Esophageal damage can actually show these symptoms

Esophageal injury is also known as esophageal rupture, which is mainly a disease of perforation. Long-term esophageal injury can easily lead to mediastinitis or esophageal diseases, which may be life-threatening. The most obvious symptoms of esophageal injury are rapid heartbeat, difficulty breathing, poisoning, abdominal pain, and a feeling of gas in the abdomen.

Clinical manifestations of esophageal injury

1. Cervical esophageal perforation

Esophageal perforation in the neck often occurs in the thinner posterior wall of the esophagus, because the prevertebral fascia attached to the esophagus can limit the lateral spread of contamination. There may be no inflammation in the neck in the first few hours after perforation. A few hours later, the fluid in the mouth or stomach enters the retroesophageal space and along the esophageal plane into the mediastinum through the perforation, causing mediastinitis. Patients complain of neck pain, stiffness, vomiting of bloody gastric contents and difficulty breathing. Physical examination revealed that the patient was critically ill with varying degrees of dyspnea. Rough, noisy breathing is usually audible from nasal breathing. Palpation of the neck revealed a stiff neck and crepitus due to subcutaneous emphysema. Symptoms of systemic infection and poisoning often occur after 24 hours.

2. Chest esophageal perforation

Thoracic esophageal perforation directly causes mediastinal contamination, rapidly leading to mediastinal emphysema and mediastinitis. This inflammatory process and the massive accumulation of fluids caused by esophageal perforation manifest clinically as severe pain in one side of the chest, which worsens with breathing and radiates to the scapular area. There is clear dysphagia, hypovolemia, elevated body temperature, and increased heart rate at the perforation site, and the increased heart rate is out of proportion to the increased body temperature. Systemic infection and poisoning symptoms, difficulty breathing. Physical examination revealed that the patients had varying degrees of poisoning symptoms, were afraid to breathe hard, rales could be heard at the lung bases, and when they held their breath, mediastinal friction sounds or crepitations could be heard with each heartbeat. Subcutaneous gas is felt at the base of the neck or the anterior chest wall. When the perforation breaks into the pleural cavity on one side, signs of hydropneumothorax appear to varying degrees. The upper part of the chest cavity on the affected side is tympanic when percussed, the lower part is dull when percussed, and the breath sounds on the affected side disappear. A small number of cases may develop into tension pneumothorax with tracheal displacement and mediastinal compression. Inflammation of the mediastinum and chest cavity causes irritation to the diaphragm, which may manifest as abdominal pain, upper abdominal muscle tension, and abdominal tenderness.

3. Abdominal esophageal perforation

Injury to the abdominal segment of the esophagus is rare. Once injured, gastric fluid enters the free abdominal cavity, mainly causing abdominal contamination, and the clinical manifestations are symptoms and signs of acute peritonitis. Sometimes this contamination may not be in the peritoneal cavity but in the retroperitoneum, which will make the diagnosis more difficult. This is because the abdominal esophagus is adjacent to the diaphragm, and is often accompanied by upper abdominal pain and dull pain behind the sternum that radiates to the shoulders.

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1. X-ray examination

X-ray examination is performed based on the location and cause of the perforation. Neck perforation may reveal gas in the cervical fascia plane, tracheal displacement, widening of the retroesophageal space, and disappearance of the normal physiological curvature of the cervical spine. In some patients, air-fluid level, cervical or mediastinal emphysema, pneumothorax, and pneumoperitoneum may be found in the retroesophageal space. When the esophagus perforates in the chest, it is found that the mediastinum is widened, there is gas or air-fluid level in the mediastinum, and there is air-fluid level in the chest cavity. Free gas may be found in the abdomen when there is esophageal perforation.

2. Esophageal radiography

For patients whose conditions allow, esophagectomy is used to confirm the diagnosis. For cases where ordinary X-rays indicate esophageal perforation, esophagectomy is also used to determine the size and location of the perforation. It should be noted that despite the use of angiography as a routine diagnostic tool, there is still a 10% false negative rate.

3. Gastroscopy

It has important diagnostic value for esophageal injury caused by chest trauma and foreign bodies. When esophageal angiography is negative, gastroscopy can sometimes be used to directly observe the esophageal injury, provide accurate positioning, and understand the contamination situation. The results of esophagoscopy also help in the selection of treatment.

4. CT examination

The diagnosis of esophageal perforation should be considered when the following signs are found in CT images: ① There is gas in the mediastinal soft tissue surrounding the esophagus. ② The abscess cavity in the mediastinum or chest cavity is close to the esophagus. ③ The air-filled esophagus communicates with a fluid-filled cavity adjacent to or beside the mediastinum. Pleural effusion, especially left-sided pleural effusion, further suggests the possibility of esophageal perforation.

5. Others

In patients with esophageal perforation, saliva, gastric juice and a large amount of digestive fluid enter the chest cavity. During diagnostic thoracentesis, the pH of the pleural fluid drawn is lower than 6.0, and the amylase content is elevated. This is a simple and diagnostically meaningful method. In cases of suspected esophageal injury, oral administration of a small amount of methylene blue may reveal a blue color in the drainage thoracentesis fluid, which is also helpful for diagnosis.