Esophageal Emergencies

Your patient is a previously healthy 26-year-old male presenting for "something stuck" in his throat. He was eating a hot dog on "game day" when he felt it stick in his chest. Since then he's had trouble swallowing anything. He is carrying a can of soda--into which he's been spitting out his own saliva. What is the next move here? Is there any role for glucagon? Is papaya, kiwi, or pineapple a better option? Should you get him another can of soda?

Click on the following helpful guide to esophageal emergencies to solidify your esophageal emergency basics.

References (Pneumomediastinum):

•Bakhos CT, Pupovac SS et al. Spontaneous pneumomediastinum: an extensive workup is not required. J Am Coll Surg. 2014 Oct;219(4):713-7.

•Banki F et al. Pneumomediastinum: etiology and a guide to diagnosis and treatment. Am J Surg. 2013 Dec;206(6):1001-6.

•Caceres M, Ali SZ, Braud R, Weiman D, Garrett HE Jr. Spontaneous pneumomediastinum: a comparative study and review of the literature. Ann Thorac Surg. 2008 Sep;86(3):962-6. 28

•Case courtesy of Dr Ian Bickle,, rID: 56837

•Wu CH, Chen CM, Chen CC, Wong YC, Wang CJ, Lo WC, Wang LJ. Esophagography after pneumomediastinum without CT findings of esophageal perforation: is it necessary? AJR Am J Roentgenol. 2013 Nov;201(5):977-84.

References (Perforation):

•Awais M, Qamar S, Rehman A, Baloch NU, Shafqat G. Accuracy of CT chest without oral contrast for ruling out esophageal perforation using fluoroscopic esophagography as reference standard: a retrospective study. Jun 2019;45(3)517-525

•Hasimoto CN, Cataneo C, Eldib R, et al. Efficacy of surgical versus conservative treatment in esophageal perforation: a systematic review of case series studies. Acta Cir Bras 2013;28(4):266–71.

•Nirula R. Esophagal perforation. Surg Clin North AM. 2014 Feb;94(1):35-41.

•Schweigert M et al. Endoscopic stent insertion versus primary operative management for spontaneous rupture of the esophagus (Boerhaave syndrome): an international study comparing the outcome. Am Surg. 2013 Jun;79(6):634-40.

•Soreide JA, Vista A. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011 Oct 30;19:66.

References (Impaction and Solid Ingestions):

•Arms JL et al. Safety and Efficacy of a Protocol Using Bougienage or Endoscopy for the Management of Coins Acutely Lodged in the Esophagus: A large case series. Ann Emerg Med Apr;51(4):367

•Aronberg RM, Punekar SR, Adam SI, judson BL, Mehra S, Yarbrough WG. Esophageal perforation caused by edible foreign bodies: a systematic review of the literature. Laryngoscope. 2015 Feb;125(2):371-8.

•Birk M et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy Clinical Guideline. Endoscopy 2016 May;48(5):489-96.

•Case courtesy of Dr Henry Knipe,, rID: 32704

•David J, Backstedt D, O’Keefe KJ, Salehpour K, Gerkin RD, Ramirez FC. Effervescent agents in acute esophageal food impaction. Diseases of the Esophagus. 2019 Apr;32(4)

•Dedhia K. Is there a need for repeat examination of children with esophageal coin foreign body? Otolaryngol Head Neck Surg 156(1):173, January 2017.

•Jarugula, R, et al. Oesophageal Button Battery Injuries: Think Again. Emerg Med Australasia. 2011 Apr;23(2):220.

•Kim ES et al. Traumatic esophageal perforation by a self-bougienage. Journal of Thoracic Disease 2017 May;9(5):E408-E411

•Long B, Koyfman A, Gottlieb M. Esophageal Foreign Bodies and Obstruction in the Emergency Department Setting: An Evidence-Based Review. J Emerg Med. 2019 May;56(5):499-511

•Mangili G. Gastric and Esophageal Emergencies. Emerg Med Clin N Am 29(2011)273-291.

•Shuja A, Winston DM, Rahman AU, Mitty RD, Jaber BL, Keo T. Esophageal food impaction during cultural holidays and national athletic events. Gastroenterol Rep (Oxf). 2017 Feb;5(1):43-46.

•Singleton J, Schafer JM, Hinson JS, Kane EM, Wright S, Hoffman B. Bedside Sonography for the diagnosis of esophageal food impaction. Am J Emerg Med. 2017 May;35(5):720-724.

•Waltzman ML et al. A Randomized Clinical Trial of the Management of Esophageal Coins in Children. Pediatrics. 2005 Sep;116(3):614

References (Caustic Ingestion):

•Anderson KD, Rouse TM, Randolph JG. A controlled trial of corticosteroids in children with corrosive injury of the esophagus. N Engl J Med. 1990;323:637 – 640.

•Aronow SP, Aronow HD, Blanchard T, et al. Hair relaxers: a benign caustic ingestion? J Pediatr Gastroenterol Nutr 2003;36(1):120–5.

•Betalli P et al. Caustic Ingestion in Children: Is Endoscopy Always Indicated? The Results of an Italian Multicenter Observational Study. Gastrointest Endo. Sept 2008;68(3):434.

•Bruzzi Et al. Emergency Computed Tomography Predicts Caustic Esophageal Stricture Formation. Ann Surg Jul;270(1):109-114.

•Chirico M, Bonavina L, Kelly MD, Sarfai E, Cattan P. Caustic ingestion. Lancet. 2017 May 20;389(10083):2041-2052

•Gorman RL et al. Initial Symptoms as Predictors of Esophageal Injury in Alkaline Corrosive Ingestions. Am J Emerg Med. May 1992;10(3):189

•Gupta SK, Croffie JM,Fitzgerald JF. Is esophagogastroduodenoscopy necessary in all caustic ingestions? J Pediatr Gastroenterol Nutr 2001;32(1):50–3.

•Mangili G. Gastric and Esophageal Emergencies. Emerg Med Clin N Am 29(2011)273-291.

•Nascimento WV, Cassiani RA, Dantas RO. Gender effect on oral volume capacity. Dysphagia. 2012 Sep;27(3):384-9.

•Riffat F et al. Pediatric Caustic Ingestion:50 consecutive cases and a review of the literature. Dis Esophagus Feb 2009;22(1):89

•Salzman M, O’Malley RN Updates on the evaluation and management of caustic exposures. Emerg Med Clin North Am. 2007 May;25(2):459-76

•Ulman I et al. A Critique of Systemic Steroids in the Management of Caustic Esophageal Burns in Children. Eur J Ped Surg. April 1998;8(2):71

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Important: If you think you have a medical emergency, call 911 or go to the nearest hospital. The views expressed on this site are my own. Do not attempt emergency care through this site. The intended audience for this site is other emergency medicine physicians in an educational setting, and the information contained on this website provides general information for educational purposes only; it is not a substitute for medical or professional care. This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider. I am not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this site. The views expressed on this site should not be considered complete or exhaustive, nor should you exclusively rely on such information to recommend a course of treatment for you or any other individual.