Injuries of the esophagus

1. Big picture

Esophageal injury is a surgical emergency until proven otherwise because leakage of saliva, gastric contents, food particles, and bacteria into the neck, mediastinum, pleural cavity, or peritoneum can rapidly cause mediastinitis, empyema, sepsis, and death. The most exam-relevant injury is esophageal perforation, especially after endoscopy, dilatation, intubation, foreign body ingestion, trauma, or forceful vomiting.

The examiner usually wants you to say:

Suspect it early → stop oral intake → resuscitate → broad-spectrum antibiotics → CT/contrast study → drainage/repair/stent/resection depending on stability, timing, location, and contamination.

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