Editing Oesophageal perforation (section)

== Aetiology: ==

* Iatrogenic (60%)
** Endoscopy - diagnostic and      therapeutic - usually in distal oesophagus with an associated pathology
** Intra-operative - especially      cervical
** Intubation - NGT and ETT
** ''Overall      mortality 19%''
* Boerhaave's - spontaneous     rupture of oesophagus in the absence of prior pathology
** Secondary to barogenic      trauma, likely caused by failure of cricopharyngeus relaxation, leading      to immediate and gross gastric content contamination of the mediastinum      +/- pleural cavity. There may be an underlying anatomical predisposition      to this which we have not yet discovered.
** Differs from a Mallory-Weiss      tear (shearing forces) vs barogenic forces in a perforation
** Most common injury location      is just above GOJ in the left posterolateral position
** Mackler's triad: vomiting,      chest pain, surgical emphysema - uncommon
** Pleural effusion on left      (can go to right in hiatus hernia)
** Endoscope: visual defect
* FB
* Caustic ingestion
* Malignancy
* Trauma
** Penetrating - cervical stab      wounds, mediastinal gunshot wounds
** Blunt - rare - secondary to      blast
** Needs high index of      suspicion to diagnose

{| class="wikitable"
|Medical  Instrumentation
|Percentage  Risk of Iatrogenic Oesophageal Disruption
|-
|Dilatation

Dilatation  for achalasia

Endoscopic  mucosal resection

Stent  placement

Endoscopic  thermal therapy

Treatment  of variceal bleeding

Endoscopic  laser therapy

Photodynamic  therapy

Stent  placement
|0.5

2

2

2

1–2

1–6

1–5

5

5-25
|}