instrumental ones, when a foreign body is removed, are manifested by a sharp deterioration in the general condition.
There is shock or collapse, a sharp pallor of the skin, cyanosis of the mucous membranes, a drop in cardiac activity and blood pressure; cold sweat and severe pain during breathing appear. When the cervical esophagus is wounded, the neck area is localized, sharply restricting the mobility of the head. A wound in the thoracic region is accompanied by pain in breathing, radiating to the interscapular space. Injury of the lower esophagus leads to the appearance of protective tension of the abdominal press in the epigastric region.
Perforation of the esophagus is accompanied by the rapid development of subcutaneous emphysema, sometimes spreading widely to the face, scalp, chest, and abdomen. Emphysema occurs as a result of the ingestion of ingested air through a perforated hole in the surrounding loose fiber. With limited emphysema of the mediastinum, an X-ray examination plays a large role in its recognition, in which Belkina's symptom can be established - the appearance of vertically located strips of enlightenment in the region of the esophageal tissue (Figure 5.9).
The experiments showed that for the appearance of air in the peri-esophageal tissue, a perforation hole in the esophagus about 1 mm2 in size is enough (Belkina N.P., 1951).
Phlegmon of the esophagus and mediastinitis develop with lightning speed. In some cases, death from sepsis occurs after 1 - 2 days.
With the development of mediastinitis, the condition of patients is assessed as severe and extremely severe. They feel severe pain behind the sternum, radiating to the neck, interscapular space, or to the epigastric region. Breathing shallow, frequent; tachycardia is noted, the pulse is weak to filiform; blood pressure decreases; the skin is pale, mucous membranes of cyanotic color; bad breath. Body temperature is elevated, there is a high neutrophilic leukocytosis with a sharp shift of the leukocyte formula to the left, a significant increase in ESR. Physical studies can establish the expansion of the mediastinum, the presence of effusion in the cavity of the pericardium and pleura, the purulent nature of which is determined by puncture.
Of the more rare complications, esophageal-bronchial fistulas, spinal lesions (usually in the cervical spine), with the development of cerebrospinal meningitis, cervical radiculitis and plexitis should be noted.
A terrible and almost always fatal complication is bleeding from large vessels adjacent to the esophagus. Bleeding is most often secondary in nature - they occur when the vascular wall is involved in the inflammatory process, followed by ulceration. Most often, the source of bleeding is the aorta, which is in close proximity to the esophagus for a considerable extent.
Bleeding from the aorta does not always lead to rapid death. In many patients, with the onset of bleeding and a drop in blood pressure during the development of collapse, a clot forms, temporarily covering the place of perforation in the aortic wall. In this interval, mediastinal hematoma and often hemothorax are formed. Bleeding resumes after a few hours or days and sooner or later ends in disaster. However, these patients are characterized by multi-stage intervals of temporary well-being. Such observations give hope for their salvation by using the entire arsenal of modern surgery.
The treatment of damage to the esophagus and its complications in most cases is surgical. Only with esophagitis or with a limited abscess caused by shallow damage to the wall of the esophagus, it is possible to limit ourselves to conservative therapy, carried out under close monitoring of clinical dynamics under systematic control. At the same time, along with adequate antibiotic therapy and diet therapy, iodinol or its analogue, amyloiodine, is useful.
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- Injuries, foreign bodies of the esophagus, trachea and bronchus
Injuries, foreign bodies of the esophagus, trachea and
- Barrett's esophagus, adenocarcinoma of the esophagus
There is no reliable data on the incidence of adenocarcinoma with Barrett's esophagus, but it is proved that the risk of the disease increases in this case by 20-40 times. Presumably, the mechanisms of carcinogenesis are similar to those in colon cancer - chronic damage to the epithelium and cell proliferation lead to genetic rearrangements and, ultimately, to the neoplastic process.
- LESSON 13 First aid for injuries. Closed soft tissue damage. Traumatic brain injuries. Damage to the chest. Transport immobilization for injuries.
Purpose: To teach students the differentiological diagnosis of various traumatic conditions, the rules of first aid to the victim. Test questions 1. Injury. Definition Classification of injuries. 2. Closed soft tissue damage. Injury. First aid. 3. Stretching. Complaints First aid. 4. The gap. Complaints First aid. 5. The syndrome of prolonged crushing. Pathogenesis. The clinical picture.
- The mechanism of injury. Classification of injury types
A. External forces Newton’s law of inertia: “A moving body continues to move until an external force acts on it.” 1. The horizontal moment. Force = MA = MDD = V2 - V1 / t = braking V2 = final speed V1 = initial speed 2. Gravity. Force = GmM / R2 = mg g = GM / R2 = acceleration due to gravity = 9.8 m / s2 R = radius of the Earth; G = grav. Constant; M = mass
- Esophageal stricture
- narrowing of the esophagus associated with congenital or acquired factors Classification of cicatricial narrowing of the esophagus (G. L. Ratner, VI Belokonev, 1982) By etiology: burns with acids, alkalis, other burns By the time of obstruction: early (3-4 weeks), late (later than 1 month) According to the mechanism of development and clinical manifestations: A. Functional obstruction of the esophagus 1.
- Damage and foreign bodies of the esophagus
Damage to the esophagus is external and internal. External, rarer ones include a breakthrough in the esophagus of abscesses of the lymph nodes, a tumor growing in it. Military injuries and incised wounds of the esophagus are possible in combination with damage to the pharynx and trachea. Internal damage - all cases of damage to the mucous membrane or the entire wall of the esophagus by foreign bodies, chemical agents,
Damage to the esophagus, complicated by perforation of its wall, is a severe form of trauma to the upper sections of the digestive canal. Isolated wounds of the esophagus are extremely rare. Pathogenesis. For any perforating wounds of the esophagus, there is a certain pattern: continuous flow through the wound opening from the organ into the fiber of the mediastinum of air, saliva, and in case of vomiting and gastric
- Esophageal diseases
1. What symptom is most often observed in diseases of the esophagus? Regurgitation. 2. What is the difference between regurgitation and reflux? Regurgitation is the passive, retrograde movement of swallowed food to the upper sphincter of the esophagus; as a rule, food does not have time to get into the stomach. Most often, regurgitation occurs as a result of a violation of the motility of the esophagus, esophageal obstruction, or asynchronous
- Esophagus DIVERTICULES
- blindly ending process or protrusion of the organ. LINKER DIVERTICULES - localized along the back wall of the pharynx and esophagus. Classification of diverticulums of the esophagus, diverticulitis (according to Yusbasic, 1961) By localization: 1. Pharyngo-esophagic (Tsenker), 2. Bifurcation. 3. Epiphrenal. Largest diverticulum: Stage I - protrusion of the mucous membrane of the esophagus
The esophagus (esophagus) is a cylindrical tube 25-30 cm long that connects the pharynx to the stomach. It begins at the level of the VI cervical vertebra, passes through the chest cavity, diaphragm and flows into the stomach to the left of the X-XI thoracic vertebra. There are three parts of the esophagus: cervical, thoracic and abdominal. The cervical part is located between the trachea and the spine at the level of the VI cervical and up to the II thoracic
- Esophagus Features
The esophagus in young children has a fusiform shape, it is narrow and short. In a newborn, its length is only 10 cm, in children in 1 year of life - 12 cm, in 10 years - 18 cm. Its width, respectively, is 7 years old - 8 mm, at 12 years old - 15 mm. There are no glands on the mucous membrane of the esophagus. It has thin walls, poor development of muscle and elastic tissues, and is well supplied with blood.
- Benign Tumors of the Esophagus
Classification 1. Solitary myomyomas. - acquired neoplasia. 2. Nodose-multiple myomas. 3. Common leiomyomatosis 4. Polyps: adenomas, lipomas, etc. 5. Cysts. Diagnostic criteria Dysphagia, dyspepsia; pain along the esophagus. Examples of diagnosis: 1. Solitary myoma of the esophagus. 2. Knotty-multiple esophageal myomas. 3.