Oesophageal Perforation
MECHANISM
- spontaneous (Boerhaave syndrome, deceleration injury)
- penetrating (intra and extraluminal)
CLINICAL FEATURES
- subcutaneous emphysema
- retrosternal or pleuritic chest pain
- fever
- dysphagia
- odynophagia
- hoarseness
- cervical tenderness
- sepsis
INVESTIGATIONS
- CXR: pneumomediastinum, pneumothorax, pleural effusions.
- contrast esophagogram: high sensitivity and tolerated well
- CT: wall discontinuity, contrast extravasation, pneumomediastinum, oesophageal thickening, mediastinal fluid collections.
MANAGEMENT
- within 12 hours: optimally repaired with drainage of collections.
– > 12 hours:
-> primary closure discouraged
-> generous drainage
-> diversion of oesophagus
-> antibiotics
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC