Canadian Journal of Anesthesia, Vol 33, 222-226, Copyright © 1986 by Canadian Anesthesiologists' Society

Iatrogenic Oesophageal Perforation due to Tracheal or Nasogastric Intubation

¹ Department of Anaesthesiology, Saint Barnabas Medical Center, Livingston, New Jersey

Address correspondence to: Dr. Edward A. Norman, Saint Barnabas Medical Center, Old Short Hills Road, Livingston, New Jersey 07039, U.S.A.

Oesophageal perforation, due to a difficult endotracheal or nasogastric intubation occurred in a 49-year-old female. Perforation of the oesophagus is a rare complication of intubation of the trachea or oesophagus. Endotracheal intubation alone is most often blamed for iatrogenic oesophageal trauma following surgery. The incidence of iatrogenic oesophageal trauma is similar after nasogastric or endotracheal intubation. Iatrogenic oesophageal perforation occurs principally over the cricopharyngeus muscle on the posterior wall of the oesophagus. Here the oesophagus is thin and is markedly narrowed. Contamination of the perioesophageal space with gastric contents leads to diffuse cellulitis and infection. Diagnosis is made by evidence of cervical subcutaneous emphysema, cervical pain, dysphagia, temperature elevation and leukocytosis. Plain roentenograms of the neck and a contrast media swallow will confirm the diagnosis. Treatment consists of massive antibiotic therapy followed by surgical repair and drainage of the area. Mortality ranges from 10-15 per cent with early diagnosis to 50 per cent if surgery is delayed.

Key Words: COMPLICATIONS: oesophageal perforation, iatrogenic rupture of the oesophagus • ANAESTHETIC TECHNIQUES: tracheal intubation, gastric intubation