Updates in the Management of Esophageal Emergencies (Caustic and Iatrogenic Injuries)

Abstract

Esophageal emergencies as caustic and iatrogenic injuries are a life-threatening condition that requires an optimal management to avoid fatal outcomes. Diagnosis is based on clinical manifestation, computed tomography imaging, and esophagogastroduodenoscopy. Conservative treatment including respiratory, metabolic, and hemodynamic optimization is the most frequent approach after caustic ingestion. When surgery is mandatory, the most common procedure is esophagogastrectomy by laparotomy and cervicotomy, followed at least 6 months later by esophageal reconstruction with colon interposition. Esophageal perforations are most frequently caused by iatrogenic injuries. Drainage and reinforced primary repair are the treatment of choice of esophageal perforation in a patient without malignancy. In case of malignancy or pathological esophagus, esophagectomy is the preferred choice. Non-operative management may be considered in case of contained esophageal perforation invery selected patient.