True about esophageal injury:
Ans is All Most injuries to the esophagus are from penetrating trauma. Associated injuries are the rule.Symptoms include odynophagia (pain on swallowing foods or fluids), subcutaneous or mediastinal emphysema, pleural effusion, air in the retro-esophageal space and unexplained fever within 24 hours of injury. Mediastinal and deep cervical emphysema must be seen as evidence of an aerodigestive injury until proven otherwise.If the diagnosis is made early, primary surgical repair is generally possible. If the diagnosis is delayed for more than 24 hours, primary repair may be impractical, with diversion and drainage being the only alternative. The major morbidity and moality associated with esophageal injuries are the result of delay in diagnosis, which underscores the necessity to aggressively exclude esophageal injury during the initial evaluation of a patient with neck injury. "The moality rate rises exponentially if treatment is delayed for more than 12-24 hours."- Bailey and LoveEsophagoscopy can be performed to evaluate the esophagus, but injuries have been missed with this technique alone. Therefore patients at risk should also undergo a soluble contrast esophagram looking for extravasation of contrast. If no extravasation is seen, a barium esophagram should be performed for greater detail. Failure to identify esophageal injuries leads to fulminant mediastinitis that is often fatal.Treatment consists of early debridement, primary repair, and drainage if identified within 24 hours after injury. Injuries diagnosed after 24 hours with mediastinal contamination are treated by cervical esophagostomy and distal feeding access. Esophageal resection is rarely needed but may be indicated in patients with esophageal necrosis or severe mediastinitis.. A drain should be left in place after all esophageal repairs.
Most common after penetrating injury
Can lead to mediastinal collection
Barium swallow is diagnostic
All