A patient is admitted to the hospital after ingesting lye. The following day he complains of chest pain. His pulse is 120 bpm. On physical examination he is found to have subcutaneous crepitus on palpation. His chest x-ray shows widening of the mediastinum and a pleural effusion. What has occurred?
Esophageal perforation has occurred. Caustic alkali ingestion results in liquefactive necrosis while acid ingestion causes coagulation necrosis. The esophagus is more often involved than the stomach during alkaline ingestion (and conversely, the stomach is more often involved than the esophagus during acid ingestion). Features on x-ray suggesting esophageal perforation include pneumothorax, pneumomediastinum, and pleural effusion Ewald tubes or nasogastric tubes should be avoided because of the risk of perforation.
Aortic rupture
Coagulation necrosis
Esophageal perforation
Oropharyngeal inflammation
Stomach & Duodenum