Damage to the esophagus

Damage to the esophagus can be applied on the outside if stab and gunshot wounds and inside, from the mucosa, when ezofagoskopia, birovni, the ingestion of foreign bodies (see). Damage to the esophagus often combined with injury nearby structures of the thyroid gland, trachea, lungs, heart and major blood vessels. Injuries of the cervical esophagus are accompanied by pain and isolation from the wounds of saliva and blood swallowing, swelling and air crepitation (see) in the soft tissues of the neck, high fever and leukocytosis. In injuries of the thoracic part of the rapidly evolving phenomenon of mediastinitis (see), pleurisy (see), mediastinal emphysema. Injuries abdominal esophagus lead to the development of peritonitis (see). For suspected damage to the esophagus prohibit the use of water and food through the mouth, the patient is urgently hospitalized. To diagnose damage to the esophagus, the presence of foreign tol and varicose veins used x-ray examination, as well as the esophagoscopy. Treatment of lesions of the esophagus is an urgent operation. The power of the patient prior to healing esophagus produce a tube inserted through the nose into the stomach, in severe cases - through a gastrostomy tube (see Gastrostomy).
Burns of the esophagus is almost always chemical. In a domestic environment they are mainly caused by strong acids and alkalis: vinegar essence, caustic soda, liquid ammonia and others, are frequent in children left unattended. Chemical burn of the esophagus is often accompanied by burn stomach. Symptoms of burn of the esophagus: burning pain in the mouth, throat (in connection with their defeat), the sternum and in the epigastric area. Swallowing difficult. Vomiting with blood, increased salivation (salivation), cough and hoarseness due to swelling of the epiglottis, larynx and trachea. When the stenosis of the glottis, you may need a tracheotomy (see). First aid for chemical burn of the esophagus: early and copious lavage with warm water antidote - weak alkali when you burn acid, a weak acid (for example, citric, tartaric) with alkali burns. Subcutaneously injected analgesics - morphine, omnopon, promedol, heart - camphor, caffeine, mezaton. Intravenous 1000-1500 ml of 5% glucose solution, 300 ml of 4% solution of sodium bicarbonate, a complex of vitamins (ascorbic acid, vitamin b,a), protein hydrolysates. Prescribe antibiotics, hydrocortisone or cortisone to prevent the formation of cicatricial stenosis; rinsing the mouth cavity and pharynx weak solutions of rivanol or furatsilina. Through the mouth can be given only butter or vegetable oil, pieces of ice. In severe burns to power patient produce gastrostomy. When superficial burns inflammation gradually decrease, swallowing, and the passage of food through the esophagus becomes freer; with deep burns through 6-8 weeks formed cicatricial stenosis in the course of the esophagus, sometimes with complete obliteration of the lumen. Above narrowing occurs compensatory hypertrophy of muscles of the esophagus with a subsequent gradual extension of the lumen and the thinning of the walls. Stagnation of food, its decomposition cause esophagitis (inflammation of the walls of the esophagus), often with the formation of ulcers, impending perforation. Treatment of cicatricial stenosis of the esophagus spend long bagirovym, which is the primary method of treatment of stenosis of the esophagus in children; when the failure resort to esophagoplasty - operation is the creation of artificial esophagus with preliminary imposition gastrostomy to power of the patient. Artificial esophagus create now completely out of the loop of the small intestine or large intestine with a piece of thin and placed intestinale (under the skin ahead of the sternum), or retrosternal (chest), which is much more profitable in terms of functionality. During this surgery, intestinal loop is held in front of the mediastinum and displayed on the neck, where after 4-7 days connects to the cervical part of the esophagus above the place of its narrowing. Patient preparation for plastic esophagus from intestinal loop consists of activities restorative nature: supply through a gastrostomy tube high-calorie, rich in protein and vitamins food, transfusion of blood, blood plasma, solutions of glucose. Three days before the operation is prescribed "this template shall not" (without the fiber) diet; for the destruction of the microflora of the large intestine within three day to enter through a gastrostomy tube monomitsin or neomycin 100 000 IU three times a day. Before the operation the intestines carefully clear of laxatives and repeated enemas. After surgery, the stomach is possible accumulation of blood, mucus, so you should keep gastronomicheskie pipe open to give free outflow of gastric contents.

There are internal (from the mucous membrane) and external (with injuries of the neck, the chest) damage to the esophagus. Internal injuries most often arise from ingestion of foreign bodies (see), sometimes with careless ezofagoskopia or birovni of the esophagus.
External isolated injuries P. (stab and gunshot) are rare; they are often combined with damage to adjacent organs: trachea, thyroid, large vessels, heart, lungs and other Symptoms wounds in the neck part P.: pain when swallowing, the allocation from the wounds of saliva and food when eating. 2-3 days develops esophagitis, periesophageal, and then mediastinum, the latter often due to purulent streaks. If the damage thoracic appear chest pain when swallowing, blood vomiting, mediastinal emphysema and subcutaneous emphysema in supraclavicular pits, high temperatures. The rapidly evolving phenomenon of mediastinitis, pleurisy, pericarditis. Injuries abdominal esophagus lead to the development of peritonitis. Closed breaks P. occur very rarely in a sudden compression (car, buffers cars, wheels, etc.,).
Treatment of injuries of Peterhof is an urgent operation. In severe injuries produce (depending on localization) exposure P. neck, mediastinotomy or laparotomy and diafragmei. If the injuries of the cervical spine P. wound its walls sew, leaving the remaining tissue wounds unembroidered. The wounded lay on the bed with lowered head end to warn numb pus in the mediastinum. Fed through a probe inserted through the nose, and in severe cases impose a gastrostomy tube. Within three days is forbidden to eat and drink, pour glucose, protein liquid, physiological solution, administered antibiotics. With the development of mediastinitis, pleurisy or peritonitis shows pleurectomy (see Thoracotomy), mediastinotomy (see) or laparotomy (see).