Oesophageal trauma

Trauma to the oesophagus is a rare but life threatening emergency. The majority of injuries occur as perforations secondary to therapeutic upper gastrointestinal endoscopy and, to a lesser extent, diagnostic endoscopy. The principles of investigation and management are similar for all causes of oesophageal trauma with outcomes more dependent on the severity of the injury than the cause. These remain difficult conditions to manage as the diagnosis is frequently overlooked and through the lack of exposure and experience amongst clinicians in dealing with the spectrum of oesophageal trauma. A high index of suspicion is therefore required. Initial investigation with chest radiography or contrast swallow is standard but CT and endoscopic assessment are used increasingly to make the diagnosis and to monitor the status of the injury or its repair. Non-operative management is possible in carefully selected patients. Surgery, when indicated, should be performed in a specialist oesophago-gastric centre.