3.ACQUIRED
The acquired disorders may present in childhood or in
adult life
and manifest most
often with complaints
of difficulty in
swallowing(dysphagia).
* The
complaint may follow
a history of having swallowed a
chemical (corrosive
stricture) or it
may be a
slow
progressive dysphagia
(aclasia, reflux oesophagitis,
carcinoma)
* The other
complaints in disorders of the
oesophagus are
related to the
under nutrition as a result of the dysphagia.
* The retained
contents of the oesophagus can also be aspirated
into the
lungs resulting in
infection and respiratory
insufficney.
2.2.1 CORROSIVE STRICTURES
These are caused by alkalies (sodium hydroxide, sodium
carbonate)
and acids (hydrochloric, nitric, sulphuric) they are used
in the
households for cleaning purposes and may be
accidently ingested.
- In these
cases strictures may form at any
site from the
oropharynx to the
small intestines in addition
to the
oesophagus.
- It is
important that the chemical
be identified by the
history, examination of the container or from analysis
of
the contents
of the container.
*
Neutralisation can only be possible if
the patient is seen
within the hour
after ingestion.
* Inducing
vomitting or gastric lavage are contraindicated.
* If the patient
has stridor, hoarseness dyspnoea or shows sign
of burns
in the mouth and pharynx the patient
should be
admitted.
* To prevent
excessive inflammation and oedema treatment should
be started with
antibiotics and steroids.
* In cases of increasing respiratory
difficulty,tracheostomy
may be
required.
* X-ray of the
chest and abdomen should be studied for evidence
of perforation into the mediastinum and into
the peritoneal
cavity (air
leak)
On diagnosis of burns further treatment consists of :
* Medical
treatment with antibiotics and steroids (3 weeks) to
minimise
fibrous tissue laying down and
Dilation and
splinting of the burn segment so as to
maintain
the lumen of
the oesophagus
In cases where inspite of above regime strictures form.
* Gastrostomy may
be required to maintain nutrition.
* This is
followed by dilatation using direct visualisation of
the stricture
through an oesophaguscope or
alternatively
retrograde
dilatation through a gastrostomy.
* Savary-Gilliard
bougies are another dafe method. A guide
wire
is introduced through the instrument channel
of a
flexible
esaphagoscope. The scope is then
removed and savary dilaters
threaded over
the guide wire.
* In
some cases of
extensive persistent strictures,
reconstrcution of oesophagus by
interposition of colonic
segment may be
required.
Operative
intervention is indicated when
-
there is complete stenosis in which all
attempts at dilatation have failed
-
severe periesophageal reaction or
mediastinitis develops with dilation
-
a fistula forms
-
the patient is unable to undergo
repeated dilation for a prolonged period of time
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