The esophagus

 Begins: in middle line as a continuation of pharynx (

pharyngo-esophageal junction ) , at the level of lower
border of cricoid cartilage ( level of C6 vertebra ) .

 Ends: By piercing the right crus of diaphragm at the

esophageal hiatus , at level of T10 vertebra , one inch to left
of midline , to end at the cardiac orifice of the stomach i.e
cardio-oesophageal junction ( at the level of T11 vertebra =
left 7th costal cartilage, one inch to the left of mid line, 45 cm
away from incisors, and 10 cm deep to anterior abdominal
wall ) .

 Size: it is a narrowest muscular tube , has the thickness of the

thumb (2 cm ) .
 Length :about 25 cm in adults (10 inches as the duodenum).

 Parts: The oesophagus has 3 parts:

A) Cervical oesophagus: extend from pharyngo-
esophageal junction to the inlet of thorax .
B) Thoracic oesophagus; is the longest part and lies in the
superior and posterior mediastinum .It is divided into :
o Upper thoracic segment : from thoracic inlet to tracheal
bifurcation.
o Mid thoracic segment : from tracheal bifuraction midway to
cardioesophageal junction.
o Lower thoracic segment : from the end of mid thoracic segment to
cardioesophageal junction, including abdominal esophagus.
A) Abdominal part; is the shortest , terminal one inch.

*esophageal sphincters :
1- Upper esophageal sphincter : At the upper end of the
esophagus and formed of cricopharyngeus muscle which relax
during swallowing to allow passage of food .
 2- lower esophageal sphincter : is 3-5 cm physiological high
pressure zone at the lower part of the esophagus , detected by
manometry but no muscular sphincter .

 Constrictions: It has 4 normal constrictions:

1) 6 inches from the incisors : at the beginning (pharyngeo-
oesophageal junction ).
2) 9 inches from the incisors : where aortic arch crosses it.
3) 11- 12 inches from the incisors : where left bronchus crosses it.
4) 15 inches from the incisors : as it pierces the diaphragm.

*Arterial supply : esophageal branches from inferior thyroid , tracheal ,

bronchial , descending aorta , intercostals , inferior phrenic & left gastric
arteries .

*Venous drainage :
1- Extensive subepithelial venous plexus drains superiorly into
pharyngeal veins .
2- esophageal venous plexus on the outer surface of esophagus drains
into inferior thyroid , azygos and hemiazygos veins .

* Lymphatic drainage :
1- Cervical part : to cervical lymph nodes .
2- Thoracic part : to posterior mediastinal lymph nodes .
3- Abdominal part : to paraesophageal ( paracardial ) lymph nodes .
 Curvatures:
1. Two Antero-posterior curves: Cervical part is convex anteriorly and
its thoracic part is concave anteriorly (like the vertebral column).
2. Two lateral curves : esophagus begins at the middle line and curves
two times to the left :
• The first curve is in the lower part of the neck.
• The 2nd curve where it crosses the descending thoracic aorta .
 Parts of oesophagus *
Beginning, course and end of the esophagus
 *Oesophageal constrictions *

 Relation of the oesophagus:

A .Cervical part :
- Anterior : Trachea & RLN .
- Posterior : cervical vertebrae and prevertebral muscles
- Lateral : lateral lobe of thyroid gland and common carotid
artery in the carotid sheath .Thoracic duct on the left side
only .
 T.S in the neck showing relations of cervical part of
esophagus

B. Thoracic part:
- On right side: right pleura, right lung and arch of azygos.
- On left side:
• In the upper part: Left pleura and lung, left subclavian
artery and thoracic duct.
 • In the middle part: The aortic arch and upper part of
descending aorta.
• In the lower part: The left pleura and lung.
-Anteriorly: from above downwards:
• The trachea and left recurrent laryngeal nerve
• The left bronchus crosses in front of oesophagus.
• Base of the heart [left atrium] .
• Diaphragm
- Posteriorly:
• Thoracic duct
• The vena azygos, superior and inferior hemiazygos veins.
• Right five ( 3-7 )posterior intercostals arteries.
• Lower part of descending aorta.
• The vertebral column .
Relations of oesophagus in the thorax
Mediastinum ( right lateral view )
Mediastinum ( left lateral view )
C. Abdominal part :
- Anterior : left lobe of liver .
- Posterior : diaphragm .

* Relations of abdominal part of oesophagus *

*N.B : The oesophagus is attached to the margin of the
oesophageal hiatus in the diaphragm by phreno-esophageal
ligament .
 Blood supply :
1. Arteries:from inferior thyroid ,tracheal, bronchial ,
descending aorta & left gastric arteries.
2. Veins: oesophageal veins passing into inferior thyroid ,
azygos , hemiazygos ,left gastric & short gastric veins .
3. Lymphatic drainage :
- Cervical part : to lower deep cervical L.Ns.
-Thoracic part: posterior mediastinal , posterior
diaphragmatic & trachea-bronchial L.Ns
- Abdominal part : para-oesophageal then celiac L.Ns .
 Nerve supply : oesophageal plexus from 2 vagi ( which
becomes anterior and posterior ) and greater splanchnic nerves
from thoracic sympathetic chains .
 Clinical importance:
• The constrictions of the oesophagus are at the levels of 6,
9, 12 & 15 inches away from incisors, at these sites there is
difficult to pass oesophagoscope and foreign bodies may be
impacted.
• Radiological visualization of the oesophagus by barium
swallow , trans-oesophageal ultrasound , CT scan &MRI.
• Oesophagoscopy and biopsy are the most important
investigation to diagnosed any oesophageal disease .
• The left atrium is in front of esophagus, and if it enlarges, it
presses on oesophagus and barium swallow & trans-
oesophageal ultrasound will show the degree of
enlargement, thrombus & blood flow inside the left atrium .
• In the lower part of the esophagus there is porto-systemic
anastomosis leading to esophageal varices in case of portal
hypertension .
• Herniation of abdominal part of oesophagus & upper part of
stomach into the thorax is called hiatus hernia .

*Trans-oesophageal endoscopic ultrasound *