Oesophageal trauma

Trauma to the oesophagus is encountered rarely, but these injuries represent life-threatening emergencies. The majority are perforations secondary to therapeutic upper gastrointestinal endoscopy and to a lesser extent, diagnostic endoscopy, probably as a result of the dramatic increase in its use. The principles of investigation and management are similar for all causes of oesophageal trauma and outcomes are 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. 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 may be possible in carefully selected patients, but should be viewed as the ‘radical’ choice. The majority of patients require surgery and this should be performed in a specialist centre with experience in dealing with these patients.