食道穿孔 II: 臨床症状と管理。

The clinical manifestations of esophageal perforations depend on the injury's location and severity.

Patients with cervical esophageal perforations may present with symptoms like neck pain, dysphagia, odynophagia, or dysphonia.

Thoracic perforations lead to retrosternal chest pain, often preceded by nausea and vomiting.

Abdominal esophageal perforations result in epigastric pain radiating to the shoulder.

Additionally, Perforations extending through the serosa can cause acute peritonitis.

Unstable patients with hemodynamic instability, respiratory distress, or sepsis require immediate ICU admission for airway management and supplemental oxygen.

Additionally, encouraging nothing-by-mouth status, IV fluids, antibiotics, proton pump inhibitors, and percutaneous drainage of fluid collections are essential.

In some cases, total parenteral nutrition may be necessary.

Nonoperative methods, such as endoscopic stent placement or endoscopic clips, may be appropriate for closing esophageal perforations in hemodynamically stable patients.

Lastly, surgery involves esophageal diversion or resection and esophagostomy.