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Esophageal Trauma, Emergency Medicine

Susan E. Dufel Reviewed 06/2017



  • Adult esophagus is ∼25–30 cm in length in close proximity to mediastinum with access to pleural space.

  • It begins at hypopharynx posterior to larynx at level of cricoid cartilage.

  • On ei...


Signs and Symptoms


  • Dysphagia: Difficulty swallowing

  • Odynophagia: Pain with swallowing

  • Chest pain: Angina like, often pleuritic, severe, and unrelenting

  • Hoarseness

  • Dyspnea

  • Tears or perforati...



  • Chest pain should be presumed cardiac.

  • Airway protection, frequent suctioning

  • Intravenous crystalloid if patient is hypotensive, vomiting, or if hematemesis is present

  • Pain manageme...



Admission Criteria

  • Caustic ingestion

  • Sharp foreign bodies

  • Airway compromise

  • Penetrating neck or chest trauma

  • Evidence of sepsis, mediastinitis, or esophageal perforation

  • Significant ble...

Pearls and Pitfalls

Factors to predict outcomes in esophageal injuries: 
  • Time to diagnosis and definitive therapy: 24 hr decreases mortality by half.

  • Location of injury: Cervical less than thoracic or a...

Additional Reading

  • Abbas  G, Schuchert  MJ, Pettiford  BL, et al. Contemporaneous management of esophageal perforation. Surgery.  2009;146(4):749–755.

  • Gander  JW, Berdon  WE, Cowles  RA. Iatrogeni...



  • 862.22 Injury to esophagus without mention of open wound into cavity

  • 862.32 Injury to esophagus with open wound into cavity

  • 935.1 Foreign body in esophagus

  • 947.2 Burn of esophagus

  • 530.4 Perforat...

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