Table 2 Main management principles of esophageal injuries
Foreign body ingestion (FB) | |
• Computed tomography (CT) is the key exam in patients with suspected perforation or other FB-related complications | |
• Emergent endoscopy (< 6 h) is recommended for sharp-pointed objects, batteries, magnets and for complete esophageal obstruction | |
• Indications for surgery include perforation and FB which are irretrievable or close to vital structures | |
• Esophagotomy with FB extraction and primary closure is the preferred approach. | |
Caustic ingestion | |
• The quantity of the ingested agent and the accidental-voluntary ingestion pattern condition outcomes | |
• Emergency management can be performed safely relying on computed tomographic evaluation alone | |
• Endoscopy remains the main diagnostic and therapeutic tool for caustic strictures | |
• Patients who do not have full-thickness necrosis of digestive organs can be offered non-operative management (NOM) under close clinical and biological monitoring. Emergency resection of caustic necrosis can be lifesaving. | |
Esophageal perforation (EP) | |
• Contrast-enhanced CT and CT esophagography is the imaging examination of choice | |
• NOM can be offered to stable patients with early presentation, contained esophageal disruption and minimal contamination of surrounding spaces. Endoscopic (clips, stents) treatment and interventional radiology techniques are useful adjuncts during NOM | |
• Emergency surgery should be undertaken in patients who do not meet NOM criteria. Direct repair and adequate drainage is the treatment of choice; if repair is not feasible (large disruption, delayed surgery, preexistent esophageal disease), external drainage, esophageal exclusion or resection are possible options. | |
Esophageal trauma | |
• Physical examination and laboratory studies are not useful for early diagnosis of TIE. | |
• Contrast-enhanced CT and CT esophagography should be performed in hemodynamically stable patients with suspicion of TIE. Preoperative flexible endoscopy is useful for TIE diagnosis in unstable patients | |
• Patients with TIE can be offered NOM if they do not have EP or if they meet NOM criteria for EP | |
• Patients with TIE should undergo immediate surgical treatment if they have hemodynamic instability, obvious non-contained extravasation of contrast material and systemic signs of severe sepsis | |
• Operative repair is the treatment of choice of TIE. Appropriate management of associate injuries conditions patient survival |