Spontaneous perforation of the esophagus most frequently occurs in the:
|A||Left pleural cavity|
a. Spontaneous perforation usually occurs in a patient with gastroesophageal reflux disease.
b. Perforation usually occurs either in the left pleural cavity or just above the GE junction.
c. Esophageal perforation or rupture may initiate a virulent periesophageal infection.
d. Most esophageal perforation today occur after some form of esophageal instrumentation.
e. Of equal incidence are those encountered after GERD, foreign body ingestion, stress associated with neurological disease. burns, penetrating external trauma.
f. Patients with a perforation in the middle portion or lowermost portion of the esophagus may have difficulty swallowing, chest pain, and difficulty breathing.
g. The wall of the oesophagus may be breached in number of ways.
h. Breaking down of the wall by localized inflammatory process resulting from mucosal tear may occur.
i. Perforation from pressure necrosis or devascularization may occur.
j. Perforation by instruments may occur at any level of the oesophagus.
k. Sites of the narrowing are frequently involved.
l. Anatomic consideration are important, both in the evolution of signs and symptoms and in treatment of perforation.
m. Anterior wall of the cervical oesophageal perforation occurs in the lateral pharyngeal spaces.