Pediatric emergency medicine trisk 4080 4080
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FIGURE 124.4 A child with chronic partial obstruction of the esophagus caused by a
congenital web. Similar bulbous enlargement of the proximal esophagus can occur with any
type of stricture and results in pressure on the trachea and recurrent regurgitation with
aspiration. T4, 4th thoracic vertebrae.
Clinical Recognition
Clinical findings range from a normal physical examination to respiratory distress
and hemodynamic instability. Most patients will complain of oropharyngeal
discomfort, odynophagia, dysphagia, and chest pain. Stridor may indicate
laryngeal and epiglottic edema, and if accompanied by drooling should raise
suspicion for esophageal injury. Other signs of esophageal injury include
dysphagia, retrosternal pain, epigastric pain, and hematemesis. However, clinical
symptoms may be poor predictors of the extent of injury. Ominous signs include
hemodynamic instability, fever, tachycardia, and mental status changes; such
findings raise concern for esophageal perforation and developing mediastinitis.
Management
Initial management includes the assessment of the severity of injury and the
prevention of further injury. If possible, the type and amount of corrosive agent
