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, Radiopaedia.org, 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, Radiopaedia.org, 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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