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Esophageal Non-traumatic Emergencies

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Textbook of Emergency General Surgery

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Abstract

Esophageal non-traumatic emergencies are more common as compared to the traumatic etiology and are mostly represented by iatrogenic perforation, barogenic (Boerhaave) perforation, foreign body ingestion, complications of reconstructive esophageal surgery, descending necrotizing mediastinitis, and esophageal bleeding. In general, esophageal emergencies are rare but burdened with high morbidity and mortality if not recognized and treated promptly. Early diagnosis, stratification of risk score at presentation, and individualized treatment are consistently recommended, but management strategies vary widely and are influenced by the patient’s physiologic status, type of clinical presentation, site and size of injury, hospital setting, and locally available expertise. A high degree of suspicion is recommended in clinical situations that may be associated with or have the potential to progress to esophageal perforation. Both computed tomography (CT) scan and endoscopy are reliable diagnostic tools and their use should be tailored to the patient’s conditions in order not to miss subtle findings that may significantly impact clinical decision-making and prognosis. Endoscopic and surgical approach still represents the mainstay of therapy. Hybrid minimally invasive techniques, including interventional radiology/endoscopy and/or thoracoscopy/laparoscopy, are effective and increasingly used in centers where multidisciplinary expertise is available. Non-operative management is a reasonable option in carefully selected patients, but a low threshold of alert and an aggressive policy of percutaneous drainage are mandatory to control sepsis.

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Authors and Affiliations

  1. Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Milan, Italy

    Luigi Bonavina, Emanuele Asti & Tommaso Panici Tonucci

  2. Department of Surgery, I.R.C.C.S. Policlinico San Donato, Milan, Italy

    Luigi Bonavina

Authors
  1. Luigi Bonavina
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  2. Emanuele Asti
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  3. Tommaso Panici Tonucci
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Correspondence to Luigi Bonavina .

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Editors and Affiliations

  1. General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Pisa, Italy

    Federico Coccolini

  2. General and Emergency Surgery Dept., Bufalini Hospital, Cesena, Italy

    Fausto Catena

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Bonavina, L., Asti, E., Tonucci, T.P. (2023). Esophageal Non-traumatic Emergencies. In: Coccolini, F., Catena, F. (eds) Textbook of Emergency General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-22599-4_56

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  • DOI: https://doi.org/10.1007/978-3-031-22599-4_56

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