Esophageal perforation: Difference between revisions
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#Iatrogenic | #Iatrogenic | ||
#Boerhaave syndrome | #Boerhaave syndrome | ||
#Trauma | #[[Thoracic Trauma]] | ||
##Penetrating | ##Penetrating | ||
##Blunt (rare) | ##Blunt (rare) | ||
Revision as of 07:01, 3 January 2014
Causes
- Iatrogenic
- Boerhaave syndrome
- Thoracic Trauma
- Penetrating
- Blunt (rare)
- Caustic ingestion
- Foreign body
- Bone, button battery
- Infection (rare)
- Tumor
- Aortic pathology
- Barrett esophagus
- Zollinger-Ellison syndrome
Diagnosis
History
- Pain
- Acute, severe, unrelenting, diffuse
- May be localized to chest, neck, abdomen; radiate to back and shoulders
- Dysphagia
- Dyspnea
- Hematemesis
Physical Exam
- Cervical subcutaenous emphysema
- Mediastinal emphysema
- Takes time to develop
- Absence does not rule out perforation
Imaging
- CXR
- CT chest
- Emergent endoscopy
DDx
- ACS
- PE
- Aortic catastrophe
- Acute abdomen
- Peptic ulcer disease
Management
- Volume resuscitation
- Broad-spectrum IV Abx
- Emergent surgical consultation
Source
Tintinalli