Canadian Anaesthetists’ Society Journal

, Volume 33, Issue 2, pp 222–226

Iatrogenic oesopha-geal perforation due to tracheal or naso-gastric intubation

  • Edward A. Norman
  • Mitchel Sosis
Article

Abstract

Oesophageal perforation, due to a difficult endotracheal or nasogastric intubation occurred in a 49-year-old female. Perforation of the oesophagus is a rare complication of intubation of the trachea or oesophagus. Endotracheal intubation alone is most often blamed for iatrogenic oesophageal trauma following surgery. The incidence of iatrogenic oesophageal trauma is similar after nasogastric or endotracheal intubation. Iatrogenic oesophageal perforation occurs principally over the crico-pharyngeus muscle on the posterior wall of the oesophagus. Here the oesophagus is thin and is markedly narrowed. Contamination of the perioesophageal space with gastric contents leads to diffuse cellulitis and infection. Diagnosis is made by evidence of cervical subcutaneous emphysema, cervical pain, dysphagia, temperature elevation and leukocytosis. Plain roentenograms of the neck and a contrast media swallow will confirm the diagnosis. Treatment consists of massive antibiotic therapy followed by surgical repair and drainage of the area. Mortality ranges from 10-15 per cent with early diagnosis to 50 per cent if surgery is delayed.

Key words

complications: oesophageal perforation, iatrogenic rupture of the oesophagus anaesthetic techniques: tracheal intubation, gastric intubation 

Résumé

Les auteurs présentent un cas clinique de perforation cesophagienne dû à une intubation endotrachéale ou nasogastrique difficile. La perforation de I’azsophage est une complication rare de I’intubation de la trachée et de I’cesophage. Vintubation endotracheale seule est consideree le plus souvent comme responsable du traumatisme cesophagien après la chirurgie. Les statistiques démontrent que iincidence du traumatisme cesophagien iatrogénique est égale après I’intubation nasogastrique que I’intubation endotrachéale. La perforation cesophagienne iatrogienique survient principalement au dessus du muscle cricopharyngé au niveau de la paroi postérieure. A cet endroit I’cesophage est mince et retrécit. La contamination de I’espace péricesophagien avec le contenu gastrique aboutit à une cellulite diffuse et à l’infection. Le diagnostic est fait par la présence de I’emphysème sous-cutané cervical, douleur cervicale, dysphagie, eélévation de la température et leucocytose. Un rayon x du cou et une gorgée barytée confirment le diagnostic. Le traitement consiste en une antibiothérapie massive suivie d’une réparation chirurgicale et drainage de la région. La moralité s’étend de dix é 15 pour cent avec un diagnostic précoce et a 50 pour cent si la chirurgie est retardée.

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Copyright information

© Canadian Anesthesiologists 1986

Authors and Affiliations

  • Edward A. Norman
    • 1
  • Mitchel Sosis
    • 1
  1. 1.Department of AnaesthesiologySaint Barnabas Medical CenterLivingston
  2. 2.Saint Barnabas Medical CenterLivingstonUSA

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