Injuries of the Esophagus.
The oesophagus is often involved in injuries inflicted with suicidal intent, the ingestion of corrosive fluids and at tempts at throat-cutting being the chief casualties of this kind met with in prac tice. Many accidents occur also through the accidental swallowing of acids or strong alkalies,—concentrated lye, for instance,—or a household disinfectant, such as carbolic acid, or, again, boiling tea or coffee from the spout of a vessel.. A corrosive substance taken by a suicide is usually taken hastily and thrown, as it were, far back into the mouth. Spasm of the larynx usually ensues and col lapse follows. The same effect is gener ally, however, produced in accidental cases, and the lips, the gums, or even the front part of the tongue do not al ways indicate the severity of the lesions produced. If death does not immedi ately occur from laryngeal spasm,—i.e., asphyxia and shock, — severe pain is experienced and acute cesophagitis (see below) ensues. Wounds of this region due to accidents or military weapons are extremely rare, however, but one injury of the cesophagus, for instance, having been recorded during the Rebellion. The protected position of the cesophagus anteriorly and posteriorly seems to ac count for this, the sternum and spinal column acting as shields.
(Esophagitis.
Symptoms.—In cases arising from in jury of the cesophageal tissues pain is marked, especially during deglutition, unless the traumatism be of such a na ture as to completely destroy the tissues and their nervous supply, as sometimes happens when caustic acids are swal lowed. these circumstances slight pain in the periphery of the disorganized mass is the general result. The pain usually experienced is continuous and dull, and usually follows the long axis of the sternum, extending to the back and neck. Motions of the head or shoulders sometimes aggravate it. At times it is burning. especially if the le sion is not deep-seated and when regur gitation of the acid gastric contents oc curs. Spasm is frequent in such cases. A sensation suggesting the presence of a foreign body is complained of.
After a lapse of time, varying with the gravity of the injury, hmmatemesis may occur, owing to the contraction of the muscular supply around the ulcer ated areas that are undergoing the proc ess of repair; but this is generally of short duration. Large quantities of mu cus and muco-pus are often voided.
The sequel of these cases are usually serious. Even after slight injuries, sometimes, cicatricial stenosis occurs that leads to cesophageal stricture.
The presence of blood in the food and localized pain suggest that a foreign body may be present when no other clear indication is furnished by the history. This form often becomes phlegmonous and is usually attended by a febrile re action. Pseudomembrane may also be vomited: indicative of the form of stenosis present. Thrush, it must be remembered, may be attended by no other symptom than impediment to the passage of food.
In some cases the local inflammatory symptoms — difficult deglutition, the muco-purulent discharge, etc.—continue for some time. Such cases are termed chronic cesophagitis by some authors.
Diagnosis. — In traumatic cases the history and the symptoms render the di agnosis easy. The location of the pain usually points to the seat of the lesion; this may be verified by the passage of the cesophageal sound: a dangerous pro cedure in severe injuries. In acute cesophagitis occurring in the course of febrile diseases a condition with which it may be confounded is the irritation following repeated vomiting of acid sub stances. The discomfort resulting from this, however, is of short duration, while the symptoms of true cesophagitis are continuous and more marked.
Etiology.—Almost all cases of acute cesophagitis are due to mechanical and chemical irritation or destruction by caustic acids, hot liquids, and foreign bodies. Cases due to the ingestion of acids are often met in connection with attempts at suicide, while the two latter exciting factors usually come into play accidentally. Carbolic acid is most fre quently used by suicides, while the acci dental agents are boiling liquids, con centrated lye, and spicules of bone.