It is often caused by trauma, foreign bodies, or a sudden increase in intra-abdominal pressure (such as severe vomiting or childbirth), and can also result from iatrogenic injury, such as improper manipulation during esophagoscopy or gastroscopy.

bubble_chart Diagnosis

1. History of trauma, ingestion of sharp foreign objects, endoscopy, or severe vomiting.

2. Severe chest pain, difficulty swallowing, or severe upper abdominal pain that may be misdiagnosed as an acute abdomen.

3. If the injury is in the cervical esophagus, a lateral neck X-ray may show widening of the retro-pharyngeal space shadow and subcutaneous emphysema. If the injury is in the thoracic esophagus, mediastinal emphysema or hydropneumothorax may be observed. Oral administration of iodized oil may reveal contrast medium leaking outside the esophageal lumen into the mediastinum or pleural cavity. In cases of mediastinitis, widening of the mediastinal shadow may be seen.

4. In cases of hydropneumothorax, thoracentesis after oral administration of methylene blue may yield blue-stained fluid. If the pleural cavity is infected, pus may be aspirated during thoracentesis.

5. Physical examination may reveal subcutaneous emphysema at the root of the neck.

6. Esophagoscopy may reveal a perforation in the esophageal wall. {|105|}

bubble_chart Treatment Measures

1. Immediate fasting, jejunostomy, and infection control.

2. For injuries in the cervical esophagus, perform drainage via the neck.

3. For injuries in the thoracic esophagus, perform closed thoracic drainage and mediastinal drainage, along with jejunostomy. If the infection is severe, consider cervical esophageal exteriorization.

5. For patients with advanced-stage thoracic esophageal injuries (diagnosed more than 24 hours after injury), esophageal reconstruction may be performed after controlling mediastinal and pleural infections and improving the patient's overall condition. {|104|}