ESOPHAGEAL

OBSTRUCTION
ESOPHAGEAL DISORDERS
INTRODUCTION
The esophagus is a mucus lined, muscular tube that
carries food from the mouth to the stomach. It begins at the
base of the pharynx and ends about 4cm below the
diaphragm. Its ability to transport food and fluids is
facilitated by two sphincters that is hypopharyngeal
sphincter which is located at the junction of pharynx and
esophagus and gastro esophageal sphincter which is
located at junction of esophagus and stomach.
Definition of Esophageal
obstruction
Esophageal obstruction is the name given to a medical
emergency that results when a food bolus or other foreign
body fails to pass through the esophagus and becomes
lodged on its lumen instead.

It is commonly known as "steakhouse syndrome", since

meats such as steak, poultry or pork is among the most
common foods that can trigger the syndrome.
This is usually recognized by the abrupt onset of a difficulty
in swallowing, which prevents the subsequent passage of
food through the esophagus and results in the need for
emergency.
Incidence
• Esophageal obstruction occurs more frequently in adults,
although it is occasionally observed in children too.

Etiology
• Large food bolus
• Strictures or stenosis
• Carcinoma
• Shatzki’s ring (15% of people have fibrous stricture near
GE junction)
Plummer Vinson syndrome: It is a rare condition
characterized by classic triad of iron deficiency anemia,
dysphagia and esophageal webs along with cheliosis,
glossitis, and friable mucosa.

Zenkers’ diverticulum: out pouching of pharyngeal mucosa

because of improper relaxation of the cricopharyngeus
muscle; may feel a mass in the neck.
Zenkers’ diverticulum: out pouching of pharyngeal mucosa
because of improper relaxation of the cricopharyngeus
muscle; may feel a mass in the neck.

• Anomalous right sub clavian artery is the most common

vascular cause
• Goiter
• Foreign bodies
Clinical manifestations
• Difficulty Swallowing
• Choking
• Dysphagia
• Drooling of saliva
• Chest Pain
• Neck Pain
• Abdominal Pain
• Heartburn
• Gastro esophageal Reflux
• Painful Swallowing (odinophagia)
• Asthma
Diagnosis
• Endoscopy .
• X-ray.
• C T Scan.
• MRI
Management
Medical management
• Obstruction of the esophagus represents a potentially serious medical
problem.
• The choice of treatment depends on the specific characteristics of the
case, including the nature of the obstructing object.
1. Rigid Oesophagoscopy under general anaesthetic ; The standard
method of removal in cases, if the object presents sharp edges
(such as bony material) or has a corrosive capacity (for example
batteries). It should be removed urgently.
2. Esophageal obstructions in patients with a non-sharp food bolus
are known to eventually pass spontaneously.
3. "push technique" ; Numerous techniques have been proposed to induce
spontaneous resolution of the obstruction without resorting to endoscopy,
including the blind insertion of Maloney dilators and nasogastric tubes to
push the object into the stomach. This is known as the "push technique".
4. Another alternative to treating esophageal obstruction is the insertion of a
Foley’s catheter in order to extract the foreign body.
5. Pharmacological techniques have also been advanced as a potential
solution for esophageal obstruction. These include agents that alter the
muscular tone of the esophagus, allowing the foreign body to pass, and
enzymatic digestion of the bolus by the use of carbonated beverages such
as Coca-Cola or mixtures of citric acid and sodium bicarbonate solutions.
Surgical management
In the event of a failure of medical management,
• Endoscopic removal using either rigid or flexible
techniques remains the mainstay of treatment for
esophageal obstruction.
• A wide range of endoscopic devices, including rat-tooth
forceps, Dormia baskets, polypectomy snares, and
different sizes of Roth net are suitable for surgical removal
of the obstruction.
• Roth nets are particularly useful in the case of
obstructions provoked by food boluses because they can
be contained completely within the net, thus avoiding the
use of general anesthesia or an over tube and minimizing
the risk of aspiration.
Complication
• Esophageal perforation .
• Mediastinitis .
• Intestinal perforation
Nursing management

• Advice the patients to avoid swallowing large chunks of food without proper
chewing, especially when dealing with meat.
• Careful monitoring and treatment for numerous underlying conditions that
contribute to the narrowing of the esophageal lumen can prevent the
occurrence of obstruction.
• Reflux of stomach acid to the esophagus can cause inflammation and
scarring, a condition known as acid peptic stricture. The fibrous scar then
contracts and narrows the esophageal opening. Effective acid-suppressive
therapy with proton pump inhibitors is an effective way to keep the
symptoms under control and prevent a potential esophageal obstruction.
• Accidental foreign body ingestion is another common

cause of esophageal obstruction, particularly in children

aged 6 months to 3 years.
• Careful monitoring of children during this developmental

period and removing from their reach those objects that

can pose a threat are obvious measures to be taken in
order to prevent obstructions.
• In particular, young children seem to be very prone to
swallowing liquid dye and other caustic agents that can
severely burn the esophagus, leaving it narrowed and
prone to obstruction.